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HomeMy WebLinkAboutMINUTES - 01161990 - 1.19 CLAIM 41 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Agikibst the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 16, 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: $175.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: KAMM, Jeffrey D. County counsel ATTORNEY: DEC 18 mg Date received Martinez Cly C)d ADDRESS: 170 Peppertree Ways. BY DELIVERY TO CLERK ON December 1_S1939' (via r Pr`k!s Pittsburg, CA 94565 Office) 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: December 18, 1989 BY: Deputy 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: . `� I BY: ( �. /J Deputy 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. 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 16 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 7 / BOARD ,OF SUPERVISORS OF CONTRA CO.%TAt �Sg -11Tv e ur i M application to: Instructions to Claimant Clerk of the Board P.O.Box 911 533 A. Claims relating to causes of action for death or torn inCury��to4. 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' Fine Street, Martinez , California 9455.3. C. Lf 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, Penpl Code Sec. 72 at end of this form. RE: Claim by ) Reserved for Clerk's filing stamps rILA rym11 , ' D Against the COUNTY OF CONTRA COSTA ` DEC.181989rHIL vi --- — C!ERKEOIRD 0oUPE,.v!SORS (Fill in .name) c ,v CO: oa CO-STA. _o B ir . The undersigned claimant hereby makes claim against th County of Contra Costa or the above-named District in the sum of $ ,, o DO and in support 6f this claim represents as follows : - '� 1.-� en did thE= dama e�or injury occur? (Give e act aate'and hour) aha X15+41 1` $ 10.,coVi c ►r-9i t r 2. Where did the damage or inDary occur? (Include city and county) 3. How da.d 5` _2 e or in ur ©ccua:'? (Give full details , use extra g J sheets if required) .'c �► covdtti4 T. 4 .- What p-articulAr act or -omissi, on on the part of county or district officers , servants or employees caused the injury or damage? --3-0 lir (over) i '.:5..:-:•fiat! ar.e.,the...names of county or district officers, servants or I employees::causing the dam, ge or injury? ---------------------------' - -------------------------------------- 6 . What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage) LLQ �• t� 7 . How was the amount claimed above computed? (Include-the -st atedV` - amount of any prospective injur or damage. ) 6h0 Q — �� Pari -i-AO5 '. 'axe r�cL home. -Iig>w ------------------------------------------------------------------------- S. Names and addresses of witnesses , doctors and hospitals. ----------- ------------------ - ----. -'----------------------------- --- ---- 9 . List the ex- ditures you made on account !of this accid - accident or injury: DATE I TEMMOUNT ***********icic********:':f:*t`.s:*'•':*.':7:+ct.+fir'!"':' .h:i�:t�::: i.ic.• � '.�i':sti:'ic*yr*yc**�citic�c********* Govt. Code Sec. 910. 2 provides : _ _ "The claim signed by the claimant SEND NOTICES ,TOI-.- k GAttorney) or by some :Terson on his behalf. " Name and Address of •Attorney IfC lai an ' s Signa ure ak A ri C l 9 Telephone No. - . . Telephone No.. 3' NOTICE Section 72 of . the Penal .Code provides,- - - "Every person who, with-intert to defba.uz,, 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 J4nuar� 1 19?0 and Board Action. All Section references are to ) The copy of this document mailed to you Is you no ice o California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Not-stated Section 913 and 915.4. Please note all "Wa¢ , Y Counsel CLAIMANT: DIKES, Robert A. EC � 8 1 ATTORNEY: John Diaz Coker - Maltinez CA .�.P Coker, Tays & Ramirez Date received 4.�53 ADDRESS: 525 Marina Boulevard BY DELIVERY TO CLERK ON December 18, 1989 Pittsburg, CA 94565 BY MAIL POSTMARKED: December 15, 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pMIL BATCHELOR, Clerk DATED: i)Pc Pm Pr l R, 1�3RA BY: Deputy 7 ,7 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: Datedjig BY:) Deputy County Counsel U YJ 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, (l Dated: JAN 16 199 0 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect' 13) 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 16 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator COKER, TAPS & RAMIREZ ATTORNEYS-ABOGADOS JOHN DIAZ COKER FRANK PEREZ TAYS A.ARACELI RAMIREZ RECEIVE" JON CHRISTOPHER WEIR LDECA 8 1989Clerk, Board of SupervisorsPfHL BATCHELOR Contra Costa County ✓'"'c°OSTA CO.oss 651 Pine Street eU Martinez, CA 94553 December 15, 1989 RE: Claim of Robert A. Dikes Dear Clerk, Please find enclosed the original and one copy of the Claim of Mr. Dikes. Please retain the original and return the copy, stamped with your received date stamp, to our office in the attached, self-addressed, stamped envelope. Sincerely, Secretar� me Enclosures CC: Mr. Robert A. Dikes 525 MARINA BOULEVARD 0 PITTSBURG, CALIFORNIA 94565 • (415) 432-7373 CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND ITS AGENTS AND EMPLOYEES ROBERT A. DIKES hereby presents a claim for himself for damages against the County of Contra Costa for the actions of its agents and employees. Claimant's Address: 604 West 19th Street, Apt. C Antioch, CA 94509 Address to Which Notices Should be Sent: FRECEEIVED "CLEE.PK 16 1989 ROBERT A. DIKES C o JOHN DIAZ COKERTCHELOR / OF SUPE�'VISOR5 COKER, TAYS & RAMIREZOSTACO. 2 U 525 Marina Boulevard Pittsburg, CA 94565 Date, Place and Circumstances of Occurrence: Claimant was an inmate of the Marsh Creek Detention Facility in Clayton, California, on September 27, 1989. In the evening hours Mr. Dikes injured both of his ankles and feet as he was playing basketball. He suffered fractures in his right ankle and his left heel. Although Claimant was in great pain and was sure that he had some broken bones, the sheriff's deputies ordered him to walk approximately half a mile to the detention facility office where they searched him and then left him in a cell until transporting him to the county hospital about four hours after the incident. Claimant protested to the deputies that he had such pain in his feet that he believed that he had a fracture and that he should not walk on it. Despite his requests and entreaties the officers ordered him to keep walking, and in fact, to walk r faster. Another inmate came to Claimant's assistance and allowed Claimant to partially support himself on this inmate, as he painfully made his way on his forced march to the office. Parties Responsible: This claim is brought because of the acts of the two guards at the Marsh Creek Detention Facility, whose names are not known by Claimant. General Description of Injuries and Basis of Computation of Damages: As a result of the injuries suffered, as above described, Claimant had severe and multiple fractures of his right ankle and a chipped-type fracture in his left heel. Extensive medical attention was needed to make the right ankle functional and Claimant has 13 screws and a metal plate permanently installed in his right ankle in order to make it functional. He will have limited motion and limited strength and increased susceptibility to injury for the remainder of his life to that ankle. Claimant was 27 years of age at the time of his injury. Claimant estimates that his medical bills will be approximately $15, 000. 00 within three months of the incident and that he may spend an equal amount in maintenance and care for that leg the remainder of his life. Claimant will suffer limitations on his use of the leg affecting the occupations which he can follow for the remainder of his life, which will affect his earning capacity in an amount which is difficult to estimate but for purposes of this claim is estimated at $200, 000. 00. The pain and suffering from this injury is also difficult to translate into monetary terms, but for purposes of this claim is stated at $30, 000. 00. Punitive Damages: $100, 000. 00. Dated: December 15, 1989. N DIAZ COK torney for Haimant OBERT A. DIKES p G) � o --t z D " � r A � b 0890 z ° ,;u D � 0 1 ol m N rnn (7 A� to O �i ►- r, (D rt- �s " N. ro rF (D N 0 0 F'h 0En N 0 12 y t tD rt O _ �A rt, fi FtU7 Pi 1Un O PC rt- ti t" E'- r to 7 0 ri j di {1 co : Y U Qo -LO Plr7 7 n 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 16, 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: $1,262.96 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: KNITTEL, Bryan K. ATTORNEY: Date received ADDRESS: 247 Anchor Drive BY DELIVERY TO CLERK ON December 15, 1989 (hand delivered) 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. p gg DATED: December 18, 1989 BUIL BATCHELOR, Clerk eput 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: 12 BY: J Deputy 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 OR ER: 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: JAN-1 6 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk rIf WARNING (Gov. code se io 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: . AN 1 6 1990 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY E; INSTRUCTIONS TO CLAIMANT A. Claims. relating to causes of action for death or for injury to person. or toper- 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 f orm. RE: Claim By ) Reserved for Clerk's filin stamp rva� k 6 e/ RECEIVED Against the County of Contra Costa ) DEC V_ 1989 or ) PHIL BATCHELOR CL R30ARD QF SUPERVISORS District) NTR OSTA dill in name ) e Deputy The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 4-2, 6 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) -------1 =-0/ 8g--- t-- = ------------------------------------ 2. Where did the damage or injury occur? (Include city and county) ,-- Z -----------11--- _Z oil 3. How did the damage or injury occur? (Give full details; use extra paper if required) D e b oru h ;Tu rie- i noolei/, a. e/0'Wfl,�y e'"p%ye-e Aerve,Yecl he, V ev O i6 6 tie y J1 r 0 K f' .9 f d er "aa r /(i y ---------------------------------------------------- ------ ------------------------- 4. What particular act or .omission on the part of county or district officers, servants or employees caused the injury or damage? a Molle , (over) 5. What are the names of county. or district officers, servants or employees causing w the damage or injury? pe ho rd b ~ja- oe kii-9,le// 1 ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? '(Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- B. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ,✓G� ai✓ BS f J wla fE' 70 A/at/��1....v�.A_..G♦� �-:�vayc�s r; P y r 3 Yc�q. t .� iv�t ,5/repa%r' e�timae r Gov. Code Sec. 910.2 provides: },,k, .:1A <,;, E "The claim must be signed by the claimant SEND NOTICES�T0 w?e (Attorney),, orb some person on his behalf." Name and Address of Attorney . 1 C imant's ignature lAe Address Telephone No. Telephone N6. # # # # # # # V V N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with int, nt ,to-defraud; presents for allowance or for pay pnt 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 ($10,000, or by both such imprisonment and fine. CUSTOM AUTO PAINTING TELEPHONE 689-6117 2520 MONUMENT BOULEVARD - CONCORD, CALIFORNIA 94520 , Date f f 1 NAME-" '�''' '' '' WK.PHONE HM.PHONE % r J' t r Make �� <'"� Year L. Serial No. Mileage License No41 A4 /!Yr Body Style `.(,ryaialrf Prod.Date REPAIR REPLACE ESTIMATE OF REPAIR LABOR HRS. PARTS SUBLET h/o� ` e�'a►� 1 t' �• ., . rf TOTAL REMARKS: J. A HRS.OF,LABOR @$ 'MPER HR.$ )`d r PARTS$ PAINT MATERIALS$ $ INSURANCE DEDUCTIBLE SUBLET$ SALES TAX$ . BY: THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS ESTIMATE TOTAL$ OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED.AFTER THE ADVANCE,CHARGES$ WORK HAS STARTED,WORN OR DAMAGED PARTS WHICH ARE NOT EVIDENT ON FIRST IN- SPECTION MAY BE DISCOVERED. NATURALLY, THIS ESTIMATE CANNOT COVER SUCH CONTINGENCIES.PARTS PRICES SUBJECTTO CHANGE WITHOUT NOTICE.THIS ESTIMATE IS GRAND TOTAL$ FOR IMMEDIATE ACCEPTANCE. THIS WORK AUTHORIZED BY NO CREDIT CARDS ACCEPTED. ,. MIKE ROSE'S AUTO BODY INC. DBA �� /�•) YE OD C D MILEAGE �� SERIAL N0. 686 -17 3 J INSURANCE COMPANY CLAIM# 2001 FREMONT ST. CONCORD,CALIF.94520 A COMPLETE QUALITY PAINTING&REPAIRING SERVICE ADJUSTER PHONE TOWING - FRAME STRAG - EXPERT COLOR MATCHING IGHTE f NAME HOME# WORK# REPAIR REPLA ESTIMATE OF REPAIR COSTS PAINT BODY PARTS SUBLET L s _ r a � K. �4 � o 4 PARTS PRlr.FS­SWJECT TO INVOICE ALIGNMENT t HRS. @ $ Per Hr. $ —' CHARGE AIC PARTS $ «c /J PAINT MATERIALS $ l � AIM HIL SUBLET- PARTS $ STRIPE SUBLET- LABOR $ COLOR MATCH STORAGE/TOW $ C SALES TAX $ TWO ONE I STAGE I G RAN D TOTAL Roc GUARD THIS ESTIMATE IS BASED ON OUR INSPECTION AND DOES NOT COVER ADDITIONAL PARTS OR LABOR WHICH MAY BE REQUIRED AFTER THE WORK HAS BEEN STARTED. AFTER THE WORK HAS BEEN STARTED, WORN OR DAMAGED PARTS WHICH ARE NOT EVIDENT ON FIRST INSPECTION MAY BE DISCOVERED NATURALLY THIS ESTIMATE CANNOT COVER SUCH CONTINGENCIES, PARTS PRICES TOTAL SUBJECT TO CHANGE WITHOUT NOTICE.THIS ESTIMATE IS FOR IMMEDIATE ACCEPTANCE. 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 16, 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: $$5,206.71 Section 913 and 915.4. Please note all "Warnings". COUnty Counsel CLAIMANT: BROHARD, Grant J. ATTORNEY: California State Automobile Associatii©n a L C .� u 1`a �ng Date received Martinez CA 'n�¢ �2 ADDRESS: 2329 Buchanan Road BY DELIVERY TO CLERK ON December 15, 1989 ((vi° 1 s9 Mgmt) Antioch, CA 94509 BY MAIL POSTMARKED: December 1, 1989 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JVMIL BATCHELOR, Clerk DATED: December 18, 1989 BY: eputy II FROM: County Counsel TO: Clerk of the Board of Supervisors ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: _ Deputy County Counsel U '*'�ir 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 0 ER: 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 1 6 �`�J PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code secti 3) 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 16 1990 8Y: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator � . ^ California State Automobile Association ' . ~ `�� * lnter_I nsu rance Bureau - ANTIOCH CoUnty (415) 754-1613 2329 DUCHANAN RD ANTIOCH CA 945 DECEMBER 4 , 1989 DEC� ~ Q1989 � � r»��« K� �� � eovu ;-�--= RISK MANAGEMENT INSD : BROHARD,CRANT, J 651 PINE STREET STE 160 CLM-NO: 04-L90649-6 MARTINEZ CA 94553 DOL : 06-09-89 RISK MANAGEMENT : THIS TS NOTICE OF OUR SUBROGATION INTEREST ARISING FROM THIS LOSS. BECAUSE SETTLEMENT HAS BEEN ARRANGED WITH OUR INSURED, PLEASE MAKE PAYMENT DIRECTLY TO THE CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU (CSAA-IID) . WE SHALL FORWARD COPIES OF THE REPAIR BILLS WHEN THEY ARE RECEIVED. YOUR {NSURED: CONTRA COSTA COUNTY PUBLIC WORKS OTHER: ATN: JULIE AUM0CK no ly7ED SINCERELY , ;,=E BOARD'OF 5; s PHI PATCHELOP RVISOR DANIEL HECK By C CLAIM REPRESENTATIVE Ly , . ` ' /~ ' RON HARVEY Claim For Damages DEC 1989 ® ' In accordance with Section 910 of the California Government Code, this is to formally place you on notice of our subrogated claim for the loss described below. ff 1a"`"a�CA PUUC' Lj°�'L' Date: IJCl/el'�OEx Co;�-dry. �oS�f� Cov� Ay _ • /.3 2.0 A r,1a d -brwRECEIVED Sk 1(0 DEC _ a�p Y1"���C•h ,��h�ftrr'n is 1Y1,d,;ne2, C4 5J Risk Management Claim is hereby made and filed against the COINI , C0_,1-44- ao C-J 10P as follows: Name of Claimant: California State Automobile Association Inter-Insurance Bureau Address of Claimant: ry (Send notices to this address) Po Go y Z�s�ci A i/�-�l o� e CA ��� Date of Occurrence: 1 , /� v /V Ni Ce�r� .J jvne Place of Occurrence: CoIA4(, C0Sf4- C-0 t'�V1jy Nature and Amount of Damages I Il Items Making up said Amount: Name of Public Employee(s) } causing said Damage(if known): Facts & Details: // / Our id1�reJ WG5 Ec.s4 bound on Cc-mi-noZ),sU4,1 6.ooh �roxi -��(� �es cr fAwe- sir ldsurea - ���► G_ v Cover; isICAJ /C)sj Ovt- i v1 U 0 f 6 ✓Ey o *i -f l 11'- t California State Au obi 'e As ciation Inter-Insurance Bu u By: F1688 (REV.5-78) °�•��5�•� assignment of claim and '�"*ai.p.�'"� subrogation agreement In consideration of the payment to the undersigned of X the sum of spur ❑ a sum estimated to be 1 v Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number 00o 0b issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 94day of ,J�7h P 19M, the said undersigned hereby assigns and transfers to said Bureau said claim in the above amount plus eC _additional claim for damage resulting from said accident, not covered under said policy of insurance, in the amount of$ 42.46 3 , constituting 5�1 a total claim ❑ a total estimated in the amount of $ Said Bureau is hereby subrogated in M place and stead to the extent of the above amount of the said total claim and is hereby authorized and empowered to sue, compromise or settle in name or other- wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to me therefor, and collect and receive any money payable thereby. The undersigned covenants that SIC ha S not released or discharged any such claim or demand against such party or parties and that—"P- _will furnish to said Bureau any and all papers and information in possession, necessary for the proper prosecution of such claim. Dated at A i�1�10C ' this Wday of /VVC�W1hPY" 19 D . WITNESS F1433 (.REV.7-77( S ej _ --j sr t::fiy?.. a.•e"c '- a. t �jy,d;t - ,�"'•:,' w -;- *.�:`.��.�+ r`� z s,fi+. :'a '� -r sr* ,r�"'�+: .'y ^r'c ti. .e;. rX, a '3. yt FJ..- ue"-Y.." ..aa.S- * n 't ss.` ' ' ;A *FL s-ry'!csw,s� .4, ^..{. qh.,.s k=i _. ?cam - t' '.SF r-.r ' K ?t"'t, rlx�, :a, ,a -ti-a �5? .; Kw .d"'+.,,.t.. r l ,F °. S' �' --t =4' e -n-G4"._3'r .s:' '4 �"-t? .?bF.z ,_s`,^_w+' ,+F" ;fir c,y,{?" - t;;'xr`-r , ? .5 � "aha3 +`i+b E..,.s .'� io .:: �n'Sr�y. i ll v- .tea,-s s ° n;Tr` n a ; cs�r xe t { j; 51J 7 SLY: le a, yr .=t tT ` t r 6 r�. 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' ,.t_, r Y- t 'r P r -a A a S<.s -.� r e .4`"F` ,� _ a S F'7, P u 3 " 'c..'s `kms � i r"' .r'"t_ :� - 3 r ''_.; y z- ,r x 3.P's e :' - r -ti: ,, 55"x,. �F s11 - % 1 c5" -�. . f �;'ia �''�a ` J Jx E°�"r�k- p3 ,}i 'l 's�-°t "' Y s f „�'. !'• .s 111,W11— °• 3dK '�' °• 5s�- z-E'{ r ; .�J S - t ..o- r:; I-s 1' 4 1- x i - t$�. [ of`>;S y ; " - r t v '{"+`it 9. n a r a; crfi fy .� A r { a r tr- k ,,�., :rr�L>}4 1 s' rk .e*s Si. t 11r'^ �i.)'C"•. J t .. '3': e .,s, ,r .'v :. q- _..r,•'' ?.`a'r" _ +? _ •;,,1 3.. k-'1 e s. ,^':A �•N®� ` proof O 1 los Claim No. p 04—L90649-6 receipt and release Policy No. Date Policy Expires L90649-6 07-06-89 :• According'to the terms and.conditions of the Policy of Insurance identified above, the California State Automobile..- Association Inter-Insurance Bureau (Bureau) insured Brohard, Grant J. against loss to the automobile escribed ira said Policy as follows. Make Year Body Type Engine Number Mitsubishi J 1987 I Sedan I JA3BA36K7HU019745 A loss caused by collision occurred on the 9th day of June ' 19 89 about the hour. 8:00 a. m. the particulars of which are as follows: On the" date and time indicated my vehicle was damaged under the circumstances contained in my loss report. Claim is hereby made for the actual cash value of the vehicle as indicated below. The vehicle will be retained by: )EI Bureau ❑ Insured The loss described was not caused intentionally or otherwise by the design, procurement, or fraud of the Insured, nor by any agent or any other person acting for or on behalf of the Insured. There is no other insurance in force as to this loss. There is no lien, conditional sale contract, bailment lease, or other interest in the described automobile except: Loss/Damage Less Amount of DeductibleOther Deductions Amount Claimed Due by the Insured $ : 5215.68 I$ 250.00 I$ 1$4965.68 68/100 - In consideration of the payment of FOUR THOUSAND NINE HUNDRED SIXTY FIVE AND the Insured hereby assigns,transfers and sets over to the Bureau any and all claims or causes of action of whatsoever kind and nature which the Insured now has,or may hereafter have,against any person or persons as the result of the occurrence and loss as described above,to the extent of the payment above made;the'lnsured agrees that the Bureau may enforce the same in such manner as shall be necessary"orappropriate for the use and benefit of the Bureau,either in its own name or in tk le name of the Insured;that the Insured will furnish such papers, information, or evidence.as shall be within the Insured's possession or control for the purpose of enforcing such claim, demand, or cause of action; and The Insured understands and agrees that the furnishing of this form or the preparation thereof by any adjuster or agent of the Bureau is not a waiver,of any rights of the said Bureau,..,---* "<FIVE AND 68/100 The insured acknowledges receipt of the sum ofFOTTx T1 6uSAND NINE HUNDRED SIXTY ($ 4965.68 ) and 'hereby releases and discharges the Bureau from any and all liability whatsoever for any claim under Policy No. L90649--6 for the loss or damage described above and further acknowledges receipt of said amount in full satis- faction for all such claims or demands: AND 68/100 The Insured acknowledges receipt of the sum of FOUR THOUSAND NINE HUNDRED STXTy -F TV $ 4965.68 Paid under his direction as follows: To Citicorp Acceptance the sum of $ 4965.68 To the sum of $ To the sum of $ *IMPORTANT—READ OTHER SIDE BEFORE SIGNING. / INSUUD � DATE 1/ 19 � n NSURED^� t_ WITNESS: F1408(Rev.5-87) 26010 Crow Canyon 11, ¢SF,an Ramon, C91 94583 • (415)3866-1100(y800) 521-8514 �A [f' 11 3 J�ab.2.$. f';&R4' 011 "�' �!'yfE M.'6$ f�� g 'Al NtlA�as �s � v s a. "§A VIN: ..1A_,BAUK7HU019745 1 1 1 1 1 YEAR . 1937 ENGINE: : 4-1 .5--GAS 1 MILEAGE: . 50K 1 1 C1Ftl:E A MITSUBISHI 1 TRANS : U-SP. 1 EXT COI II+ e Good 1 1 1 1 1 MODEL. HIRAGE 1 EXT COLOR : BLUE 1 IHT COHb w Good 1 i 1 1 Eli IT --- 1 IHT COLOR 1"I A 1 MECH Ca'HD Good 1 BODY 4-UR SEDAN 1 i TIRE COHb Fair 1 1 1 i ,EGIUIF't1CFIT 1 es t1lft CC11ILt 1 ---A APWR ANTENNA A - Roa .F-SPEC 1 . -- .HEEL—SPEC 1 1e , CFtUJ:SE GI�ITh .1 YesF WR BRAKES 1 ROOF-OTHER 1 --- RfiItIO--FiPf 1 1 1 1 1 . YesItEFROST R/W 1 --- PWR LOCKS i -- ROOF—VINYL 1 --•- AN/FM 1 1 -.YO . e . MIRROR=Rf;_M 1 "--- e PWR SEAT : Yes : , SEAT—CLOTH 1 --- a AM/FM—ST 1 1 1 , --_ . PAIHT-•SPEC 1 --- s PWR STEER 1 --- a SEAT-LEATHER! Yes 2 FH-ST+TAPE 1 1 1 --- d PWR WINDOW 1 •---- e TILT WHEEL 1 ---- 2 DLX SOUND 1 ------------ ---•---•--•---i---—--------------+-------------------+ COMMENTS: +------------_--------------- ----_._—_--_-_•_-_.._._ _•_-_-_._-_..--..-..__.--.._.....—_._._--------------- 1 ._..—_._.— _•-•—_--__-Y• 1 1 1 1 1 1 1 -{,.------------------------------------------------- --------------7— ._.....__.._..,.._.._.........—_..-..__.._..—.-------'--7— Based on the AUTOTRAK MATHEMATICAL ICAL_ MODEL, the automobile with oJ::1't.iflnis and Conditions as described above is predicted is t.ed to have an Actual Ca_ " Value an June L ;, 1939 of . . . . . . . . . . . . . . . . u $Vi ,a t.e) t ,;r , } s ' y x�e� . •�� ,�Y s�� �x �� 3 u,� � v��.s :s r�' z y � ��t� �°s; ' nr s w "',t� , . �.r��, r :hl<<ni� ;ts-(' Ing +�t`�1.1 Itt;C=1-1r�f,Lt ��� '� � �7 t-► tfi F�cSS�/A-i j-i it�t at- i�ik(iCi-1r'tC�1 N F vl zcy lGl stir.;;# u , q 1-L90s5�lr�rIlitte . 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INVOICE ` DATE RECEIVED.. 6/19/89 VAL'LEJO : b/20/89 --- ------------ 707;}b44�4468. -- -- _ - -__..__ __-- , . -- --- —_ .. y LED . 8 .Ca ANT- I . . STATE. AUTO ASSOC 6/14/ COMPANY.. . INSUREDe .e .BROHARGe GRANT :� - STEPHEN B. MENCHACA ADJUST ER•• • �' 415 754 22 10 E;'>INER• • • • S AME PHONE. . .. . . . Y QOLIC._Y+`! •' . ..`pOLe BCO CONTACT:. . t CLAIMi�• •:• Q411 L906496 6/09/89 BCO CI TY e e • • • ANTI.�C+� _SEQ/UNIT.. _ _ :BC Pr1OtdE. . 415 754 2I , _ } _ - - r LIC��. 1SGU60$ ry riITSUBSI MLRAGE11 :VEHICLEl . .87 BLUE VIN.'•• JA28A2bOHU014745 . — flAMAGE . .e :ROLL — t TO COPART SERVICE Y,ARO : VA< L1. EJO FROM.. H M flISMANTLERS 282'-5TH�STREET 3 _ NWY 4 AT SR OWNSTO�►E :Ru• ; V.".11EJ0 gRENTrJtOQ+ ,:GA• 707-644;--4k68 J J J 415-645— L753 - J.1 J h J J.h. J L'1 C !Y'� Y J J J h YY J.J J.J `� h - 1 CHAFc6ES -AND RECEIPTS :' ITEM Y 41l2Q ­11-1300.0,0 H L b1 0I S �AfdTLERS 6/20189 TRAPdSPfl�T. Ct,ARGc T_0 POOL ., _Q0035113 : 6/14/89 2 M 6120/89 ApVai�CE "., K, `; 3 61z�/gg POOLING SERVICE CHARGE. — 41.2 s` Y - TCiTAL A"yOUNS flUE $382.40 J ALVAGE pOGLS FAY1. ABLE TO CG?ART ITdSURANCE _ J CJ J ----,r h Y {-1AKE CHECKS 4.4 J e .T �J J J Mti Y 4Mh J.J 'Ji YJ YYhth YhtYYhS�Y. Y Y. J yY _ J J J �, t J A �. �h J.M I'YTY•7t.Y�•YM'�1 Z. .s 4t y J. } F J J J J J J M Y Y\ �` 4 ��y y �, ! y f j t.✓i .G",�L •-a`•`L �..� �,r-� `_ F 5 r ', Y 1�,. 1-1--...JA h h Y t Y ,:" 9� i,j' y T.r-..: 4>T'�r t d' 1 �' hG.. a Y �� ? 5 '-' r-Y'1 a v,� _ l f i s--y L f i.Z �^c �` ^..`� .t«}.7;,'�1n`k` t ,}T i ` ,S Y^� i S, ysib-, g � ✓'^ .s' Y .�1`t•-,i' ' L j t 4,F i 4 : , i .; e �S 41..,-• r+ < ^- F L! s ,,''., i x r i 5- d^ a < i u�' 'jG �.-.iy:_ �*:` 't4.w, r'-i-s r _z r t. . �, a F t y �; $ t ..v - -.�;, T L i� ?� { _11- .." �.� :tee - r ` f _ '. s - t _ _ 3,L t t 14 b --atfi+ � Y 3 S ` ! - b G y .�.._., _ . L. - - Y, t ' �C SIL SS 1 i' - - J_4 1 '�xr o �' } _ - _ . 4 } t - n r .�L, v. ? rc'. A £..Y ads .Z%es fC,,i"� j. .,ie r ; u / .yam �y. t�' i, , icc.1 I ,a�r..+C �Y;� Xt `�{�,5�,.L` k�•-p ( a t r t`� s .��- ate.. fr r ser z=- S i;lv� J, Ar pt 3^V 3 L tv J. } ,i t y yr -'a" >. F f ' $ir $y.tom v' .t'*a.i't�J 'ied i 2 x '.'7 zc�OP!y - [- t - � �.7.N.,y g,+�.�.t�Ct+{^? �; � s .1. „'4" yrs KC k t `i'�. {�� _ 51.�f.F;'Y .-I •,z; c.— g�+�,�-F<C ��.� '�y ,!gav,"�;r,�534 �. ,, r ^ � - ; 'sr ' sN kxc ` _..��. + x ­_,_ s . . ... .. . . _ ..''a +.y .,;�P. +FXX• .—.. .L' wcw>awa��xwir.'�Gta�2t1.. .. - THIS DRAFT MUST BE PROPERLY �ENDOFSED ON TFIE REVERSE SIDE ,_- , Else AN yux- i�-�iae�.. CT ASA %ry..y.9...�Z S` •g ' k •gyp j�y+��� .dv A My� m 5=' M OL p`'`'er" -"- - Mfg JIM- 3 � t sz�Z r Urex. O i IVN wgy r �.'`"' �vy ...• 7e :��' r r,�, ;f fiat �,nF �df., � eye ' s ' � . MW Ak O.'- r.k -�a sit Sly - � . h- qg' r h f i • ,s, \ !: T R - .. 3 _ REN AL 60 oT IA�1 r \ ✓/ FE4,L E FORD&CTH R Fire G ,S /1 J \ Tucks•wick-ups 4-Wheel Drives F j� t�tEtvTAL INC. (�" ACCOUNTIiV CO ! ' 712-15 Pas enger Vans ' i/,e "dba 1>s �eit � REN IAL U $` �.. + Pe:t V IICLE UNIT.NO LICENSE NO- BAR 1 NOTICE M2ko#2 VE-MC UNIT.NO f y .LICENSE NO :A0f1CVYCd an etf CBrS`" TE IN IGl� r✓v 16 pected every 3t1 days�+rI-hh-.n,-o''r our -,t -LESSEE S. Y t•`ti .. F•v -x* r,Tt 7.; ..-.rS..-Ls+.r?'s°ct r ..-� e '.:+ �s-r3 x �-2•- ce iions�`ag NAME .+ ts' SSD•, a 6r :r t eX P s bs a ry rPe i Ni'Lv,iTf�S •'_x RESIDENCE ADDRESS,. z t9d4a<$4 p'1G1 �i'F °+ 4111--% ";%1., Mf , NOT�CE S z y 'RENTER RESPONSIBLE ^ ?r., t •=,si Y ,.rPer-,- a .li,...t +If +,'.; a^c'hY+' FOR A�L�'i"S„%".•= MILES CITYlSTATE ,�hwu- s �, u z --3 ! :# S x+v W. tTR a ;, xt y 9 a s 1 s vs�£G. R 1`. L't yl •"I �3 S r ? t, i,PAF?KING TICKETS a' x aCAR M rsi'�•`�x A y hC fi CA r 1 t ar v'r 3 f J J r r r, R�i2 DRIYE9 5 LICENSE ND * S '. a c ,BIRTf1DATE THIS:VEhiCLE MAY NOT , - .r.- e ,t; , �r r •,-I, > - '`'� s'•�'� "#`L' st `°t •-.f. .s”` 4•..a d TiM `% N �• •< r.� ,/,, ,,.�„,'Y? + r ^� B SiVCYOFj„USEDBY N t .;ANYONE NOT `r s:`. -+'e'�� �w •�3'�- �f''�'_ W_ ek STATC FRCP DATE: HOME PHONE y, s PHONE t r EXTv Lx ADJUSTER S NAME } ++ a e L r F ...I ..yam L•CMA-Zi`2Ye. .� + " )"e 'v°t"' e4 f-F'1}...c'� �.fi� sz" f''"'F""n•iF h••.5�7� ?�� �::'L�" , f '_v�_ e k t• w- r xss• 'z� ::E-:7 .... M��N�,,•.=,K'-ri �;; �-� ...,,,, a-_: r f i s 3 u1' M s 5 .x a x "I IMPOttT1!?IT iDTC� CDCtt"xe u^.: -y INSURAvCECOMPANY n XCNDITiCKALGOWSIONDAh1AGEWAIV TyM silo? *'fi r ;' eYt Y i GOtV does'not Muer owrhsad damage(above 336y iLErS (t�;, Y y�« x ` '" ,t k r e• F+ O G :�Ieyei)en og,,�t I box vans'and C lMdoes not cdvccT, '3. Uri ehaigdamaga lbd are fully t1a51e`kcall toNlsien;� ? 4 M{LES z ry re}?$ 'rf t � < ,-c x h.tsx�-. -`"'�sr� `�,-r r���'� 3t;�'=�•.`+^Szayrll:(�``+,�>s 3� ;n _znd)or;t:nmpmhen.ige dan3ag4 toss�otnseandlots i,alyCARL,2•s.�•t?�::zr'�rt�x s�>r(>;'�h>3'�'. IP down UrnoTtd;our veh!cle.{dnlimlted);regardies +oT t ,.„e r; �' 'k ` K {. . :MILES 3 t 3y a'fi 3`s ' is negOgenceSatdda3nageszrscalcatcotatada:agreed# , +rZIP + rad Tie PHONE t t l,cn�R ;an the revetseside otihlsegreemeol Yobezn7eddee' SCAR s ti o c 7 # a tnibll m ieto tn/not vtnl2Ung D31s eontiael} c T t z y�a�".r + MAI : "P •+t>r "e,t7"�a-dM Q /sri .i32'a f`e3. 4'rti "}'t[,..'i3 ,yrsz yC fESPd_ py i ' , 1 fi ..a• -r, �� �' I� K POLICYOR.CLAIM NO A�k LIr"_5"itK s s�..?S: }D/L, F t h 4 —' per of ttetlo� MILES r N .>"+,. ti m ,wa e� and Daytng S P aua Y Q thersoi r *i. wry NUMBER y a IJMITEw e yrs r1M t .. :CJIIENDVIR DAY �r4`T C/' `4� r r✓ �/ > t:yrtlUR DCOLUSIONOAMAGEWAiVER OFQAY3 dam INSURED =a'.xS',i,'��sa" .,.�',r sr__ ` °.3i1_`"• ,.s,+. Y"t' :�.,qhs �.�' p z•+ .. ISNOT„1NSUfiANCE ,;v�.A •DAILY, .- T•w :..�t i d ;3n� �. /J k e -r.s r�-k ,;T •7 #sof ++r.r f-.x pyrz" I.ACCEPT;�}. I11.DECLIN 1� %? ::.:s`�.•. ' ; y 7 Jlr' �'V I C.I 'd',-"ru• ,ry�i`u 'y.� .,..13: •a x+.}, ` •cn f:, ES'F �s r i Y•�.�a y -'r'teaa'�'J-N 3 !no ry,M i Y h rUF1 S+ O BOD f SHOPSIS ti ePHONE r is rsrk ori e " .ORiVE 1 Zr+*i r -E f tiiezrar ,•Fap33"j A t y.(I, t£'1t_ r, ". r, rt r F{r�rf� sat;s1 t p °»'s'zs �3cR1iPOi�fANr�1Oi1CF1�? 9i� aDi AaE (D l �'1::ASi o3i33at�snit ea h aa, d .r�=u.,• �,r M tAlI:E11(iE CHAii6� ' �'`'. ==v+�, AUTHORIZED'$YDUErE3ACK 4 E fC ,2_VehWes mus!be returned to or(p;nalRoO SC-44— Age a. : ,� � dr-f`y,y�:�z �� ,- � -�°'�:,r �, ,� tor;5ie.'roveryle$Soil(:Sgthal;ted.,•,��4_�w,�v-•g , - :Y." -",w;t w :r v 3.N-:�1 .� '-` �f. �•it,j a�.y :�:""�'3 vi :.M1a>a•s-. � }��4a•.��.Y ���s�c t^1110idf10M 9r4 Ufe nl'SpdaS16!TNrI 011h0; ����"�wI1:E)Ef,�*; k-�i�rarr+i�.�.q�t`g� 'L�ti .�f `;lrri L`s"Yy tnrLZ�n�•1�G�'t'.✓fit.l 'Tli .. -f'3s'r. �Gt "# x �+af+wr q� TenSCL�I'`� !S• 'b r�a'� •'S t"'1.�E36iP+�r L rrF� K' +, x, ,.j§ j1�y r 3 : '. � �: a � ,'4s MUeage read(np_iakon lrmn}attdry`(a�sDed , i -�;' i k �+a s3� .« ^s c * -.r•s:« tr A } h"•d l'h >&'`.L�.".t ,>r '��� 't�*t � »�- >x.�Y � s +#t �i'� �' k�n+�x � r.-•� :odomeiec ._>i- ro'�' ,N P ., * CE 0 �� � 143 ;r of ,ticY lt4 ,ir� .+ a "`✓Cif. �' �, t, z K.r�y , T'S!a t _ #mss - c s.>;t .�' ,,; �`��;:,:.� t t •��..rim-mss.°IyGs,.-.,-�,.:�f>s•'!(f, 'E'',� ''S'Ciea3rrmcharpeonotryvehi�ebronghtbadct>x�,r -I�r�� }I HAVE READ 4ND AGREE TO BE BOUND BY THE TERMS AND CONDITIONS CONiAINGD xs ' {r ON BOTH SIDES OF THIS P.ENTALAGRE EIAENT'ANO.AGREE TO RETURN VEHICLE TOS You must pet our pernitssSde to maka re n,NO; ,Su AVCAA Dt1E'BACk DATE OR UP DEMAND::I AUTHOAIZETHE USE OF M(CREDIT I !TIONS.s v r43* + r�a1=k y.« tXCE r ,' 7 Lossee is roayron,lMe torthct!and/or vandaOsm of + . +s "K� a ti CAFID. FULFILL ANY C N L OBLI ONST�T ° rz yohitl k `r a v alt G.+7 rU1 �r1 `t,e�rl45a f.`c'^a .�*'39i��,tai t� ��r ,1.• ?�.r" ,.� t t ,; . - z ( >x �✓' �%tt�z &Autho3lxed,�vemm�atbe25yrsor,oiderendtiavet _ , J Irr „� z.t"` StGNATURC � : vI *131 the co antf your'liett on t will bg,t RATES DONt7T SPtoISENtio 'd d r;,'� ,Hf yvu�violate�the`�o�lse_etyo�ur�t�w"rdttte�wii�l;b�, WCLUQE.GASOl16�E. 'cdotiGAe.� '�tt�:& I"z lz'MMI�r'fh`vi•. I:USIDhlf7i ... .. �!4( ` ✓ t �,� i INSPECIEDTHE' ;WARNING �ftll r zy 3 J y 4,Sg i.�al"?tsM3e �Z123.- f z" t J Q �y�� u Zn 3i= tvi' It ycu do airy olLle.folidvuSngToSt ertii�e fn violaUoa. + HO NOTA `Z-'% 3r 7 z fir` VEHICLE ANO,,x r CHECK ,;c. a # t :'x, b {- M+`p}A4 2i• n UPON.';' ,ot Nis cont ACC f r IUnq';i11 lyhbc endktovenpe In r r b Y r 5; r� OOY =15•:;dnd!ng at17pt1onaYtm erzrie r c' r,f-a':.ga y '? rA'r y ,3ACCEFDWCE ar'� L AI'ow s x oat adl�er`c33d�•'"h edtrbict In dr}ra,t .tt -` a" `�"`, ` Iu ��,.tcr' .s j�l.,I: tf .x r i " �(M V ` t ✓ 'a Y2r�' ^A w-1010 LEDGE9? rTtf383RhtC1P�?x.SAt to r>�`fin.', ' ":�` t$Y tJ bEP031T4'ti�x✓ty T t Vis":} �'7'a31 5 rZTI3 :w r.'° „s .en:; �3 �,•�.,s1r.:.::...,�'� THATAi.I;$, � ..y,DrNSnq-atter dr'aking ANY ak�`ohol et taking ANY.;. �,Ta,�;�r•v'. `K` '(tc.-� tix �- t. ;� 'dpi 6 _ :.• r r-.i.'•l„i�..+n •y'SI.CSS IOA� + T¢ ; _ t r ._ ys-. tL'tirJ•}`uh.: + ,23I .y g + =f s. & l'1 r• t &'• " It' `;~3 " `3".tr t"x ANY ARE N�iEC ,:- c sof{5'2 NEAEON"� ipe3misslon ;' `4 -' ' tiv s1./t{rM ifi�s,h ,i tl0ama0tlNiher ij/CGas °ik'§t _ �s C OO 4 P N',>.'?r d ..0.Drlvmg on:arlftnp red rs+tace �It , t`kw Sherr Es,sy r �r Lx�s 't r°:ir t 3. ;5 Orlvinp the"biUe unsa.,eiy fricivdss speselaj,; 1OiFiER 3 J �� �• Y t c ^7 x.:+TT9r ' ? '^: reetless ddvinq cM Ya n ' a: Z tPald iry.�O CASH _y'.'t7 CHECK•, cCiitCARD tL Failtr o to,Fmm report(wl+li d8,ltourst and/cr. i ' 1 ,F R# Fi h 1 ❑MO DAMA r' } ,111erI,invest gailog atciden �INSU�fANCE'COMPANY`TO PAYS r,•,- a - -< -7.Fallarati3.renmim k bom the leased vehlele while VISA z' I z}�r xis r unatlo3ided Tessa 1 r° d TIME O SURCHARGE o ?r „ij t ,- 'Wditss•. 3�i<3°: i u•i_: # �-�_ �! r r t�f.rr•+ K'r �Yt-t7 °7 `i T1s _. f enc �+• .-� l tf:Giving of!caving keys aecessaS 9!o am/unaulho-;, ,� "� /S_ s��., �I M.C. '-• :6 c A ,r,�- ��+. - . . � 9. 20 r s� w AMEX •,rn t t t ,_ r ! ;• ” # •x,(415)459-5090 "r,. '� ;f 3 CART s5 � I;,UTHCRI�E7HE.NSURANCECOMPANYTOPAYTERW YCARRENTAL DBAAVCARRENTAL,INC DSRCC -- r FOR 7HF R'cNTJ,L CHARG= INDICATED ABOVE,1 FLIRT iER AGflEE THAT M,THE EVENT THE INCUR N: mil SER 1 S V .A�ie f�FtFiet 01%1 QPA'AV }�CNTAL iNC FOR ASYOFTHEABOVEAEhfi. 1R FS P;WrLL ASSU6 rVCL P,ESPONSSBiL rJFOR-�^dENT� 1 z�- _ISCCVER I a qq , 1 R r;f L•?i� •.. .. ';'• ,•_. ... .-. .:. _ ,-� LESSEE SIGNATUR � 73Y SII t r }.V.Br OItIC"b' G S.F.AUTO C;:NTC-+ ' C'AOJaT'3, SEc LEY:U -PlY�4tl6i 1"1G�1 tr'4L� 'i 15!h&Brvan!S rs 415) �9 DO ea .' tJ t„rA E 1 nlvJrsifv CUPt tN! LF.Gia1NTDIt, I '�Q,'(jOX�: 9 SaRrli&`1e' C�9>912 23 tra F.00 RI70V,(J1,t •'zlxt'y1..,�1:25& 4f _• - .> _ (r 5j S45.3Q5 X02 1k:esa 1F ft_> t...•��_..•.. . (415 63 r. ....et.. 779 _ -'.ClSAR',RAFAc i :-SOtiOMA 't -r�'OA`CLANO7t-IIjNJ.V:'n..chSl�OCSLD?nP� ,nNALC 7EOAndersenDrive '. 4f75SanL'tRe ven,3e 30;:E'rcadw,f:.; -VAL'EJO/NA'%A -, - CORRE rT tlr M iRKET .(.115)4a0 2700 -'(70?)5;5•iL00 (dt•3 a'33 - t 50 Ge rn Stredl ` . (707)4-07 1 tR Fsr!"i1 L '�zp•I.',t :i?„R. . 0 GRSENnRA rt =,0EMI E/ ( r^-�'r ! 7 ^)R-S MAct--nA .. U ri!% . a ) nij BTATEOFCAUFO;WIA g i 3^' ,' ': I TRAFFIC-COLLlSlO o_,'`RET< 4 SPEOALCONDRWNS NUMBER -Nora RUN CITY �LIpIgAL aSTRILT OCAL R[POltT NULIBtII Y y . - .. INJURED FELONY NUMBER WTI RUN COUNTY RE DISTRICT .SEAT p ,-)7CCS-TAg� Es/�9TF . , COLLISION OCCURRED ON - YM DAY YEAR TIME(2I00) NCIC a OFFICER L 0. as .� , -x. rt '_• sem, . �1' MILEPOST INFORMATION DAY O WEEK TOW AWAY 4 PHOTOGRAPHS BY: h U P> ,la S M T W YE T.F S sr_Ono ; U J ATECT10N WITH ^ A HWV REL - OR: I -itRM / l W + ... ." ❑Yp NO rsa": E D ER'SucamsaNUMBtIt • STATE CLASS- i VEKY MAKE OIL _. PARTY ,; LICENSE :STATE 3 EJ F2 6"',7 ut31�H�:Iy�l gG . : I..SGUGBB u9 DRIVER NAME(FIRST.MIDDLE.LAST)CAR ))�' V WN -. $ OE STREET AoORESi,•, _ - OWNER'S NAME •....- .AME AS-0RNER ^<.•.,# TRIAN - ❑ S A 3 I M. .F �' - PARKED CRY 1 BTATtI 71F - OWNER'S ADDRESS SAYE AS ORNEIt VEHICLE _ 7740 5" _ > BK:Y- ..BEIf HAIR .tiYii 'NEIOITT 'W ""- 'BIATHDATt RACt DISPOSITION P: y ,r FFICER'•� RIVER OTHEIt '*-�'I"`` t`' COST -: `:, - y'Y0. ,�: aOAV '('VEAR 4 �' ;S". 'z '' o :S ICJ J. OTHER HOMa PiWNE4ti:�t4-; �4 ? �- SU81ME88 PHONE - X - ' ' ,.�..�•.1- { .r.e.:-....� ^.�� ° S YteCNNiCAi OEiHC'Tk,,•fy t*` 'v,kNONEA� I�•fER TO�,�AVB � : . v.. 1 _„ CHP USE ONtr `- ,.,' `•'^ �= g SHADE N D M AREA ❑ r" .. „ ,. .� VEHICLE TYPE `. ,DESCW INSURANCE CARRIER _,_ ....POLICY NUMBER ` w .. OINK NO MINOR .... ....�•..s+.w, .tiF 4 . -❑MOD`' AJ011 OfOTAL •� DIR.OF' otirrRaE'T011MOHWAY -_ .,--- SPEED PCP KxQ •. .. ,.�..>_. is " '.}t w.r '•. ' ' .- C. CHP ar d �u O a. >kn4 -• F s "��:5r` PARTY OWE"LICENBQNUMBtR - ... STATE Cu88 iAFETY vIKV[AR - YwKErYO rCalarl w4 4 _ w c Ett�iN �"'STATE �M;:.t ,».+ .�..».� P -«. .,.. :.. 's r':.,•r°".'-.ti's ., ,tt 's his 4 d �.y a,*. ( �•$ `' +1` x'i"Iw=,>•<*'. t`7adltx' ,x $'vR`y`vy° r�".�f'9'°$: m i DRIVEN NAME(AMT.,MIDDLE Nt9T) AT❑ , ,� t 3,�•fss.:- , 9 �:':I r - .._ '3.3:� r vim'"�. s" •rti� +�5 .. � _ '.�&'��i''$I�k�"�'r)»� s'� ,1'„ PEOE8- STREET ADDRESS -...' _ OWNER'S NAME" BAMt AS DAR/EIITRIAN 01. k �' .,may PARKEDCRY/SW TATE, :.W: ,. :;:r ADDRESS Stott AS DRIVER :g` VEICCLE. ., a... ❑ L I. ti ❑ T +r ri BiCY 86% ./MMR tYEt ..—H001R..•aW —STRTNOATE"' -' _�; "pgs��VEHICLE ON ORDERS OF:` _ �OPRtt11--❑DRtV R- OT EAR1611_ — - — L,J -- DA ❑ ,. - - - - s OTHER HOME PHONE SUSIMS88 . PRIOR tlECMANICAL DEFECT!: NONEADPAAENTO REftR To NARRATIVE❑t ❑... ,(. ........,,'. ..,.,. _ ., .. -. �,... ,...- CHF USE 0t6T.- .�: . ,.:a„u......-WIAo[N DAMA,00 ARtAr:..a oEBarti rtncu awAot , INSURANCE CARRIER POLICY NUMBER VaNICLSTM ... •T.. r3' - . 0-ft NONE ONINOR -...O„DD:-,a MAJOR ❑TOTAL . DIA OP ON oA HIGHWAY SPEED PCF TRAVEL .,tRYT PUC Q ' CHP Q PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEK YEAR MAKE I YODEL I COLOR LICENSE NUMBER STATE $ [GUIP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER NAME(RRST,LBDDLE,LAST) - PEDES- STREET ADDRESS OWNER'S NAPE ❑SAME AS DRIVER TRIAN ❑ PARKED CITY I STATE I DP OWNERS ADDRESS OSAME AS DRIVER VENCLE !ICY. SEX HAIR E`/ES HEIGHT WEIGHT BIRTHDATE RACE DISPOSITION OF VEHKLE ON ORDERS OF: OOFRCEA ❑DRIVER []OTHER y_ CUST Y0. . DAY YEAR O c OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEPICTS: NONE APPARENT O REFER TO NARRATWE O ❑ { } ( } CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGEDAREA INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE : OWI' []NOME []MINOR i ❑MOIX ❑MAJOR OTOTAL aA OF ON STREET OR HIGHWAY SPEED jPCP ICC Q TRAVEL LIMIT PUCQ CHP Q PREPARER'S NAME j DISPATCH NOTIFIED REVIEWERS NAME � DATE REVIEWED S/ S NO � W ^ Ab.-9 16—) CHP S55 PAGE/ (Row 140) 00F04", 88 48667 (' r ' 'STATHC .andv, Zti ? .�. A ,g�n. " TRAFFIC COLLISION CODING, *x� k°' k a; � , DATE Of. ..4 M1SION',' - TY[(YI00 NCICx'YE6 + -y 't t 9 w&s"` h ss k'a V ( � �f MO. DAY. YEARS '0- 3 OWNER'S NAME/ADDRESS ..• ,.: PROPERTY YES [:]NO DAMAGE IMAGE DESCFUFnOON OFDAMAO[ $. ( ✓•. ,w ­'SEATING POSITION a ._ SAFETY EQUIPMENT EJECTED FROMNEHICLE ' j# t , s M/C RN:YCLE_HELMET . OCCUPAM i { L-AIR SAO DEPLOYED 0. NOT EJECTED ' A-NONE IN VEHICLE M•AIR BAG NOT DEPLOYED DRIVER 1-FULLY EJECTED- 8•UNKNOWN N-OTHER V-NO2_PARTIALLY EJECTED' C-LAP BELT USED P-NOT REWIRED W-y� 3-UNKNOWN I-DRIVER D-LAP BELT NOT USED 1 2 3 2 TO 6-PASSENGERS E-SHOULDER HARNESS USED PASSENdiA' 4 5 6 F SHOULDER HARNESS NOT USED CHILD RESTRAINT 7-STATION WAGON REAR 8-HEAR OCC.TRK OR VAN G X NO LAP/SHOULDER HARNESS USED O-IN VEHICLE USED+ y-yES 8-,POSITION UNKNOWN H LAP/SHOULDER HARNESSNOTUSED R•IN-VENCLENOTUSED,� .., 7 0-OTHER J-PASSIVE RESTRAINT USED 8'=1N 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 MOVEMENT;P,RECEDINiGr r UST NUMBER OF PARTY AT FAULT TRAFFIC CONTROI.DEVICES # 1 213 * TYPE OF vrRic2 E � k; I1 2, .3. :COILiSiON A [ YES ACONTROLSFUNK:TtOHING ' " APASSENGERCAR lSTA AGON ,;. ASTO)+PED-4,7-' M VC SECTION VIOLATED: C` D `'" '? ^?' NO B CONTROLS NOT FUNCTIONING• BPASSENGER CAR W! R' B PROCEEDING STRAIGHT,--l-5. "I 9 BOTHER IMPROPER DRIVING CCONTROLSOBSCUREDF, ---- C MOTORCYCLE%SCOO RAN OFFT{OAD. D NO CONTROLS PRESENT/FACTOR D PICKUP OR PANEL 10m D MAKING RIGH TURN (;OTHERTHAN,DRIVER --tTYPE.OFCOLLISION ... , .. ERCKUPIPANEL* CKW./TRAILER MAKINGLM_TURN G UNKNOWN„ j NEAO-ONxa F TRUCK OR TRU TRACTOR'-' MAKING U TURN E T, B SIDESWIPE„- GTRUCK/TRU TRACTOR W/TRLR BACKING ti act REAR END' t,'rs.� raz#i a SCHOOLS ” _� SLOYWNK:I STOPP1Nfi A .,.. x. . WEATHER:C MARK I-TO'21TEMS)"" D BROADSIDE' S.."i" " I OTHERS I f g PASSING OTHER VEHICLf'ff ACLEAR E HIT OBJECT. J EMER HCY VEHICLE J CHANGING LAMES .,- CLOUQYa_ =- F:OVERTURNED C I(N9G AYCONSLEOU_IPtiEItT" :: PARKINGMANEUVER °F"1A .. G RAINING GmEmcLE t PEDESTRIAN_..... ..' .-:__. L 81 CLE,. EN ERIN O TRAFFK,1 D SH04VLNO_, - OTHER': .-. 14 «- THER VENICLE; OTHER u•HSAF(s„T�RNINa. x E:FOG,VISIBILITY' FT. MOTWt VEF4CLE IMVOLVEO WIH PEDESTRIAN 1•�s + $t Xtt/(3;INTOOP„ NG LANR� () "PIF OTHER Z�Vct­l, ANON,',"GOIUSYON' :�ut fir _ IAOPEOg.__. PARKED , GWIND 3 PEDESTRIAN. : d MEROiNO r LIGHTING C OTHER MOTOR VEHICLEI, aw. .w 4 i,,, ,,r 7RAYELIHG WRONQ WAY;`, ,t ADAYLIGHT MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTORS) OTHER s (F er h* t # DUSK-.DAWN _.._ PARKF-0,MOTOR VEHICLE . .1 2 3 (MARK 1 T021TEMS) ,_ - � � h�=t DARK-STREET LIGHTS AVC SE E; LA CTRAIN CITED _ G DARK•NO STREET LIGHTS BICYCLE rR w ) -STREETLIGHTS NOT ...__ DARK- " B CSECTIDNvauTwN: arEo FUNCTIONING• t_ OYES -- ROenWAYSURE -ORUQ DRY—"! TO 21TEMS)f�� �`- _. vim B WET OTHER OBJECT: NAD NOT BEEN DRINKING SHOWY,ICY J D B HOD,UNDER INFLUENCE SLIDPERY.(MUDDY,.OILY.,ETC ) »,.,,.- E VISION(OBSCUREMENT .--., �"""" MBD;•NOT UNDER INFLUENCE, INATTENTION*:' 77 ROADWAY CONDITIONS) IG STOP 8 GO TRAFFIC H9D-tMPAlAMENT UNKNOWN' (MARK 1 TO 21TEMS) PEDESTRIAN'S INVOLVED UNDER DRUGINFLUENCE* . ENTERING/LEAVING RAMP mi ANO PEDESTRIAN INVOLVED_ . IMPAIRMENT-PHYSICAL'A HOLES,DEEP RUT• B CROSSING IN CROSSWALK I PREVIOUS COLLISION' ""-" IMPAIRMENT NOT KNOWN LOOSE MATERIAL ON ROADWAY NK DEFECTIVE VEH.EQUIP.: • AT INTERSECTION UNFAMILIAR WITH ROADNOT APPLICABLE _ pTEpOBSTRUCTIOON ROADWAY• CROSSING IN CROSSWALK•NOT SLEEPY/FATIGUED D CONSTRUCTION,REPAIR ZONE AT INTERSECTION ONO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK I IL UNINVOLVED VEHICLE ANAZARDOUS MATERIA FLOODED E IN ROAD-INCLUDES SHOULDER OTHER•: H�E G OTHER-: IF NOT INROAD E4 1 IN NONE APPARENT H NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS 10RUNAWAY VEHICLE SKETCH LG6jG \ OMISCELLANEOUS INDICATE NORTH vill ,P _ .. CNP S55 PAGF 7 1 Rev'14A I OPI 047 ^ STATE Of 6Al6''OR dA�'1?. IN JUR1D /::W{TNESSES_./ P�►SSENGERS t M, : . __ :._.. r. �`- w - �OKffiOf. MME(t NCIC'N. - OFRC NUMBER . . T�yJ 10, . - WITNESS PASSENGER ONLY ONLY AGE sex EXTENT OF INJURY( "X" ONE) INJURED WAS("X"ONE) PARTY BEAT. SAFETY EJECTEDNUMBER POS. EOl6P. FATAL SEVERE OTHER VISIBLE COMPLAINT DRIVER PASS. PED. BICYCl1ST OTHER /HURT INJURY INJURY OF PAIN 'i; m ❑ ❑ F I ❑ 1 ❑ 1 ❑ 1 U I ❑ ID I ❑ I ❑ NAME I D.O.B./ D Bt), - TELEPHONE I4 (INJURED ONLY)TRANSPORTED BY: TAKEN TO: t- a S EH- D0 C=CA DESCRIBE INJURIES F; ❑ VICTIM OF VIOLENT CRIME NOTIFIED ." f It o El 111,101 0 101 1 /D.O.B./ADDRESS TELEPHONE d- -y0 6l o O N Row L 2 (INJURED ONLY)TRANSPORTED BY: TAKEN TO. DESCRIBE INJURIES ; FIA CRIME NOTIFIED 3 ❑* ❑ 1 o I ❑ ID 1 ❑ 1 o NAME/D.O.&I ADDRESS .- -:.TELEPHONE'-•: . ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES "° 'VICTIbt OF VIOIEPNT CPtlME N071PIED � ? ',��. ❑# ❑ o ❑ o ❑ o a a ❑ h. NANEI O.O.B.I ADDRESS .. - - .TELEPHONE,•` ..__.T-ONJURC-0ONI: TRAlRIED-BY• TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑ D ❑ ❑ ❑ ❑ ❑ 101 D ❑ NAME I D.O.B.!ADDRESS - TELEPHONE (INJURED OILY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES O , VICTIM OF VIOLENT CRIME NOTIFIED ❑� ❑ ❑ 11 ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAMR I MO.&I ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED B TAKEN TO: DESCRIBE INJURIES j. VICTIM OF VIOLENT CRIME NOTIFIED PREPARE"NAME MO � AY YEAR REVIEWERS NAME MO. DAY YE CHP(15555-Page 3(Rev.7.87)OPI 042 87 43637 5 STATE OF CALIFORNIA ACTUAI'DIAGRAM x ,> ax .�...,.. .. (DATE," COLLSION fi1 Y �. ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE�� CAM I NO O )A&0 _ NORTH � 4 t7� _. ♦a:lr ..i. x.,...:4 :. s.. .� b ::M". >�.:< 2, a Y 'h -F.i"; t'• VASco Q0-WAWU7 m, .L6OS:c Pm I-oosc C-1, /Zf /Wk.dufLFRc�.t,,v_��.�D i GRAvK GC- . DMN ffpKn 11 FT DEEP A PP2OY, 14 FT AP°r�GX F7-J rAp-xS I" ()1R-7 V/► A7 /'6,Y- 01- 1 A Si ID(_ F2c:-7 R[)rpFrt DRAWN � . ]�/"6 I yOER (Q DL IREVIE WERY NAME I i-_= ♦R, CHP 555—Page 4 (Rev II-85)OPI 042 111 F; + 7> �_ s �g STATEF AUFO N FT3t"ct NAS WXTiVE/SUPPLEMENTAL_ 4 PAGE:3- DATE OF INCIDENT CE TIME(2400) NCI-NUMBER ]OFF RED. NUMBER - ff(O D 2 Q 'K ONE W OONyE� TYPE SUPPLEMENTAL('X'APPLICABLE) - NARRATIVE 1 A COLLISION REPORT ❑ 13A UPDATE �D FATAL a HIT A RUN UPDATE I SUPPLEMENTAL ❑ OTHER: a HAZARDOUS MATERIALS- ._aSCHOOLBUS ❑.�_I OTHER:. CITY/COUNTY/JUDICAL DISTRICT REPORTING DISTRICT/BEAT GTATIONNUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED YES NO Y2- 3. .3. 00✓ ,0 4. (/ O s. 3 6. 7. EA* ti Al " — - s. O_ r 9. G ! tL. _f E tt 10.. O ' J �--G - ? A' 15. r r Ifa 16. 17. 18. V Q. r i 19. 20. .rfJ r ta+ 21. G G 22. 23. A,704ALTIA/ Q 24. o OL,E ` fti AL-0 25. S'F'c- c 26. 27. OTP O1t fi' Y,c f f (:"-,-A-7,h,A //)r 28. 71P . 1 29. 30. 31. 32. PREPARER'S NAME I-D.NS(jAB�R NTH! Y/YLR REVIEWER'S NAHE MONTH/DAY/YEAR - CHP 556(Rev. 7-87)ON 042 uwpevaus.a onew He.p«ra 88 48641 r Y, JI t,•r'v .,k RAWKII /E/SUPPLEMENTAL "L3 ' ': s�`" •"� 'fid }vAGE"FJ"yes e DATE OF INC ENT% TIME(2400L - NCIC NU OFF "'- NUMBER 'X'ONE WONE TYPE SUPft"ENTAL(')C APPLICABLE) - __.. '-„•.:. __ .. -... NARRATIVELUSION REPORT ❑ BA UPDATE ❑ FATAL .a; NIT 8 RUN UPDATE i SUPPLEMENTAL O OTHER: a HAZARDOUS MATERIALS ❑ SCHOOLBUS O OTHER .., `- I CITY/COUNTY NUDICAL DISTRICT •• ^• - - - ' 7 REPORTING DISTRICT/SEAT CITATIONNUMBER LOCATION I SUBJECT STATE HIGHWAY RELATED YES El NO 1.SZt y- 2. r 4. S/ l/l/ 6. ST/ / c-r - -7- ✓ . 7. 8. 1029T2S s 'I-L Ql2ti1 11. i -' 13. L.�4 -S`A w A r;. 16. M4r ” CC" 1713 JAX-, j 19. I� G3�C 20. 21. o 11S""T ® (d - 22. 23. CO C. t C VA 24. 25. ^ C / ..A - 7 *�VfFml 7 26. f f 27. ?(?.moi -,77;, 27. 29. G E o C d i 30. TZ C civ S L CT sl o 31. 32. PREPARERS NAME LD. R MONTH/ Y! AR REVIEWER'S NAME MONTH/DAY/YEAA r �7 CHP 556(Rev.7-87)OPI 042 o G UOpr odb^'unlldeF/°lwl 88 48641 TATE F LlFORNA �VA�i�AT�VE/SICPPLEMENTAL � ' " -PAGE DATEOF NC1=E /_ UR NCE TIME(24001 OFFID LO7 - - NUMBER ' G O 'X' O---NyyNEE• 'X'ONE TYPESSUPPLEMENTAL('X•APPLICABLE) NARRATIVE COLLISION REPORT ❑ BAUPDATE O FATAL HR B RUN UPDATE• OSUPPLEMENTAL O OTHER ❑ HAZARDOUS MATERIALS a SCHOOLBUS ❑ OTHER ., CITY/COUNTY/JUOICALDISTRICT REPORTING DISTRICT/BEAT CITATIONNUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED LjYES NO 1. y SG� a :) A.• ti d AQ thST 3. OF COo -(, 4, 5. — CCr t.'(, 772 E LMX 6. J�'tJ E- 7. 1/) , G - . - --- - - 8. 9. l 10. . 11. 12. 13. 14. 15. 16. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. PREPARER'S NAME t.O.N}1y8ER L.T.IDAY/ A REVIEWER'SNAME MONTH/DAY/YEAR CHP 556(Rev.7-87)OPI 042 SB 48AI m o,cl, N a' o D 1 V n Z to n _ o;t4z:} ICU ^�I/ yq! t t. 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 16, 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: $1,000,000.00 Section 913 and 915.4. Please. note all "WaCi3wty Counsel CLAIMANT: BOJORQUEZ, Virginia Padilla DEC 18 1,989 ATTORNEY: Martinez CA V4553 Date received ADDRESS: 62 Orinda Lane BY DELIVERY TO CLERK ON December 14, 1989 (hand delivered) 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. p gg DATED: December 18, 1989 �tIL DeputyLOR, 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: t2 117, ,1.11 BY: SI&JDeputy County Counsel 0 NKJ 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 o.f the Board's Order entered in its minutes for this date. Dated: JAN 16 1990 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sect 3) 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 16 1990 BY: PHIL BATCHELOR by �ftDeputy Clerk CC: County Counsel County Administrator DE iu � r,rL cA;.C,xLOR CLUK BOARD Of SUPERVISORS ON STAj& B .�.. ,.... d;�f: De ut CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND ITS AGENTS AND EMPLOYEES VIRGINIA PADILLA BOJORQUEZ hereby presents a claim for damages on behalf of herself and the children and step-children of DIONICIO BOJORQUEZ, namely DIONICIO BOJORQUEZ, age 8, HECTOR BLANCO, age 12, MARCIA BLANCO, age 14, OCTAVIO BOJORQUEZ, age 5; and, JORGE BOJORQUEZ, age 2 . This claim is for damages against the County of Contra Costa for actions of its agents and employees. Address of Claimant: 62 Orinda Lane Pittsburg, CA 94565 Address To Which Notices Should Be Sent: VIRGINIA PADILLA BOJORQUEZ 62 Orinda Lane Pittsburg, CA 94565 Date, Place and Circumstances of Occurrence: On June 18, 1989, Mr. DIONICIO BOJORQUEZ (Claimant's husband) was in the right front passenger seat of a 1973 AMC Gremlin, license #067HRX, when the driver, Cesar Joel Martinez, heading west-bound, lost control of the vehicle when he left the road and the vehicle hit the soft shoulder and/or the ditch and crossed into the east-bound lane of North Parkside, and struck a P.G. & E. pole, impacting the right side of the vehicle. This accident occurred on North Parkside Drive in the area of the City of Pittsburg, County of Contra Costa, California. Mr. Bojorquez was taken to John Muir Hospital in Walnut Creek, where he died from multiple traumatic injuries due to this motor vehicle accident on July 12, 1989 . Claimant believes the County of Contra Costa is responsible for the injuries to her husband and father of her children, due. to negligent construction and/or maintenance of North Parkside Road, its north and/or south shoulder, ditch on the north and/or south side of N. Parkside Road, the placement and/or lack of removal of the P.G. & E. pole, and lack of any warnings, guards, etc. to prevent the accident. (See Exhibit Police Report #C89- 5286) . Parties Responsible: Agents and employees of Contra Costa County whose names are unknown to Claimant. Amount of Damages: $1 Million Dollars. General Description of Iniuries and Basis of Computation of Damages: Mr. Dionicio Bojorquez died on July 12, 1989 from multiple traumatic injuries due to the motor vehicle accident of June 18, 1989. Mr. Bojorquez was the husband, father and step-father of Claimants who provided both emotional and financial support. Dated: December 13 , 1989. 61i�VIW w 7a"p �02 VIR NIA PADILLA BOJORQUEZ Claimant on Behalf of Herself and the Minor Children Named il►!'', -',;COLLISION REPORT GP YPa(:tAl.r+NITIMIM , NLtrrEN MR[NUN CppCUtt/TTTTT������ JUOKJAI pSTIrCT LOCK REPORT MUMS"MJU -♦ RaO faLQ EtR JST•RUN rwlwYrr AIP'ORTWO DiNTRKT SEAT PALLED a* OLLOM011 OC, A M0. DAY Yam I)Ma(JAoO) NGC a OPFICAA L D. ---------------------- O -`- ---- ----------------------------- -------Y14wST M10RrtAllOOt DAY OF WEAN TOW AWAY /HG OURAPMS IY: < T W T F S nm []NO - c.woo U OF JOAT IMn NElLT10N YMrrM $rAn MWY REL �✓ b�i rn No ONONa 1 PARTY Dwv[R M uc ENMr NwMER ows CLASS SAPETY vaN r4,A fig L CO Licaftes NOMMEN STAT! -17 DRIVER NAYS(ARMY, 6GUOLS.LAIr) Pt Ut4 TALET AODRE►S _ - _ _ O"AR7 A••a ❑ EWA AM DRIVER T'WFAAAEO OTY I MTATS I ZIP ( QWNAN'S ADTRAMI SAMA M[FIN SR VONCLS 1 1144- -a-- 9. MCT• SEA HAIR Sr S HIIUMI W40MT MRTNOArs RACA OOPVWTIOn OF VILMCLI ON ORDERS OF: [OFFIj� cER (� N DV[R ❑OTHER ClOst _ / DAY ram OTMEA MOMa PHONE SUMNESB PMONa PRIOR MECnAt*CAL DIPICTI: WNS APPARENT RIPIA TO NARRATIVE ❑ ( ) ( ) CMP OSE ONLY DAMCRISa VaIECLI DAMAGE M(AOa IN DAMAGED ARIA vaFal:u TYPEIHIURAHCI,CANRIEA POLICY HuMaER ❑UrML llw,.d oMWOR 1 0.00. 0MAJOR TAl PROF ON ATR[IVOR UMWAY MP!!D ICI Icc[] ••••� !! r✓"a` a/o CK►o PARTY DIavan'I ucANal NOMMEN S1Atf CLM6 SAFtry VIM.VEAA MmE I MODAL)COLOR A."d NUraill STAIE I(xAr. Z DRIVER NAME(FIRST,WOOLS,LAST) 13 Pt UIW UIREAT ADUREYS OWNER'I NAW []SAME AS DRIVaR YIMAN 11 PAAAAD CITY I ITATSI Ito OWNrR'1 AGGRESS ED SAW AS DRYER valxu HAIR liras nMOIfT WMOMI IMO MRIo%r n+ YUR a OOpOwnON OF rAWCLa ON ORDERS Of: CloPFCAR Qonv[R ❑OTHAA COOT OTHER HONG PMONA /UAINa"PHONE PRIOR MAC HA/•CAL DIFECTS. NONE APPARSNT 0 R►PIR TO NARRATIVE❑ ❑ cn►uMI onLY Ot aCANOS VIMCLE DAMAGE SMADS M UAMAOMD ARIA INMUNAMCII CARMEN POLICY HUMMER VEMCLI TVPE CMN. 1:1 NONE []MNUR L]MOO. [DMAJOR [DIOTAL Not UP ION STRAIT OR MGMWAV YPEED PCP ICC )NAVAL L"T Fuc[] CHP d PARTY DRIVEN Y UCENII[NUM66A SIAIM CLA61 MWAFt TV VEN rtAA MAAA I MODEL I COLOR ICENi[NUMMER ITATE 3 Eu. ORIVEA NAME(ARST,600OLI,LAST) El POOEL V1Ri[T ADDRESS OWNER'S HAMA []IAM/AS DRIVER TN.AN PANAED CITY I STATE,ZIP ' OWh[R'I ADDRESS []MAMA AS DRIVIN VOMi LI MCV• 6EA HAIR 1116 MEIG1(T WEJGrR MN1 nUATE RAi:E DISPOSITION U►VEHICLE ON GROANS OF: []OFFICER [TRIVIA [OTHER CLIST MO. DAY YEAR OTHER ROME FHONE SUJMNE YM IMON[ PRIOR M[CMAtACAL DEFACTI: 'NOMI APPAAENT❑ REFAA TO NARRATIvE❑ ❑ ( ) ( ) CMI t;ILWLY 096CRISa V[ISOLE DAMA0 AGE ah"I IN DAEI10 AREA M[LA TYPE Yr N6URANCE CARRIER Poucv NUMMtA [{MIL ([]MONS []rSNOR ❑MOO. [MAJOR ❑TOTAL O+I!OF 10"STRAIT OR HIOMWAVSPtlD PCF ICC O TRAVEL OMIT Puc�^ �• PREPAREN M NAME ISPAICM NOTIFIED REVIEW EN'S NAM[ JOATI REVIEWED _. j YGS ❑ NO ❑ NIA r' 6 . CNP OSS PACE 1 (Rrr 1.86) 0*1 dvcff (I I J� (fJ�jt. i/Yd7CJft+dV/` �� QAJTSnT,- C,tP4;'4f 0^ 2r �E_ wt 7bn t,w l U �P' /il10Vr�t IL Cit c�e4 ATS- / `� It OF CALIPUnNA •1AFFIC COLLISION CODING Z l Of C i,UEI(MI - nm&I"w) NC1G NLIYI[A 1.0 mw 781A p l-'•� _- —T o.r r�AA f� Z 1 -0 WNfiOnfti•fOPEH �IY � GT u ❑NO IAMAGE sscAlrnoN oroolv di IP1d -z. c2C WL f� SEATING POSITION iSAFETY EQUIPMENT EJECTED FROM VEHICLE C"UFMiL9 L-MR SAG DEPLOYED �+�CYCI F•HIE'uET T EJECTED A.NONE IN VEHCLE lIl•AIR SAG NOT DEPLOYED DRIVER U•FULLY FULLY ED U.UNKNOWN N-OTHER v•NO 2-PARTIALLY EJECTED ^� C-LAP BELT USED P-NOT REOUIRED W-YLS 7-UNKNOWN f-DRIVFR D•LAP BELT NO USED I 2 3 E'SNUULUEH HAHNLSS USED PASSENGER 3 5 6 TSTATION WAGON REAR 2 TO E•PASSENGERS F.SHOULDER HARNESS NOT USED CHILD 1151 RM .1 No tl••REAR UCC.IRK ON VAN G•LAP I SHOULDER HARNI.Sy USED O•IN VEHICLE USED Vr.rEs Y•POSITION UNKNOWN IH: t"LAP1 5HOULULH HANNt.54 NOT USED N•IN VENCLE NOT USED O+OTHER J PAVE RESTRAINT USED 8•IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN vEHCI.F.IMPROPER USE .. _. _. U-NONf)N VEHICLE ITEM)MARKED BF'LOW FOLLOWLD BY AN ASTI:RISK(•)(MOULD UE L:XPLAINEU IN THE NAHRA IIVE• IST NUIIAW N I a I C0 PAIIIV AT FAC I AULT TNAFIIC GONTNOI.DEVICES 1 Z TYPE OF VUICLE 1_12 MOVEMENT pf1ECEDING COLLISION A v'5EC ZION VIOLA IED; C'�u ACONINCx 81U HC,f I UN NO •• APA SL NGEIl CAH 14 I A i ION WAGON ASIOPPLD l who Ne ZZI�J No I]CON IHULaNGJfUN(:IICMYNG' bl'ASSLNC:EHCAHWf(HAiLER PROCEEDING STRAIGHT BO1HLH IMPRUPEH UHIVING CUNIIIuLs Oo,l:Ulu:D C MUTOHCYCL.f'.1 SCOOFLfl RAN_OFf ROAD D NO CGNI l HOTS VNESLNf/FAC I L41• D PICKUP OR PANEL TRUCK D MAKING RIGIIT TURN C UTHEN THAN UNIYf:R' TYPE OF COI 1)WON E PICKUP 1 PANEL TRUCK W I TRAILER E MAKING LEFT TURN D UNKNOWN• HEAU-ON F MUCK ON MUCK IRACIOR F MAKING U TURN E FCL'L A (I SIDESWIPE G-r TRUCK I TRUCK TRACTOR W 1 THLR. �rBACKING IC fl REAM ENO SCHOOL But, 1'1 SLOWING I STOPPING WEADII-HI MARK I TO'2ITEMS) UNOADSIDE I ofmf R BUS I PASSING OTHER VEHICLE ACLEAR E NT OBJECT J EMERGENCY VEHICLE J CHANGING LANES B CLODUY F OVEN I URNED K HIGHWAY CONST.EQUIPMENT K PARKING:MANEUVER C FIAMING VEHGLE I PEDESTRIAN L BICYCLE L ENTERING TRAFFIC SN�iJMNGJH OTIif.FI•: OTHEH VEIICLE M UIHER UNSAFE TURNING _•E FOG TVISIlf1UT/ FT. MUTON VEfYCLE INVOLVED WITH INIPFOESTRIAN N ICING INTOOPPOSING LANE F OTHEII'; ANON-C(xus4,DN MOPED OPARKEO G WINO B PEDESTRIAN P MERGING LIGHIING C OTHER MOTOR VEHICLE (RAVELING WRONG WAY • A UAYLIGHf D MOI(iH vEHCLE ON OTHER ROADWAYOTHER A630aATED FACTORS) OTHER ' Z 3 ' H UUSK•DAWN E PARKLU MUTON VEI*CLE (WfiK 1 T021fEMB) CUANK•STNF.ETLiGH18 FTRAIN e?� g' AvcYcc a+VaLAnON: arco DDARK-NO5INLET UGHTS UICYCLE []vu❑NO DANK-STREI:TUGHTSNor ANIMAL: L7 OrcILCT1ONVIOLATION: arca Flt Nf,TIONING• H Qrtt Jf�} ❑lq SUBHIET Y-DRUG ROAUW Av SUHPACF. FIXED OBJECT "�"'L CVC 8(CT10N vg41ii'r♦s: PHYSICAL A DRY I € C GTlO 1 2 3 f¢",`,, (],u (MARK 1 TO 2ITEMS) Q WET OTHER OUJECII JAHAO HOT ULEN DRINKING _s,+owv-icy D - D F-1 SUPPEHY(MUDOr.OILY,ETC.I E VISION OUSCUREMENT: HBO-UNDER INFLUENCE &GOTRAFFIC HUD-NOT UNDER INFLUENCE F INA TI -: HHU•IMPAIRMf:NT UNKNOWN' ROADWAY CONDITION(S) G STOP 4 GU T (MARK I TO 2ITEMS) PEUESINIAMSINVULVEU E UNDER ONUG INFLUENCE ANOPEUES1HIANINVOLVED HENTFktNG!LEAVING:RAMP I COLLISIONF IMPAIFIMLNT•PHYSICAL' PREVIOUS COLLISION HOLES,DEEP HUT' D CROSSING IN CROSSWALK 1 U "--- IMPIUHMENT NOT KNOWN ,I NFAMIl1Afl WITH ROAD D LOUSE MATERIAL ON ROADWAY• AT IRI LHSECTION -K DEFEC flvE VLPI EUU1P.: NOT APPLICABLE C OBSUIUCTION ON ROADWAY' CROSSING IN CROSSWALK-NOT q�c' 1 !yLEEPV 1 FATIGUED D CONSIHUCTION-REPAIR ZONE AT INTERSECTION ❑"0 SPECIAL INFORMA 66N E IIEUUCLU HUAUWAY WIUIH D CHUS.AWI -NOI IN CIIOSSWALK FLL�UUNINVOLVEO VLHCLE AHAZAHDOUS MAI EHIAL OODED• r INROAD-INC-INCLUDES SIIOULUEH M OfHEN': UTHCH': NOT IN ROAD 1N NUNS APPARENT I-I NO UNUSUAL CONDITIONS APPROACHING/LLAVING SCHUoI BUS ORUNAWAY VEHICLE KTCH MISCELLANEOUS wIwCATA NOATM 0 D55 PAGE 2( RrV Usti)OPI 042 PITTSBURG POLICE DEPARTMENT Caw No. i PMSBURG,CALIFORNIA I* ORIGINAL Page No. • +•_• �SUPPWMEHT PROPERTY/EVIDENCE REPORT Code SeetjL►crdent Yieum(Lnt Name Fiat) Recording Ofe. Prop.Booked to Ufe.Booking Prop- ------- rop- t [MV C3 S 0 Finder Property S . Stalan F . Found Uigpa, EH . Enid. Room PL - Prepared for Lab ud E Evidence SK Safe_Keep" Legend K - Ref ration LO • Ket. to or left with owner Comments lem Prop. �- No. Leg. Description Value Wr 64, G� f S'lP ka' Z© �s /`�L ���.l 'moi'/,��.�/ i�'� `�Gxe' • Lin..►- . &tit*Uffiaer Ammotirgj afficerls Y Uatc tme Conumnta Rentewod by Date and Time -7 AmWwd Patrol 0 Traffic cop m D P.trol OAdm ser. ❑D-A- p Utber can ❑ ❑ Inn. Q Ju., to: ❑ Im. ❑Cluef ❑ al t�orad CP-09/13 C4) PAT%Of CALIFORNA WITNESSES / PASOGERS _ PACE 3 UATq O OtLIw N TIMI 94001 C11.NUMBER NUMBER OFRCkR 1.0. NUMtl ER 32- CB%- EXTENT OF INJURY( "X" ONE ) INJURED WAS( "X" ONE ) PARTY BEAT SAFETY ' ME PA8A011 us NLMBER POB. EOu1P. VICTW O"LlONLY NLY ONLY FATAL SEVERE OTnEN V151 tltH 1—COMPLAINT DEtlVFN PA6B. PEO. BICYCUiT r1juNY INIuRY INJURY Of PNN OTNER a ❑ ?_!o M I ❑ I Cl I ❑ L ❑ ❑ 1 ❑ ❑ ❑ Z7 T LEfnONc�` 1#"URf0 OHL Y)IRANSPOH T900Y: TAAEN 10: DFtlCRIbi INJURILU InVICTIM OP VIOLENT CRIME NOTRED ❑� ❑ ❑ ❑ ❑ ❑ ❑ n ❑ i 1 a o NAML I O.U.B.I AUU Lbs TELEPHONA eee�W .�QG cSr�c3rQ '7- (WjvpA AY)TRAN51,01,1I EU tlT: ` TAxIN f0: I OFBCRIdf INJu NILb C!4 VIC RM OF VIOLENT CRIME NDTRED ❑� - JAI ❑ ❑ 1 ❑ 1 ❑ 1 ❑ I ❑ ❑ ❑ NAMLID.O.B.Iw MEbr Zy',y/ TELIPNONF . (INA, EG ONt Y)TNAI.SFORTLD sY' TAAkN 10: UE6CRInc W'uAIE6 VICTIM OF VIOLENT CRIME NOTIFIED ❑� y ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1 , o h �il.tl./ADDNEbb TELEPn NE 070 /D�Z�49 ��ya!tcswr. -fr pNJ4 r.IL Y)IhAN::FJNfkD tlY: �11 � � IMILN IU: DESC RItlI IIv.lUhlkS �' VICTIM Of VIOLENT CRIME NOTIFIED ❑# f ❑ ❑ ❑ 101011 ❑ ❑ s b o NAM�'-�yU I wU L50 , ) TE LE Mr�-E 2S 7 IrY�Vi�I IInAN+FUR IEu 8Y. IAAEN TO: OE5ChIbE INJURIk`.a ClVICTIM OF VIOLENT CRIME NUTIFIEO ❑# ❑ ❑ ❑ ❑ ❑ ❑ ❑ 1.0 1 ❑ 10 NAN//O.O.r.I ADONfsr TELEvnoNE IIN.IIJREO ONLY)TRANSFUHTLD BY: TAIIkN TO: - 0E6CWtlE WJURIEB VICTIM OF VIOLENT CRMF NOTN[D PNEVANER'fi NAM I.D.NVASER MO. UAY YEAR NEVIi WER's NAME MO, DAY YCA CHP 555-Page 3 (H PI 042042 stww ow u.i•onniw 1\ FACTUAL DIAGRAM t t�Ml nCIC ryUMt[n O�IiCY i.0. NUMt[n ��• 1 � 1 /Do 2- D7o8 L ` D uw. a ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED ISCALE ' � INOIC ATt ryU[TN A f"13I Z 6-) A✓ 9 T ,z A) is ck C) nRrcK; �i t5L9 y y�y UnwWN tv I U. nuMYan M/u. U(wv �iv�ry. ........ . .... ....Wlry . N♦ MO. Owv ♦ry, I CHP 555--PLge 4 (Hev n-85) UPI 042 -- •1 ATE r,r r.u '.,•n. VAHRl��1�,'E/SUPPLEMENTAL PA,E UAIE i,rUFNf�c ]�JI N! fIM[1:"1 NCIC NUMisEN OEFICERID NUMBER 100 Z D A:one 'lt'ONE I YPESUPKLMENTAL('XE] 'APPLICABL xNAhFATIVE R/I COLUBION REPORT ❑ BA UPDATE ❑ FATAL ❑ MIT✓1 RUN UPDATE 17 bwPPLEMENTAL �Q❑,� OTHER NAZARDOUSMATEWAW Q SCFOOLBUS ❑ OTFER. A REPOFf,N�� STRICT BEAT WATION NUMhFA fY/JUI/n.At L11;,7 RIC - � jr Lu:Au,.N. Un,I 1 / 'if ATEHIGHWAVHEIATf.D tEs NO ��D�'1;�,�..�7io.E./'.• �'.-,s�I ,�c�i �•c�' � �w>r� �T /�'L f.�. 4. fig ( /�,�-/ /Op�� s: 1 �1 .•s�� �> fjreo / 1 .►/ 7. � 8 9. s /,4-1 `'i/ J A-1 10. 12. 114. 116. / 17. 118. 19. 20. 22. N 24. 25. 27. 2 -ull lil..r A 7i GL/h,uf [r'.74, 1ze ls.�ar 28. 10. 31. 32. PFL AME i0,NuuuFRMiJNin.GAv�vUR REVIEWEWSNAME 1AViYEAN CHP 5S6 (Hev. 7-67) OPI VO2= lib 486.11 JARRATINE/SUPPLEMENTAL :JA I L r�Lt I AAL(2�M NCI:N U MIJL H ICLH 10 NUM A'ONC NARRATIVE COLUSION IRLPO"T O HA UPDATE a FATAL a MT A RUN UPDATE "Ipll-I:-- ❑ OTHER, ❑ HAZARDOUS MAT CRIALS SCHOOLOUS ❑ W.I., 2 22 zz - 3. YLS No 4S -Ae, 4. X 7-- zo 7. 8. 2Ze 10. �3, 71Z Alh �Qwe F). 7. 8. 9. 13. =W& '4. )5. 16. )7. 5 A✓1CO CK/ AUO 4A&W7" ZO <r7b /XIIA5 t2 '2 d 'HEPAI FWNA .--l .,LWERSME THIDAViYEAR lip 556 (Ray. 7- �042 88 48641 1AIF" i. IAHFAT.VVE/ SUPPLEMENTAL a GAfE��r ihCiUl;ht Ver:C;URGNCE TIMFI:+wI MCGIvuMnLH OFFICER..D RUMtk:R 3i- K'i�nt O�NtE TYPE SUY/LEMLHTALI'1CAPPLJCAyLEj NARRATIVE COLLISION REPORT ❑ BA UPOAfE ❑ FATAL ❑ MT A RUR LIPOATE nSUPPLEMEMAL ❑ OfHER: ❑ RAIARDOUS MATERIlS ❑ SCROOLBUS ❑ OTNER' .IY i,Nl ti.�u Un.A�.USI k;T RE'NlH1 GDiS TR�CL p[.AT Ci CAii.N NUM6LR ,TA fEHiCm*AY W.IAfCU LC�.AIi�.,i YES NO ,r f _ 6.1. ��/.✓/�� 0 �hr/�L r iGk�.j 5. L� '�s�Gl.�CL.�-_1-.�l'!��-}l`✓�J � �'�.�•.Isl� .�'__�SC.l..l�-- �. %- 7. �,/,fir/�; -7 `-' G� �%.�l UL 8. /t-(. fid-,r,C�..uC �i,/fo LJ /CZ..cyyC�-�C .4�� i.r74�c�•.✓6 9. ode 10. 11* 12, 14. �ho�cv✓6i-/ 7 NOS / 6W- 15. 16. 17. _ Z- 18. 20. c� O� /�h �� /Y�40.�Sst-fcv✓ �,.iG /�i �ii.4�►/G.f�.y� 21. ?2 23. L� �/ 11fYJ '�/�,1 !_�1.�'L/.f/cat c�/�•t/ /s./ 4. G'!JG 72,62:7 125. /✓/ G'�Kll I?6. ' r X28. Ky7�/ �"'-' CCS'/.4a•� �b '� rac G+�ccr r �1 7a►�suM �29. fUcccaw-vim � .�G G.+Y�,,oc,a;� ;�� J.kic• 30. f 31. i 32. FRET? r..ME i0 NUMBER MC•NFHr CJAYrr EAR REWEIV F.WS NAME M"NTM/OAY,YEAR CHF 556 (Rwv. 7-87) 1 042 dd 4U641 '•tll Alt:r"^l;l'.. NARRAI)VE/SUPPLEMENTALO • PAGE � _ IXEIGtH10 NUMfIER FFpATk ur iNCIUt 11 NCA;NUMHE.N I UHENI E TIMt1:�UQ1 'M'i:hE 'A'JnE TYPk SUPI'LEMGhTAL('A'APPUCABLEt NARRATIVE n(T COLUWN HEPOKT Q BA UPDATE ❑ fATAL WT A RUN UPDATE k UVPf.I ME NTw ❑ OTHER: ❑ HAZARDOUS MAT GRIAl9 ❑ SCHOOLBUS OTHER: Ci(r, Hll"TINGU15THICT/UEAf CITATION NQMBEH LOGAI.,,iN I SUKII."f STATE HIGHWAY REUfED YES NO 1. 5. 3. 7. 8. 12. / G._7. 13. 14. 15. 16, 17. se 19. 20. .-. 21. 22. l� 23. 4. 25. 26. 27. 28. 29. 32. /'1.r >iC✓ il�S /d.�/'i i PREPARf:RSr~ME j �.D NUenHC.H N H/DAY/YEAR REVIEWEH'5hAMk MJNTHIOAY/YEAR HP SSG (i i•67)—0—P float ��w•^^ �°°^•�^�I��«w 88 48641 NARRATIVE/_SUPPLEMENTAL wrE ur iNinln rr i,Cn;w``r,c�r��Ue IImb(24w) NCG huMcH OFFNaR IL 0. 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O►bC HIBL INJUNILS / VICTIM OF VIOLENT CHIME NOTIFIED AODRL-% IELk PHNIV ��.�.�Cr.����.��'�.���1t'�_�'J1�--r��i'�.S�,f�-�.�"_ - j*ab"YMUNLY)TRANSYOMIEU bY: TA,1N TO: VICTIM OF VIOLENT CRIMF NOTIFIED C7" ❑ ❑ ❑ ❑ 10 1 ❑ ❑ I / .o 0 N Y I AD NLbb (In+ UNIT)TRAnSPOHILD bY: TAKLN TO: Uk' WB IN+uNIEti / ❑ VICTIM OF VIOLENT CHIME NOTIFIED ❑" ❑ J ❑ I ❑ L ❑ ❑ I ❑ ❑ lo I ❑ I ❑ NAM►I O.O.S.J ADUHEbS TELEYMONE (IN+UNEO ONLY)I HANSPORTLO b Y: TAKLN TO: Ot SCHIBk INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME,0.0 8 +ADOHESS TELLYMONE (INJURED ONLY)THIWSPUHIED Of: I"LN TO: DE9CRIYE INJURIES VICTIM OF VIOLENT CHIME NOTIFIED ❑a ❑ ❑ L� ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME 10.0.11, ^DDREBS IELEPHONL ONJuNkU ONLY)TRAn9YUHTLO ST: TAntN TO: DESC)b YL INJUhIEb ❑ VICTIM OF VIOLENT CRIME NOTIFIED PREY ER'b N I.p.NI.Y+H MO. DAY YEAR Rk VIk WLHtl NAML M0. DAY YkA CNP 555-Page 3(Rev. 7.87) OPI 042 tl/ IJU.1J NAR_RAT_ N_E/S_UPPLEMENTAL PACE DANE iw h IIII.M/ --- :E 71ME Ilw/i NCIC NUNy. Oli CLRID NUM 'R 'c UNE 'X'vnE TYPE SUPPLEMEN IAL(W APPLICAMLE) ❑ NARHALYE 4 I COLLISION REPORT TSA UPDATE O FATAL /❑ HIT i RUN UPDATE S�I'PLEMENTAL L❑]�J OTHER. ❑ HAZARDOUS MATERIALS ❑ SCHOOLBUS /y+'t OTHER. Ldt,I 1,cul AI IH-LU14 I WC1/UL A f Uf AI K,N NUMULR j_t :�- to I L LAIICIh,:.U[4t:.i S1A1 E HIGHWAY HE LAI ED YES NO V k Zh, -E. -1- .( 4. 7. 8. UZ = —) D 10. r5egKoJ ,I 12. u 13. 14. C� p I > �/ _ U J I D \,j I !a E 1a13 17. ( - 18. 19. 20. 21. 2) ?3. 4. 25. 26. 27 28. 29. 30. 31. -Wilt PAHER S NAME - IO NUMdLR N.DNTH,DAYIYEAR REVIEW tR'S hA E MGNTH/DAY/YEAH ' % CHP 556 (Rev. 7.87) OPI 042 u»p.w..awuonu a.P.we 88 4ud41 '�fA��FtA��VEISUPPLEMENTAL PA,lE bAlK 60 CGll1 -... J T"law) IIGIG NUMOEN ORIGEN LD. humbEA ,f ' ONE 0 •9t'ONE ty"SUPPl2w2NTAL rx-APP{.,^&A t a NARHATWE �,OIyNpN gEypgT ❑ SA UPDATE El El HTERUN UPDATE IYI SUPPLEMENTAL Q OT1MIt ❑ NAZARDOUSMATENIALS ❑ SCNOOLSUS ❑ OTHER: ifE14)V nG U�91HiCl/BEAT GIAINN NUMBER ,.Arr ''LIN 1Y/JUUA:AV.p9T WGT wi w::n/ N.rLG' SLATE NiGNwAY RELw1ED 2. 721 ... ..ard 6. 7. 8. ,10. 11. 12. 114. t' 1 �ri�• �4,S�C /1���'iAt/tl is ��.ic.9✓� i.,r�� 17. ]D,4, vC 18. 19. 21. -4y 22. 23. 125. ��,8 /�i - /�. . /✓ 126. rsii' ST�.> �l��../ _ f}I_ /144 28. S U 29. 6 ZZV,,4!2, La 31. D� �, Lf Ste` -�' 32. Zz;Lf ;P;PPA -5 NAM .U.Nu MUiN W TN/ A / 'AN ALVIE ISNAM �' MONTNIUAY;YEAH�(Rev. 7-87)ON 042tle /Z3. Af��c C/�fc5/NCI�?M7jG �abay �,Ni6�, �� )pCorco2t% J RRATIVE/SUPPLEMENTAL •PAGE' '3% DA If�I 'J w.nTIME 124fm NGC Nuw, OFFCAALD NUMK' 'X OhL 'XryONEE TYPE NUPPILLI[IITKr)r AYPICAKQ NARRATIVE MUJOWN REPORT O &A UPDATE ❑ FATAL ❑ WT A RUN UPDATE SUPPLEMENTAL //E OTHER ❑ IMIARDOtfB MATEWAI.N El SCMOOLBUS O OTHER: L �h1YIJUO.CALUINI 'T REPO 0[LI HiGT I NEAT GTATKIN NUMbtR LiK:Al tir UL1JI.�-f' /' 'ul Att hlIGHWAy W:IA IED 3. 4. L �i�rk c J 7. - B. + I 9. 10. 12, 13. 14. 15. 16. t=om 4Ga✓in/ 17. 18. 19. 21. ,2 23. v 24 i ?5. ?6. ?7. 10. 32. 111CPARLilS NAME L HUMNE MON TH/OAYr'/ Aq f'"Ill ER'SkAut MON HIDAYIYEAR �- :H 558 (Rev. 7-87042 U..p�/u..awNr unN o.y.w N7 nSalz • twrr. lAi�FtQT_N!E/SUPPt_EMFNTA!_ PA13F DA TE Of NCC NUMUER OFFCERLD NUWE '1P Oht '1C��O-k, TYPE buvmLmaNTAL r%'APPIJCA" �Q NARRATIVE 'yl �"REPORT ❑ OA UPDATE ❑ FATAL ❑ WT A RUN UPDATE I 1 yI SUPPLEMENTAL `❑ OTHER MZAPdXXA YATER.ALS ❑ SCHOOL W8 Q OTHER: {( :r //j/'�)uUK:wL WtlT W(:7 //y�,� HEftiHf NG DpTNICT/NEAT GTATK)m NUMUER S T A T E nIGHWAY RE LA I ED �V l y l 4 �`� J. ` F C VES NO 1. 2. 3. /� r 4. G'/h i✓L-'I l�" li���.t c.%L �J� �'lcs- �a C" c G7Y� 1 c�✓1, 5. 7. f/ i 1I r G r L y hvo 10. 11. 12. 13, 14. 15. 16. ,17. 18. .i9. 20. ?1. 22 23. �25 r26. 2.7. 28. 29. I30. 131, 32 PREPARiNS NAME ID NUMUE 11 -',NTH/DAY 016.NAM MUNTnIOAY/YEAR CHP1..__. [� r' FVP- SSfi (Rtiv. 7•�))OPI/ 4Z U..Pr�r.wA.avxr urNiG�rNN 87 45312 STATEMENT PITTSBURG POLICE DEPARTMENT <�-`�G" � Statement of �Z7'To6�%'� t� given and made this 1 Date at the hour Place /i)�Gs2c����C?�'r s_ez ,�: " o� �✓ v I certify that I have read the foregoing statement made by me whic}i was made freely, voluntarily and of my own accord, and I further declare that wheel M"- -iny said stita,nant I was not under threat, menace or duress of any kind made by any person whatsoever. Witness to Signature Name Name ry Address _ � �,�l�� -� ,�, 1, Address 3q z�}S!,(Jtj CP 09/44 STATEMENT ' " PITTSBURG POLICE DEPARTMENT given and made this Statement of Date at the hour 1�Z'C� Place Yak z_ ,,� '1.F I - / i'' /� :;hl c! /,C� r.� %'cam •�GG t G110-51' -' 70 2-2 I certify that I have read the foregoing statement made by me which was made freely, voluntarily and of my own accord, and I further declare that when making said state,nent I was not under threat, menace or duress of any kind made by ariy person whatsoever. Witness to Signature l Name I Name HCl Address < 1 C?_ /j Address CP 09/44 STATEMENT PITTSBURG POLICE DEPARTMENT statement of .� C L given and made this 1 Date �..�'. ........-- at the hour Place Ar I certify that I have read the foregoing statement made by me which was made freely, voluntarily and of my own accord, and I further declaxQ that when making said state.nent I was not under threat, menace or duress of any kind made by any person whatsoever. Witness to Signature �J � ,,�} 7 p Name ) ' t� cs - Name k� � Address l 1�� � � fJ Address CP 09/44 'TAT T' rr'....l t t,-:N IA NA.R_R_A_TIVE_/SUPPLEMENTAL ' TIATI'.jl I:ICIULNT/tL:I:UTItNCt� TIMtI:MNI NZAI -"MHC.T1 Ghhll.tNlD NUMUER �- 'A Uhf. 'A'GNE TYPE SUPPLEMENTAL]A'APPLICABLE) ❑— NAHNATIVE Iv( COWSION REPORT ❑ SA UPDATE ❑ FATAL ❑ RIT&RUN UPDATE 1\�{ :i IIVPI.EME NT AL L❑1 OTHER'. ❑ NAZAHOOOS MA T LRALS ❑ SCHOOLSUS ❑ OTHER �•�J,/f) li.aL�IIAI.II, NL.HJiI f.f�I:.IVI1 i:1 ILA.AT Gi(Afn- l. ihhMinH .I r. �l � '.. I f � r—^— :S f ATCHIi.HV1AYV,l.IATCU 4. Y/ Cc Cdi-✓G 6. 7. �.',/�� C."-_/ - !� F� qtr ��.�,f�///� ',C.; i.•�A'/ _S t [i -?' � yam, ` 8. lye 10. .✓ 1?. i( >:.c./.1• �f s�,�r c. 5�;�, .-.i�/G " `,-�'c%c ��/ ''/ 2 !J G�XTrc• 14. �/ �'�li� > %L> L�fJc Std <c,c_� tl _fl/1c'!L. �ff 4 c'C� Giti' /l> 16. 17. !/�-' //��� i/ �.%-r�>/ i�_ �l i.r./✓/ice'/�� U/`� / .CIJ 7r >C' 7 t_ // 113. •i%�/l �1��Lf l/Jf'i�/ct{ !,� /f /C"F''!')c^i(T i �'';`�c' � /n��[f•.% � J C'L/ :l�/t 20 21. ,.A+ Tc. Y� % 'Q! L •</ �,.i41/ C/J !Y"l c' �� /�� �,:YL' 22 %24 e,/� 1/7'/ti C-c�` 'c✓j ��i� �jiJ»ct � '/_1 L�/JT �r�L��Jt'! 25. 26 27. Grt'G'/.�i.v /1 /9 29. _" /JCS': %� it ilnf� lci�c '(r f/ L:/.1. /i/-L /.,/G, c i./ y1!✓ 29. Xf 30. 31. 32. PREP NAM D NUMEfeR AMjNIru DAY/YEAR r7f VIt1v EH'S NAME MGNTH/OAY/YEAR CHP 556 (Rev. 7-67f ONI 042 �"'"....°°""•�""""'•"° wI m•u ."ITAIL �NN'ARRAf(VE/_S_UPPLEMENT_A_L• PM:F i--- I0A �'r i EA TIOC uRGNCt TIME 1/ D 2 Nw NUMIC, I � oFf ICEH, --7 Nuc `� 'X'C,hL TYML SUPEU PLEMNrALrX-APPE:ABLE) J ❑ NARRATIVE r J(I COWBION HEPORr ❑ SA UPDATE ❑ FATAL ❑j NIT A RUN UPDATE 5i1PPIEMENTAL Ka OTHER: ❑ HAZARDOUS MAT FRIALS ❑ SCHOOLBUS IYI OTHER. 'I Y.�.:...r.ITr JUOICAL DIST III,:T 'ILtlhG U�1I/IIC1lNCAI Cl I ArION N UMNL FI Qr i TTSf�-U d--(,, A01-JI-ILA coo- T 0 C-L-7-A12_0. �� i rAT L HIGHWAY HLI A T ED 1. No I 3. 4. c)r.) r ril S R(c-.Qu a-rT 5. 1-vC;. -r� _ r�T1 �.— r-c - LJ�F_.i i t_' iL C' L 7. B. s. �r C_ . LJ>G�' .�v S►.l i I C, T l �1 C.? AN A Cc_ -K� r &L. 12. L'� - Zt�.�Or�_Ttc. 0 13. C i CST h1`Til �Ic C.�V�T 14. 16. 13. L iAvC. . isUiL - +�11([ C i� -'t-lig (C. - ice 1. 23. IJ0 L) i" N �Tc-)L_E 24. US cI F- CL 25. S Ek— `� c_ L �.t'7 C C.c - 1N -r, -cal ---- L c +` 127. 28. 29. GCC... LUQ ;�� ...rJ � C�,�UES�" AT T�� Lk-0(Cl. F- 30. 31. CbQy t AC_:t' ' �.?PARI:HSh NUMHEH MONTH,OArIYEAR NLVIEWER'SNAME MJNTHIDAY/YEAR cl G=HP 55ti (Rev.7-87) OPI 042 U-I.- J—.,w 68 4M-1I I Alt ••.a.:i.r:..A NARRA•f1UE/SUPPLEMENTAL PAGE - fAll:i)linrnrtNTlfi' •lr'Nr',C IIMEIi NGID NUMtItN OFFK:ERI O. NUMBER or ONE A.ONk TYNE SUPPLEMtNTAL V)r APKJGABLE) ❑ NAHNATIVE GOLLISIONREFORT ❑ BA UPDATE ❑ FATAL ❑ HR E RUN UPDATE SUPPLEMENTAL OTHER. HAZARDOUS MATERIALS SGHOOLBUS OTHER; l,1CJU0K:AL0rST{IA;T NLPUH1rNG 01STRIG(ItlEAf GITATIUN N�M(1[H ellns l(X AhI;.f, �l,tl.i(:.r' �//./'�/ ''ATL HIGHWAY}' ,D /! �V� /6-.�•Q /�/ YEA NO 1. r 4. 6. 8. 12.9. 11. ' 13. r 14. Le 15. /�� ,�� 1 � 1lllCl— 1 ?J 17. —2-1,dr— ,c ,ef7► A� .4 ,11 Gioe 19. ' 20. ¢, �s 21 22. 24 25. r 26. 27. 28. r29. :30. ? Lt ��%��Q fTF� /�� �ift! r �"1 .ri GYs! 31. 7, ", 32 pit E i' Ir'.,NAM. Mr 1NTHr AY:YI AH R I .R'S IE Mi. IHIDA I ` l. V 7•dn�} Q`. - - uM Pi�w.w wren Ha�PI«wl 88 4W41 JAARRAVE/SUPPLEMENTA BATE OfO:iDENT I OCCtjHLNCE—� 11NE 12 7/ NGL NUI+ Off t.E/� NWADEN 2-7 - L� i 'K ONE .1 ONE TYPE SUPPa"NTAL or APR.ICABL.E1 11 NAHRATIVB lJ{l COLUMN REPORT ❑ BAUPOATE ❑ fA TAL ❑ MT+RUNUPDATE 11Q iOPPUMENTAL (❑� OT HIM' ❑ WARDOUBYATEWM.B ❑ SCHOGLBUS ❑ OTHER r:itr, ,nI Y,JUDiCALD,ST ,CT REPO RI iNG DISTRICT/BEAT GTATONN�MUI:R LU.Arwm ';i, 7 51ATF.MIGNWAY HEurEO / 'SC f ZO/,(L5. 3. 4. ^" 5. .4t.�C C'l��Foci Ti f,1t'l/L. .2G 4 ,. 7. 8. 9. 10. 1 1. .+�'G �"�/ � /moo •. _._...._..._. ..._._.... 12 mmer 13. 14. 15. 16. 17, 19. Z. 20. 21. 22 3. 24. 25. 26. 27. 28. 29. Dztown 30. 31. 32. lPI�1 AM i. BER 4.jw 'DAY,YI.AR HEV.LIVERbNA/AF. AIGNTn,DAY/YEAR P 55 (Rev. -67)Ou»�: �� :, Ba ABU•11 iUC� r' •.w It OANI W4A R-.�ATI�/E/SUPPLEMENTA BAT E OFINCIOENTIOCCURE.NCE 1lMEl� NGF NUMBER OFFIC'AID NUMBER /� SA y X Ore 'Ir ONE ' T WE SUPPE.EMGH7AL f IC APPLZA" .w❑rY NANRATIVQ COLUSmON REPORT ❑ BAUPOATE ❑ FATAL ❑ WTARUNUPCATE 1� auPPLEMEMK IY'❑�� O7HlR ❑ WLZARDOUBMATMALS ❑ SCHOOLDUS ❑ OTHER f;ITYIr.IYJJUDJCALll IGT AEPUHI ING DISTRICT I BEAT CITAWNhu MUER tlA£! rl�CA r � C�Q[?.s� ^j _7t �l/.cI/ Q r ` p STATE HIGHWAY HELAfED .9fe"7 I l�/ C� ILs No Zco log&. 3. /f 4. /ti 7. 8. 10. �/ fCLa GO 11. �✓G f�� rCO _._....___._. ___.... 12. 13. 14. 15. 16. 17. Le 1010)1141"e 19. 20. 1. O fa a? iS S7 w iw v C- .4. .3. 24, iGf .Z /J S7iG� �•v /CcJ iS 25. .Q�tr4 .�3✓o sr u., �a'�•i.�tda whoi,r 26. 27 28. 29. 30. 31. 32. 'o NUMB RMier. '�DAY/Yf.AA NEVILWER'S NAME MONTHIDAY/YEAR P 556 OV. 87 OP1 042 tlB 48W ,, I I TALE f a�i .i.•,.� IkRQATWE/SUPPLEMENTA P4E / DATE OF INCIUENI/Or CUNENCE TIME P&AW OFFICERI.D. lqwNUMBER / 'or ONE X. ohht T V FE 9UPPLEUEN FAL CA'APPUGA" a NANHA LIVE IXI COLLISION REPORT BAUPUATE ❑ FATAL ❑ RIT 6RUN UPDATE ISI SUPPLEMENIAL (IIF{F❑��� OTHER: a WARDOUS MAT ERIALS SCROOLBUS ❑ OTHEH: Cin r.I Yidbiln:.AL UqT ICT RI:PORTING DISTRICT,BEAT CITAYViNN',MBF.q HWA— r-HE�tATE0 L13c:Afr. .Ir we NO 1. 2. 3. 4. 5. 8. 9. ld Ip F 12. ttda ''' r .< � 1 - 2 13. eLde 14. Lu 15. 16. 17. �v 20. 21. 22. 23. 24, 25. 26. 27. 28. 29. 30. 31. 32. PREWAerv�,NAM I.D NUMBER NTH/O r AFl i1EV hA --,j��c�'-��\ , C uNTH r CHP `b (Re 7.07) ._ 0 u...•�w.aw a na o.pa.+ tW 4W41 q ST A It -NARR)4 TIVE/SUPPLEMENT- TIVA MCK;NUk"R Ofi cem TD, 'Row TYPE WJPKWtH tAL r)r APPILCA" MNARRATIVE COLLISION REPORT ❑ SA UPDATE FATAL D HT&RUNUPDATE KSUPPLEMENTAL ❑ OTHER: ❑ HQAKVOUb MATERIALS ❑ BCHOOLBUS OTHER: CII 1,1 1,JU01GAt 0110 MK-1 KP" DlSTVlc.TIjJlAl C411410t,tlkICH 1"A b,J, STAtk HifjoHWAYkLll yLi 1. 3. -4. a. 10. 7�? 14. Z J� 16 i17. 18. 4 4 23. 24. 25, ,26. 27. 128. 29. 3& 31. 32. _787FO-0- 042 Ud 4MA I PITTSBURG POLICE DEPARTMENT Lane"'o• PITTSBURG, CALIFORNIA Yj� ORIGINAL � TCys Palo5UPPLEME'rNT �"����i� TE®Aj�'jj� . Juode Sect/ cident Victim( t N First) Re 0 Prop.hooked to 0 .Boo Prop. lj�y Q V 0 S ❑Finder 1 Property S • Malan F - Fbwri Dupo+. LR - Evid. Room PL • Prepared for Lab 1,_qrmJ E - Evidrnre A - Sa1e K eruf R • Refrigeration LO - Ret. to or left with owner Comments item Prep. Daap- No. Leg. Deuription Value JJA CJ-0�c n rU m... 42z 'g ealig 1 icer Aa.wting Offioula y ate uoe Coauacnta Reriewed by Dam and Two Avognad Patrol Traffic copies, ❑Patrol QAdo.Ser. ❑ U-AL p Omar cam 0 C3 lar. 13 Jur. to: Cl Inr. Q Chtct ❑ cu Clowd CP-09/13 (4) . N_�%�_FtRIATIVE/SUPPLEMENT AL* POW 1 iii f L t�F(.- JN��� TT«!(�1q NCC NUMdEN D OfFCER l0. 'X'ONE 'X1'—Oki! T W C OUYKLWcNTAI P7f'APFLJCA" {❑ NAHNATIVE hC 1 COlW10N 1�►OIIT ❑ DAUPOAT! 11 MTAL 13 ##TA WNUPOATE bUHY(LMt NTAL 191 DA OTNNC ❑ NAZAFK OMATUVALA C:l Yf:NOOIIWN ❑ OTN[R: Ci( .�ioNl rl,n,uA: T REPIIHLha p*fHlCTitWAT UTA11pNNUMNER At ' STATE HIUHWAY RELATw LLGwI a. SUn„n. c 1. 4. 5 �•��'r:I7 Lei _:C���+SL�" r d� Gv! � 7. ��.�s CrY✓/` .ate </J'.• %" �a..x� 8. �r .wv AC 10. ie- / i 12. - zfac AAJ r� 14. :21 d •� ii 15. 16. 07. 18. 19. w.G inAi 20. 21. 22 23. '4. 25. 26. 27. 28. 29. 30. 31. 32. pqf AR ISNA i nr kw WNTMr UwYr YEAR H 1 R'S NA ME MONThiCkAVIYEAA CHP 556(Ray.-7-87)OR 042 B/46312 TAiF�'1 •i.il ii�fA _!A__flRATIV_E/SUPPLEME_NT_AL PAGE t.Alr ii ;pfi� +riME(door MGIC NU►WCA OEFK.lR I.D. fumaER '1C GNC 'lf'ON[ TYPE[UPPLEMtNTALfrC APPMAMD ❑ NARRATIVE c4c"WGN REPORT ❑ aA UPDATE FATAL ❑ WrAft NUFOATE SUPPLEMENTAL ❑ OTNaft Q KVAROOMMATEW&A ❑ OCROOLW{ ❑ OTHER: UO cny REPO NG TRICT/DEAT GTATION NUMnER�.rvu.Ir,.::ALulanl+cT ,.. / LUCAI A.N/0 P,.IF ' STATE MIGHWAYRF.LATED YES NO 1. 14. : 5 7. _ /��'G ^ �' CAP 10. 12. Ak&eAk2 13, 114. !� O LS N f T� j_ -- 16. r 19. 20. 1 ,iv 21. i 23. l� �1 'i L �'/.✓uld 24. � j��j��� / _ r 2fi. L%' ,Gf� '!�'L,1,l�i'A[/Ei LW �Y 27 // 128. 2.9. / _ r'aJ ,l !e-l- illiIve 30. C� Z��o [� Z �"r+psi.✓ —.sb �G.�if,� /l/,yr- „ice Z ,EC -' 31. 32. tPAH-- I0 NUMA(:A No.Ih Tn/GAY/Y'A IItVI ER NAM n/ Y AR �� CHP 556(Nov. 7-87)OP1 04 G�,[.�[ �IVjt� �� lj�y F� �'f1 . al 45312 f % ��2 i STATEMENT PITTSBURG POLICE DEPARTMENT Statement of given and made this Date 6! � at the hour Place e4L 1, 2 2� I-Xca' e L e 7 L Z Yep z �zz I certify that I have read the foregoing statement made by me which was made freely, voluntarily and of my own accord, and I further declare that when making said 5"Leurient I was not under threat, menace or duress of any kind made by any Person whatsoever. Witness to Signature S2 Name Name J V Address ayclr ojJ1J, Address CP 09/44 AMENDED CLAIM r \ 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 16, 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: $500.,000.00 Section 913 and 915.4. Please note PPtdwrkicb@uns'i CLAIMANT: KONG, Hok and Sau DEC 1dv Maftinez. CA 04553 ATTORNEY: Jonathan E. Gertler Law Offices of R.Jay Engel Date received ADDRESS: 22 Second Street, 6th Floor BY DELIVERY TO CLERK ON December 15, 1989 (i ntPr- San Francisco, CA 94105 office) BY MAIL POSTMARKED: December 14, 1989 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, pH gg DATED: December 18, 1989 EVIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Sup rvisors �N) 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: _ )9- I U.9 BY: I A A Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Superviscrs present (This Claim is rejected in full . ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 16 1990 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sects Mn913) 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: J AN 16 1990 BY: PHIL BATCHELOR by Deputy Clerk /111 Y CC: County Counsel County Administrator 0 VICTOR J. WESTMAN �Cl (� CONTRA COSTA COUNTY COUNSEL TO .\Jynw_, , (��,\y') P.O. BOX 69. CO. ADMIN. BLDG., MARTINEZ, CA 94553 DATE '\SUBJECT D t fs 1989 PHIL e,:-cwr_oh C!_1,1-'\90A:i0 GF SVHVISCRS LAW OFFICES Courlty Counsel R. JAY ENGEL DLL - � 19$� A PROFESSIONAL CORPORATION R.JAY ENaEL 22 SECOND STREET, 6TH FLOOR r"e2' CA n4553 JONATHAN E.G$RTLER SAN FRANCISCO CALIFORNIA 94105 (415) 777-0644 December 13 , 1989 .....���I V Victor J. Westman DEC 1 51989 County Counsel 's office of Contra Costa �H+; BATCHELOR Co. Administration Building CLERKCO,%MOFSUPEWSORJD TA CO. P. 0. BOX 69 c TA c T`. Martinez, CA 94553 Re: Claim of Hok and Sau Kong Dear Counsel: I am in receipt of your notice of insufficiency and/or non-acceptance of claim in the above matter. Your notice indicates that: 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 of the public employee causing the injury, damages, or loss, if known. Please be advised that, as I am sure you are well aware, the accident took place on Rumrill Boulevard (C.S) , at the intersection with 17th Street. Please be advised that the public employee causing the injury, death, was David Lysle Brown. To be sure that the claim is sufficient I have enclosed, as a courtesy, a copy of the Highway Patrol Police Report, which I am sure is already in your possession. I have also enclosed an amended claim. Very truly yours, ON THAN E. ERTLER JEG:mm:Encls. 1C 144 -- AMENDED -- CLAIM AGAINST COUNTY OF CONTRA COSTA, CALIFORNIA (Pursuant to Government Code § 910) CLAIMANTS: HOK KONG and SAU KONG, individually, and FERNAND KONG, as administrator of the estate of KAREN KONG. ADDRESS: c/o LAW OFFICES OF R. JAY ENGEL 22 Second Street, 6th Floor San Francisco, CA . 94105 (415) 777-0644 DATE OF ACCIDENT: October 15, 1989 TIME OF ACCIDENT: Approximately 8: 30 p.m. PLACE OF ACCIDENT: Rumrill Boulevard (C.S) , at the intersection of 17th Street, San Pablo CIRCUMSTANCES OF ACCIDENT GIVING RISE TO THE CLAIM: Auto accident in which public employee, David Lysle Brown, caused the death of Karen Kong. AMOUNT OF CLAIM: $500, 000 ITEMIZATION OF CLAIM: Funeral Expenses: $ 5, 000 Medical: 1, 000 Loss of care, comfort, support, society and companionship of the decedent: 494 , 000 $500,000 DATED: December 13, 1989. LAW OFFICES OF R. JAY ENGEL, INC. By ONATHAN E. GERTLER ttorneys or Claimants • Ir �` •-'`TAn OF CAL'iF+ORNA TRAFFIC COLLISI N REPORIm PADS I Of Z� SPECIAL CONOITIOW �. t C: NUMOIN NJURED IT&RUN Y CRY JUOKAAL DttTRiCT l NUIBEII FAT.4 L.. / 11 SA A Z X4n J Q.j- v^VT,/ Y�/� NUMBER I[TARIN COWTT R[PORTMq DISTRICT BEAT �} EM c R GETJC�/ YLl�IC IDLLm NIP. oORTES`/ FrPbr-r 11 Copq I lq COLLISION OCCURRED ON ` 110. AI DAT VBTun(]IDS) NCIC B OFFICER L D. _ _R- c� 51 ------ WLE POSTN GRMATIOMI DAYOP WEEK TOW AWAY HOTOORAPHS BY: F u FEET,rL M T W T F S STU []NoS�L E M I SC 0j ®AT INIEREECTION RTTH RAYS HWY RSR_ FACc E 4r—� 17�,rN SarKrET C , S TbrAt ❑on: RETABLE! OF ❑YR g. I 1' S HORS [:]NON[ PARTY DRIVER'S LICENSE NUMBER RATS CLW SAFETY v[K VILLA YAKS IMOOBLI COLOR EASE NUMBER RATE 1 C an In S Q 3 » �1 I YOrA 609.0LIA Rio l&ICZ198 Cia DRIVER NAYS(RRR,WOMB,LAST) ® KA REr1 )"u f-,-1 YET /'onT PEDES- STREET ADDRESS OWNERS NAME YE❑SAAS DRIVER TIVAN ❑ 6 5'7 Los PIHo' x,.oN PARKED Cm/RAYS/ZIP OWMSKS ADDRESS ❑SAYE AS DRIVER VEHICLE ❑ r9E tAC?-/i CA Co Ail 13- F. 9 e1// SICY. SIX HAIR �Yls HEIGHT WEIGHT IBMOATS RAGE DISPOSITIONP..POSIT>ON of VEHICLE ON ORDERS OOFFICER ❑DRIVER ❑OTHER CUR YO. DAT . f. ❑ f :8L �>� S 6 1//9 1/:z E ! s66 CIVIC r',f�T SNC t X37- 6319 OTHER HOME PHONE BUSINESS PHONE LOPE YECNANCAI DEFECTS: NONE APPARENT RERR TO NJMTVE El❑ CNP USE ONLY DESCRIBE VEHICLE DAMAGE 11MADE N DAMAGED AREA VEHICLE TYPE MaURANCE CARRIER POLICY NUMBER ' ❑USC ❑NONE ❑YNOR (0/ : ❑Moo. ❑MAJOR ®TOTAL OMtoP 011RRERORMEOHWAT SPEED PCF cc C3 V4 ?UMRlLL 131-/0 3� 2)�1 oro 6�96 PARTY DMVBRR LICENSE NUMBER STATE CLASS SAFETY VtK YEA MARE 10600"OD /COLON g1A/B LICENSE [R RATE 2 OR A 3 B g6 FafrJ LTQ JA-r E'LIg97SS' CA DMIR E(RBST.WOOLS.LAST) ON bo r7 EMGto RL►, V E ® IbA Ccodl{ �l,cTe��q L LF laR4 �T)IT2",;L60S Ptom ADDRESS OWNERS NAY[ ❑SAYE AS OMER a- -;L;Z Sa C7►A T- CONTRA CnznqnFF-CE PARKED CITY/RAn/ZIP OWNER?ADORLSS ❑SAM All OW 904 VEHICLE ❑ SAW fI r.)-Q CA I-# Q0 SN L /44A9Tft-lE7- CA SICY• SQHAIR EYESHEIGH► WCGHT rRTHDAn RACE DISPOIll'.OF VEHICLE ON ORDERS OF: �OFRCER ❑D1WU1 ®oT11iJ1 CLIST Y0.. ; DAY I TEIJ1 u ❑ Rr�I R?L S-4 7� l i 22 ';�3 a�E �to(J yS' Qacl+Eco3Lvp �J�A��MrIEz OTHER HOPE PHONE Q atom"PHONE ® PRIOR YECIUNCAL DEFECTS: NONE APPARENT® RERR TO NARRATIVE❑ ❑ ( 707 ) `'L4 I - 4-7 2 t S) G- 8 8 S p0 USE ONLY DESC1rt[VENICIE DYIAOE SHADE N DAMAGED AREA INSURANCE CARRIER POLICY NUMBER VOILE TYPE ❑wl 13►1o►t ❑rNOR L F T N S V R fQ ' ❑MOD. S KAIOR ❑TOTAL DNR.OF JON FIRER OR HIGHWAY SPEED PCF MCC❑ / Ta, �I* rue Q b ?Ur ISL r3L•�r cw[3 PARTY DRIVERS LICE?-SE NUMSER RAn CLASS SAFETY VEK YEAR YAKI I YODEL/COLOR LICENSE NUMBER RATE 3 EQUIP. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DRIVER NAME I FIRST.WOOL[.LWT) /tom TREK ADORESS OWNERI NAME El AS DRIVER RB TAN ❑ PARKED CITY/STATE/R7► OWNERS ADORE= ❑SAME AS DRIVER VEHICLE cl MCY. LEI HAIR EVER HEIGHT WEIGHT - -MNTHDAn -" -" --RAC[ DISPOSITION VEHICLE ON ORDERS Of: ❑OFFICER ❑DRIVER ❑OTHER CUR YO. DAY , Yw 0 OTHER HOME PHONE BUSINESS PHONE PRIOR YECNAHICAL DEFECTS: NONE APPARENT❑ RERR TO NMRATIVE❑ ❑ t } ( ) CW USE ONLY DESCRIBE VEHICLE DAYAOB SHADE N DAMAGED AREA INSURANCE CARRER POLICY NUMBER VEHICLE TYPE � ❑URL ❑IN0,/[ ❑WNOR i ❑AIM ❑YAJ011 ❑TOTAL ION STREET ISOHWAY SPEED JPCF ICC❑ , L uYR PUC❑ CHP O IPREPAAER"i NAME DISPATCH NOTIFIED I:ZSNAME DATE REVIEWED TATA In-1q 3 OYU E3No E3 N/A CHP SSS PAGE I (Rov 140) OPI 042 v 101, �. / �.. 88 48667 fTATF OF CAUFO RHA ' 'TRAFFIC COLLISI NCO IN ►A6E OAT[7f COIU/ION /. 2� MO. I DAY I YiAR O1A1'r/QNY[/ADQ ) lye �TA��O nA IgTFlED PROPER9YEf ElNo DAMAGE DE/OTlON Of D '1�i t' r�9AL 'Z'o Poo-_CpICp�Eri FCNC'E 15, SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE MCUPANTS L-AIR SAO DEPLOYED M I C BICYC F.HEI YET a ECTED A.NONE IN VEHICLE M.NR SAO NOT DEPLOYED DRIVER t•FULLYEJECTED B-UNKNOWN N-OTHER V• 2.PARTIALLY EJECTED G-LAP BELT USED P-NOT REOUIRED W_YES 3-UNKNOWN No 1.DRIVER 0-LAP BELT NOT USED 1 2 3 2 TO e-PASSENGERS 9.SHOULDER HARNESS USED PASSENGER 4 $ 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHILD RESTRAINT x-NO 8•REAR OCC.TRK OR VAN O-LAP/SHOULDER HARNESS USED O.IN VEHICLE USED Y-YES 9-POSITION UNKNOWN H-LAP!SHW LDER HARNESS NOT USED R.IN VEHICLE NOT USED 7 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 TRAFFIC CONTROL DEVICES TYPE OF VEHICLE 2 3 MOVEMENT PRECEDING UST NUMBER (/) OF PARTY AT FAULT 23 COLLISION + A VC SECTION VIOLATED: ciao ACONTROLS FUNCTIoNNG APASSENGER CAR/STATION WAGON ASTOPPED 1 $ ( �. tq B CONTROLS NOT FUNCTIONING• BPASSENGER CAR W/TRAILER B PROCEEDING STRAIGHT + BOTHER IMPROPER DRIVING•: CONTROLS OBSCURED C MOT YCLE! DOTER RAN OFF ROAD D No CONTROLS PRESENT/FACTOR• D PI UP ORP L TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER• TYPE OF COLLISION E PiclAip/P EL TRUCK W I TRAILER E MAKING LEFT TURN IDUNKNOWN AHEAD.ON F ACK fA TRUCK TRACTOR FMAKING U TURN / E FELL SLE B SIDESWIPE TRUCK TRUCK T CTOR W/TRLFL G BACKING REAR END H scHooy BUS Z HSL0wlNG/STOPPiNG WEATHER( MARK 1 TO 21TEMS) L<D BROADSIDE I OTH BUS I PASSING OTHER VEHICLE ACLEAR E-HT OBJECT J RGENCY HCLE I I Ij CHANGING LANES B CLOUDY IF OVERTURNED HGHWA ONST.EQUIPMENT 1(PARKING MANEUVER IC RAINING n VEHICLE/PEDESTRIAN L BICYCL ( ENTERING TRAFFIC D SNOWING OTHER•: IMOTHER VEHICLE OTHER UNSAFE TURNING E Fo l VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN XING INTO OPPOSING LANE F OTHER•: ANON-CoWSioN 0 MOPED PARKED G WIND PEDESTRIAN MERGING LIGHTING C OTHER MOTOR VEHICLE TFAVEU14G WRONG WAY JADAYLIGHT D MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER•: B DUSK-DAWN E PARKED MOTOR VEHICLE (3 (MARK 1 TO 2 ITEMS) C DARK.STREET LIGHTS TRAIN Avc/EETION v1ouT10N: 0 D DARK-NO STREET UGHTS BICYCLE civ DARK.STREET LIGHTS NOT ANMAI: Bre/[-vpuTaN: �Ep FUNCnoHINA• Y"C ❑No SOBRIETY-DRUG ROADWAY SURFACE FIXED OBJECT: vrEo 1 2 3 PHYSICAL vc ucTION rau A DRY I QYo (MAAK 1 TO 2ITEMS) B WET ' OTHER OBJECT: E3NO HAD NOT BEEN DRINKING SNOWY-ICY J D D SLIPPERY(MUDDY.OILY,ETC.) E VISION OBSCUREMENT: B HBO.UNDER INFLUENCE H BO-NOT UNDER INFLUENCE• ROADWAY CONDITIONS) F INATTENTKON•. GSTOP i GO TRAFFIC -IMPAIRMENT UNKNOWN (MARK 1 70 2 ITEMS) PEDESTRIANS INVOLVED H ENTERING/U/1VING RAMPR DRUG INFLUENCEANOPEDESTRIAN INVOLVED I PREVIOUS COWSION IRMENT.PHYSICAL A HOLES.DEEP RUT• CROSSING IN CROSSWALK Ij RMENT NOT KNOWN LOOSE MATERIAL ON ROADWAY• ATINTERSECTION UNFAMILIAR WITH ROADAPPLICABLE C OBSTRUCTION ON ROADWAY• CROSSING IN CROSSWALK-NOT 1(DEFECTIVE VEK EQUIP.: ODnPY/FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTION I ❑NO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED• E IN ROAD-INCLUDES SHOULDER OTHER•: G OTHER•: NOT IN ROAD IN NONE APPARENT H NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS tO RUNAWAY VEHCLE SKETCH MISCELLANEOUS ©A1+4 Aar` D C . 4.rl>G /iD"Ti Nolml -�2 1 Y e h N r��.'G r l T%-1 3 en•_cc � C A>\l f R Tiles 1'. 1... �F�'iCGfi CN1=A1L / / 3G YJl-IOTp� Cu R6 �cSCA, N �WAa rR�K 3 (�� rNo�C FRoCn N[l coFr_� aPkfJ A LAJIGL /F rtCtl� L�tI�. CHP 555 PAGE 2( Rev/ OPI 042 _ STATE Of"CALIFORNIA. INJURED / WITNESSES / PA99KNGERS PAGE 3 DATE Of COL L"'O=J -, y}�y TIME(1400) NPC NUM R OfgCER 1. NUMBER 1O I ^^ �0- ( - P. . V'.1. Z�L-J� L' Vj/RJI wmNEss r/LssENDER ADE HE: EXTENT OF INJURY ( "X" ONE) INJURED WAS( "X" ONE) FARTT HEAT BAFEN EJECTED INJURY INJURY INJURY Of PAINONLY ONLY NIPABER Poo. EOUI P. FATAL SEVERE OTHER VISIBLE. COMPLAIN DRIVER PAS&. PED. BICYCLIST OTHER ❑* ❑ 22 F I ❑ ❑ ❑ ® ❑ ❑ ❑ ❑' / J H o NAME/0.0.L/ADD TELEPHONE TELEPHONE +"ARC YuE ! J�oN 2 I-�6 657 Los �rNo� FR£iAo,. , CA (INJURED OK Y)TRANSPORTED BY: •• ,, TAKEN TO: (O i U ► Ur,,TA t,, JPA 13 kn DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ 25 rA ❑ ❑ ❑ 1-0-10101 ❑ ❑ 2 / NA(M�E/O.O.L/ADDRESS n - TELEPHONE I.i - IS Du -.2�-(S� 2 O NArJr I;i JA�j (INJURED ONLY)TRANSPORTED BY: TAKEN TO: ©. , L. • 4o.4Gl7'A L P/NO LZ DESCRIBE INJURIES ❑ VICTIM Of VIOLENT CRIME NOTIFIED ®� i ❑ 2g M ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ - 1 J 1 q I -- NAME/D.O.S.J AODRESH TELEPHONE s l-�a-60 i/ J,Lbcs C I TrS-auR 9-/S-K5- ti/S 1-4 S-e-4f 26 ONJURED ONLY)TRANSPORTED BY: TAKEN TO. DESCRIBE INJURIES ❑ VICTIM OF VIOLEN CRIME NOTIFIED ❑# ❑ ❑ ❑ ❑ ❑ I ❑ IQ IQ I ❑ I ❑ NAME/O.O.L/ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑� o o ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ 177 NAME/D.O.H./ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES -- ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑� ❑ ❑ ❑ ❑ ❑ I-Ell ❑ 1 DI ❑ ❑ NAME/MO.L/ADDRESH TELEPHONE ONJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES - _ r ❑ VICTIM Of VIOLENT CRIME NOTIFIED PREPAREA'S NAME 1.0.NLMBERMO. DAY YEAR REVIEWERS NAME NO. OAY TEA JCA M1 S I O-I4 1 G Q9 CHP 555-Page 3(Rev. 7-87)OPI 042 87 43637 I AA AUF YNE/SU PLEMENTAL Mk PAGE GATE OFC Q �,�• T,MEab424Mti NCIC NVMBER DFFICER LO.� ^ r. NUMBER t ,325 'X ONE 'Ir ONE TYPE SUP ALCrAPPLICABLE) t' DNARRATIVE COLLISION REPORT a BA UPDATE a FATAL ❑ HIT t RUN UPDATE aSUPPLEMENTAL Q OTHER HAZARDOUS MATEAIAIS ❑ W>K)OLSUS O OTHER; CITY I COUNTY I JUDICAL DISTRICT REPORTING DISTRICT/BEAT CITATIONNUMBER LOCATIDN/SUBJECT _ STATE HIGHWAY RELATED YES NO 1. FAcrQ 2. ► c� .1 3. Y R e O o -A eS Or tA ',/,CHICLE A<lclO&,T 4. t NVO r Cr wt" C mr i 1 - LJrrv4 A 5. RCSFO E"flI 1 _` =oNr or,.k Kura LLL ► lvc' 7. 8. LL (-SRC Pr'1zOyr t� t rs . 9. R e)L L C't 10. C _ 1 11. oA A lJ ri T'IO 12. L l3 v A - A L O CIT �T' "!` 1 v xff4 13. A AN H?4Q N 14. _S r GI +T►A A IJ.J 14 ''T r Q PA. Tmz KDW./ 15. IRUKFACt7 NSi' ILA tC A ,,C'S 16. tY1Gi• Myl LAJ",rO `O 14 ,-ri? TI CF 17. tC NITI d ur-ARtLL ► lvt^ -0A T T"uP,FJ Ow-Y. LoNtklf . 18. R + n D r I tY A Co / K r 19. bAttIA104 -"C S ►tAv T m*t _ F At^ ►V+ ,� 20. R rn T` &t4 C..S 21. ?'-2 7r t r Orr QOLt� . . 22. 23. '1•► J - 24. ,� ^ F-, ice•, A� �Q. I, f- S ' � pop 25. 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NUMBER 'X ONE• ')'ONE TYPE SUPPLEMENTALCr^PPUCAMA ® NARRATIVE ® COLLISION REPORT ❑ BA UPDATE O FATAL El HIT A RUN UPDATE ❑ SUPPLEMENTAL ❑ OTHER HAZARD0001MATERULL! SCHOOL" 1:1 OTHER CITY/COUNTY/JUDICAL DISTRICT REPORTING D45TA3CT/BEAT GTATION NUMBER LOCATION)SUBJECT STATE HIGHWAY RELATED YES NO I. CAU ��// 2. , i i+O,J US (, 'T'91S Td `t'1 LFLJ SNE 3. 31.gq T_ V:--• LJ A Y cT'O At L 1.1I CLE7 S FF 0 e1 I THc (n-rznl 4. cI /r IAA,—l_" -T-HC G r^r f r I- ,I-N S. n,--A r+,L.F A r`C-1 `r. -T 1 T n A S A s E 0 U f en N' 6. , . _.I-Lc> CC 1'w (ZN- AC- I L pt -)S L s-TUC pr r 8. - ) S' L )3 CIL Art C "-0 RZ(4?,C OAR\,` O `S GReACo1N 9. I cp A O , LT 'iO 1 'T' A 1'I rl R L •- T- `r utJ'l. 10. � .� f^� R ���; , AT t T�1!'_x'OR h1 MI Q!L I ° tOT V T I Pi O,t 11 ^5 T $ Pcco [ I �, aT 12. ^. 13. 14. , 1✓ 15. =.0.i. A C I >n, I T G -A 1 A til 'O ►� C��CCtWlF 16. T'D —A-5" u i V\ c07- , ,e r A CL!C. I 17. MIF 1? TI T r.L t 1' L R , 18 19. 0r,T-,o , 20. T'" m I oo�Slo 10��'•"+Al 3i L? Ir, o*! 21. Y 1 P e ^-r-,, A 3 PAUL I-1 Pk C. 22. !) �'. rce r,A /" , ,_-./ ,• S ' p6rT- 1 - I Itis T3`/ 23. L. �' Ro I _ -T- •LE o u PI R.c r c' -rApf 24. -•zlca of S oi� ^r,A i 1 �I clm. -P' i.,-iU-r' j3 Po t 26. 27. QtA61_N 7Q,\j6 !' 29. l,.''�' L T` 1vOri 1�iL rI .,.A •� 4Ar n," IC 30. ;.oFn'PA �0�^�1 k���.� I T.. D�t � •-�at� 31. n is o 4 r., (2 -rICAI 32. Fl r1 PREPARERS NA I.D.NUMBER MONTH/DAY/YEAR REVIEWER•SNAME NONTMIDAY/YEAR s'"Tn 9 .5I��q� 1�• CNP 566(Rev. 7-87)OPI 042P^"°r`O'°"'°""0ipii° 87 45312 4 WAVIVE/SUPPLEMENTAL P 9 HATE OF COLLISION'I TIME(Z10q NGC NUMBER OFF ICER LO. NUMBER ONE ONE TYPE SUPPL.ELIENTALC)•APPLICABLE) i ® NARRATIVE COLLISION REPORT ❑ MUPOATL El FATAL _ Q HT&RUNUPOATE ❑ SUPPLEMENTAL ❑ OTHER: O NA2ARDOUS MATERIAIA a SCHOOLSM D OTHER: GTY/COUNTY/UUOCAL D13TRICT REPORTING DISTRICT/BEAT CJTAT1ON NUMBER LOCATION/SUWECT STATE HIGHWAY RELATED Fl YES NO 1. � Z►r�t'e l CPQ►.1�'� i 2. 11-1 N '�' --A ► ,, "`iG . 3. CA 1LA'-o 1c� I(i a^� 4. L y '� 6 6 8` �C�'� Y'� -I jA l m i"" > �r&'3 q z I x li 0, f l l"', 5. ) N4 Las1l 1 )SSL _ ,:���� O ) GLLLi�t I1 8'+ 't A rr,,C c-?- 6. Z6. R. ePF-C '�9a 7. p f 8. LCr 9. tj c3 t_A t- 10.10. 11. i 12. 13. 14. - 15. 16. 17. 18. i 19. 20. 21. 22. 23. 4. 25. 26. 27. 28. 29. 30. 31. 32. PREPARER'5 NA I.D.NUMBER MONTH/DAY/YEAR REVIEWERS NAME MONTH/DAY/YEAR „1 CHP 556(Rev.7-87)OPI 042 U«Pn **%am will 0.p.00 87 45312 V`. ATE OXCAUFGpNIA ' ,,��► ARRATIVE/SUPPLEMENTAL Xw DATE OF INCIDENT,OCCURENCE TtMEt26m NCIC NUMBER OFfICERIO. NUMBER 11 -� o 0 3325 ONE 'X'OO7N�E TWE SUPPLEMENTAL('X•APPLICABLE) E] NARRATIVE I)[I COLUSON REPORT O BA UPDATE FATAL Q WT I RUN UPDATE LLLL® SUPPLEMENTAL aY OTHER: ❑ HAZARDOUS MATERIALS ❑ SCNOOLBUS ® OTHER:VC NJZL6 Sr�SpE� CITY/CGUNTY IJUDCAL DISTRICT REPORTINGDSTRICT I BEAT CITATION NUMBER I LOCATION/SUBJECT STATE HIGHWAY PEUTED YES NO 1. 2. S O7'l 3. Z T-1,140 A A k C o 4. Trr v 5. 6. RT_ 7. IQ + 100 t- 70 COLOR, CALIA09,0ZAS 8. i 91 9. 10. EKrF, 2 11. 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En .S . 6. 7. 8. r c Lo6 &)tj-rs ci,.ep4f 9. -i 10. T A r NE A Tr 11. o bA s 12. Loc a. 13. 14. 15. ura T - X18 16. c_, 17. 18. - ,J 19. T - S Rz,�-G S ,2t"/ 20. 21. 22. 23. L LS l-s Tn H,<A)-)LAfwpw--r / 25. 26. 27. 28. 29. 30. 31. 32. PREPARERS NAM I.D.NUMBER MONTHIDAYIYEAR REVIEWERS NAME MONTWDAY/YEAR //70.5 1 iv-112- CHP 556(Rev.7-87)OP!042 UF.pr..-."--Wdop-w 88 48641 - ATELIATIVE/SUPPLANTAL DATE Of C.OtLSiON TIME{2AOp MGIC NUiABEg.. OFFICE O. NUMBER p • lS Q ? a4 r ? 70 � ��� c W ONE V ONE TYPE SUPPLEAxNTAL(7C APPLIGAV ❑.y NARRATIVE ❑ COLLISION REPOW ❑ 6A UPDATE 1 L1 PATAL ❑ NIT i RUN UPDATE SUPPLEMENTAL 0 OTHER Y[JfILLf 1NSP ❑ 01�MATEMALS ,'j❑� SCHOOLSUS El OTHER j&I-&GLC CTTY/COUNTY/JUOICALDISTRLCT REPORTING DISTRICT/SEAT WATION W. LOCATION/SUBJECT STATE HIGh: YES ,. A 1-K of IN Et:Lto Alif &-0V 3 1 f9 2. 3. 5 Cc ff0A/ f M.5 ,& RL r2lZ AIMA G o/✓!M AA/ 00&'/,j 4. $ /VSPfLlZvn/ y am ^41-fAIA G - 6. o ry 7. 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NUMBER 45 oz,� 'X ONE -X ONE TYPE SUPPLEMENTALCX APPLICAKA ❑ NARRATIVE 9 COLLISION REPORT O BA UPOAT= � FATAL O IYTARUNUPDATE SUPPLEMENTAL El OTHER ❑ NAZAADOUS MATEFA" ❑ BCHOOLBUS D OTHER: CITY/COUNTY/JUDCAL DISTRICT REPORTING DISTRICT/BEAT CITATION NUMBER LOCAT ION/SUBJECT STATE HIGHWAY RELATED YES NO i. FTN1 GS ON � m,r ' 2. 77,mizar A 1Yv-fA:rTM&- TEFL m sl ?�L/9T 1li(-" fNI/El 3. S00 z //,Oov cA r ? t TE 4. 'f/f �5roa/9iY/J rwc- 4m ,,r 14C n - f3 s. /4 c' 4006LL' c7"r /l/J LEL G /OISTy Ss-r" 9c s. Al o �c o F 7. A A io/o Tv 8. 1-eIYAArLf 1'1fCl/, 1V-1:5-InCHo .rlK 7/r' �' �cCl- 9. - J/V1S/YI s t� E 5r ez7 7b QAfe-AIT 7' TrC 10. /JTti S7E �oNf ?S, 11. 12. '/C r- o BiP c= /f'I t C s t� /v 13. o 6,C T1YE 11 t o Ay 14. s H 1 L aMf4 L TN/3 d Lff 15. D AIVW 7 o rJ /QzG//1 `J o,4,Y 16. 661c 7 v 7-isgraL 114FA1141fix) 41,v- 1 NCf 212-0- 17. 18. 77'11,r 11644 13RAmr /�'1FcygNISMS {y t "roolyy 720 19. 1347 IW O M It/F C o 17Z IONS 20. t ro�r, '7f E F IJILPK- Z -rlvtt 21. IAL IGH/ AS /=oyho'V iZ7 dr 7r/l CHtV 22. O ?f1E /tffc- /oNS Z]/t jS L'ASNR v 23. 1 L� �f�IC O/1/ THE" ZGt/1 Eco,v/7 /� ZGy /QI/Y1A ►� 4. /Y/J [-Cf foN L 1 /C65- 25. 26. f/C /.3� alt S�STtM 1 S !�1 L f�SFiP✓� 27. L014 M l L 7Y/q' 28. 29. %�/� /J�QSvtRs A i' /dE�AG 11 S sE 7;'V 30. L O � 77-5r 2f f--10 Lr EL SKE72 31. -o IV())"-AL [= /Vv A51y l Z T 32. S fo MAO, PREPARER'SNAME I.D.NUMBER MONTH/DAY/YEAR REVIEWERSNAME MONTH/DAY/YEAR /�R� i9r'�vctf /"3-lpl� CHP 5 (Rev.7-87)OPI 042 87 45312 I •,�TATE f AUfORN1A F'--R R' TNE/SUPPLEMENTAL AKPSE / pA7E OF COWSNHI nw-(24mqw NCC NUMBE OFFICERED. NUMBER l� 3 5 'X ONE 'X'ONE TYPE SUPRIVIENTAL C)C APPLJCA" ❑ NARRATNE COLLISION REPORT ❑ SA UPOATZ FATAL ❑ NIT A RUN UPDATE SUPPLEMENTAL D OTHER ❑ IIAZJlJVOUS MATERIALS JC❑�J SCHOOLOUS ❑ OTHER: CTI/COUNTY/JUDICALOISTRICT REPORTING DISTRICT/BEAT CfTATIONNUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED YES NO 2. 3. Awe 05ES a. IYO -GHZ o avr6 /4nr 5. C L1NDE L T LE tL W S GILL 6. 7. o13XA MK SYS E v S /JfrE-1T�`O 8. 7 f to 9. 10. 11. SIE EE ING 5rl72-14 IS 150oN TES 12. 1ol'-* lAN A I'a hrIf AM 7lPE r o(,t/t ASST 13. A L L 5PMiCAL, d 6040-M-roAl 14. j) a O 14N S E E e� 15. 16. 'Ef > GtA o S G Sj -tT tN 17. T S £A E o Co GT 18. wf P wr Ta riv ./ r s 1/Y/JIG i9, CAS SED V CdLL�s10/' w 20. 21. 01NE 10t4&,4 F - L" To 22. Powell S TEr L-r A r 6- o 23. E L 71reW 1413,iltr. 4 25. 26. S14MAI&YK A/0 DE O/ Fc40iYrC-4L E L-- Gf� iplr 27. o NNI, o T r rif/s "L Tt �v,�/ 1BN7� 28. o �HI.S ACcI/ 'N7 29. 30. 31. 32. Lg PREPARERS NA I.O.NU E NTH/DAY/YEAR =Ml MONTH/DAY/YEAR CHP 556(Rev.7-87)OPI 042a^ �^«»�^Wa�a«a 87 45312 rAV 1 UAL UTAUMAM FApw oA7■,o• co�1.�s1o.1 7*0 e1e wvr■■ le.wo. \ L5 pA• )5 .w. ooq 4 g310 10 l _3 Z5 ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE VEI41C-LE PoiJ T5 of REST ARE 4AP,126)(I ,4T1oAl� VENiccFs tiJfR£ MoJ-rD Zl/ 7-6tj do. pk)o2 Ta /Y/FASV1?EA4E� 'N01C ATw � Mp■TM S 10twRvc Z10 >2' 1�— .0 2 IV 781 } Stos,sow L1MuD[►Q. !o /� moist Cuaa Q APPRoo� qo' ' S1oe.ewps ' Cielac.t/yARw owA.. ••t ' 1,.o.NUY■mow YO. OA• •■. Iw9v1[wu's.AY[ I YO. DA• •w. CHP 555—Page 4 (Rev 11.85)OPI 042 -FACTUAL DIAGRAM PAY[ e (l... 1-c-, Mw[w O• 1.D. NyY[[w T" ro. ` LCA ♦��0 1� �3 (/ ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE Iw OICATC NOWT. Vt�na.tz�u.. ��yls. S�Otw�►vc N 121 s o l 12, r 16 7z. Slops," �U1ltaA[AR !o l�isa g►C2 W ALK it Q (a RA"iz ! Ppm," Ra' j i�PPgox Sg' • � S1oe.sWOs S�o�sK�ns _ ' S%t>tSwM ® • C�eslc.tN4�lvtl i owwww •� ,.o.Nylw e[w ro. ow• .w. wEv,[w[w's Nw..[ ro. ow'r .w. J' ti It! yN ii i7 CHP 555—Page 4 (Rev 11.85) OP1 042 COEFFICIENT OF FRICTION TESTS On November 7 , 1989 at 1800 hours a series of eight (6) skid tests were conducted- by Officer A. R. Specht III (9695) at the scene of the collision to determine the coefficient of friction of the. roadway. Present during the tests were representatives of the Contra Costa Sheriff ' s Department, San Pablo Police Department and the California Highway Patrol . San Pablo Police used radar to verify the speed of each test. A bumper mounted chalk marking detonator was used on each of the tests. Measurements were then taken of the detonator chalk marks and the resulting tire scuffs. DATA. Test 1 : (@ 45 mph) Detonator Marks 89' 7" L/Side tires 65' 9" R/Side tires 69' 3 Note: Front and rear tire scuffs could not be distinguished . Test 2: Invalid due to detonator misfire. Test 3: (@ 45 mph) Detonator Marks 8819" L/Front tire 48' 8" L/Rear tire 50' 7" R/Front tire 47' 6" R/Rear tire 60' 10" Test 4 and 5: Invalid due to detonator misfire. Detonator was re-wired and connected directly to the brake light circuit. Test 6: (@ 45 mph) Detonator Marks 90' 10" Note: Scuff marks over previous test scuff marks, measurement not possible. Test 7: ., - (@ 44 mph) Detonator Marks 93' 4" L/Front tire 56' 9" L/Rear tire 51 ' 7" R/Front tire 60' 4" R/Rear tire 59' 8" Test 8: (@ 4*ph) Detonator Marks 90' 10" L/Front tire 45' 11" L/Rear tire 47' 4" R/Front tire 42' 11" R/Rear tire NONE CALCULATIONS• Coefficient of friction calculations were done using the detonator mark distance (V1 ) and the longest scuff mark (V=) . f = V2 / 308 Test 1 : V1 = .753 V- = .975 Test 3: V1 = .761 V= = 1 . 110 Test 6: V1 = .743 Test 7: V1 = .690 V-- = 1 .070 Test 8: V1 = .743 Vo = 1 .426 SUMMARY: Using the average of the test data the following coefficients were calculated. The scuff mark measurements from Test 8 caused a 19..694 % error. Due to the three other tests where scuff marks were measured being relatively close, the Test 8 results from the scuff marks measurements were excluded from these averages. V1 = .783 +/- .032 (4.268 %) V= = 1 .052 +/1 .068 (6.416 %) CONSERVATION OF MOMENTUM Conservation of momentum calculations were done by Officer A. R. Specht III (9695) . A dynamics diagram was not made due to inaccurate and incomplete data provided . Based on the observations of Officer Jim Goodman and the data provided by him, an attempt was ma-de�o establish a possible speed range for V-1 prior to the collision . Data Provided : V-1 Ford Crown Victoria Patrol Car Weight (Occupied) 5250 lbs. Longest scuff 90' 6" V-2 Toyota Corrola Weight (Occupied) 2300 lbs. V-2 was turning left from the opposite direction of travel of V-1 . Data Approximated : V-1 P.O.R. was 50' from P.O. I . Departure angle between 330 and 350 degrees. f V-2 P.O.R. was 90' from P.O. I . Entry angle between 250 and 290 degrees. Departure angle between 330 and 350 degrees. Note: These calculations may be invalid due to the lack of speed match-up, which would negate the use of conservation formula, or an inappropriate departure angle of either vehicle. V-2' s departure angle was not substantiated by the physical evidence data provided. .Y j Calculations: s Post impact speed of V-1 was calculated using coefficient of 20" friction determined by chalk detonator tests ( .738) . Standard rolling coefficient of friction of .02 was assumed for V-2 due to lack of skids. V = SOR (30 d f ) I V-1 = 33.27 mph V-2 = 7.34 mph Departure V-1 Departure V-2 Entry V-2 Speed V-1 V-2 330 330 250 38.24 44.31 350 330 250 38.24 17 .94 330 330 290 24.96 44 .31 350 330 290 32.86 17 .94 330 350 250 38.24 41 .76 350 350 250 38.24 15.39 330 350 290 25.72 41 .76 350 350 290 33.63 15.39 Based on the calculated data the most appropriate entry angle for V-1 seems to be 350 degrees. Any of the entry or departure angles for V-2 would be appropriate. The speed range for V-1 would be 32.86 to 38.24. Using the maximum speed for V-I ' s range the approximate speed for V-1 prior to the collision was calculated . V = SQR (30 d f ) V1 = SQR ( 30 * 90 * 1 .052) V1 = 53.30 V,= = SQR (V1= + V=2) V= = SQR ( 53.300 + 38.24=) V� = 65.60 -- AMENDED -- CLAIM AGAINST COUNTY OF CONTRA COSTA, CALIFORNIA (Pursuant to Government Code § 910) CLAIMANTS: HOK KONG and SAU KONG, individually, and FERNAND KONG, as administrator of the estate of KAREN KONG. ADDRESS: c/o LAW OFFICES OF R. JAY ENGEL 22 Second Street, 6th Floor San Francisco, CA 94105 (415) 777-0644 DATE OF ACCIDENT: October 15, 1989 TIME OF ACCIDENT: Approximately 8: 30 p.m. PLACE OF ACCIDENT: Rumrill Boulevard (C.S) , at the intersection of 17th Street, San Pablo CIRCUMSTANCES OF ACCIDENT GIVING RISE TO THE CLAIM: Auto accident in which public employee, David Lysle Brown, caused the death of Karen Kong. AMOUNT OF CLAIM: $500, 000 ITEMIZATION OF CLAIM: Funeral Expenses: $ 5, 000 Medical: 1, 000 Loss of care, comfort, support, society and companionship of the decedent: 494 , 000 $500,000 DATED: December 13, 1989. ! � LAW OFFICES OF R. JAY ENGEL, INC. I . DEC. 51989 By /\/Wwuu� Pr+a BATCHELOR ONATHAN E. GERTLER CL ERC BOARD OFSUPERV!SORs ttorneys or Claimants ^ COSTA CO De ut c . 1 PROOF OF SERVICE (C.C.P. §1013a(3) ) 2 STATE OF CALIFORNIA ) 3 ) ss. , COUNTY OF SAN FRANCISCO ) 4 I am employed in the County of San Francisco, State of 5 California. I am over the age of 18 years and not a party to the within action; my business address is 22 Second Street, 6th 6 Floor, San Francisco, California 94105. 7 On December 14, 1989, I served the foregoing document: 8 AMENDED CLAIM AGAINST COUNTY OF CONTRA COSTA, CALIFORNIA 9 on the interested parties in this action by placing a true copy 10 thereof enclosed in a sealed envelope addressed to each as follows: 11 Joleen Edwards, Deputy Clerk 12 Contra Costa .Co. Board of Supervisors 651 Pine Street, #106 8 13 Martinez, California 94553 i UWJ Za � ° 14 [X] BY MAIL: I am readily familiar with the business' practice LL W � � ^ for collection and processing of correspondence for mailing 15 with the United States Postal Service. I know that the a Q `g am correspondence is deposited with the United States Postal `ALL 16 Service on the same day this declaration was executed in N the ordinary course of business. I know that the envelope 17 was sealed and, with postage thereon fully prepaid, placed for collection and .mailing on this date, following ordinary 18 business practices, in the United States mail at San Francisco, California. 19 [ ] BY PERSONAL SERVICE: I caused such envelope to be 20 delivered by hand to the above address (es) . 21 Executed on December 14, 1989, at San Francisco, CA. 22 I declare under penalty of perjury under the laws of the State of California that the above is true and correct. I 23 declare that I am employed in the office of a member of the bar of this. court at whose direction the service was made. 24 25 26 Moya B. Mulreany 27 28 i r� ro o H,� q O� w z tR cD y�r� •{fit; � ��+ � �O 3 � u � a N d D N (D � � In D m N CP moo , cn ti ON 4>' x �P,N o y a