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HomeMy WebLinkAboutMINUTES - 12101991 - 1.5 r CLAIM �►,.,,,. p�,ki' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA NOV 1. 8 1001 Claim Agrainst the County, or District governed by) BOARD AO 0 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT hf �pUNSEL December 10MaR�19�,1c�uiF. 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: $954 . 41 Section 913 and 915.4. Please note all "Warnings". CLAIMANT:BATTS, Rollan L. ATTORNEY: Date received ADDRESS: 9116 N.E. 63rd Street BY DELIVERY TO CLERK ON November 15 , 1991 Vancouver, WA 98662 Hand delivered 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: NovPmbPr 1 5 , 1 9A1 BY: Deputy rLm ett,� I1. FROM: County Counsel TO: Clerk of the Board of Supervisors Tom) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: I Dated: BY: _ /� Deputy County Counsel V V U III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( V� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 10 1991 , PHIL BATCHELOR, Clerk, By oo 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 alcertified copy of this Board Order and Not a to Claima t, addressed to the claimant as shown above. Dated: DEC 10 1991 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Clams to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the.cause. of action. Claims relating to causes of action for death or, for injury to person or to personal property or growing crops and which accrue on or after January 11 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 yearl after the accrual of the cause of action. (Govt. Code §911:2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine.Street, Martinez, CA 94553. C. If claim is against, a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty,, for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved fo Clerk!s filing stamp RECE1VED, . Against the County �lof Contra Costa ) NOV 151991 or CLERK BOARD OF SUPERVISORS District) CONTRA COSTA Co. Fill in name The undersigned claimant hereby'makes claim' inst the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: NN-N_N-_NNN--NN---N---------------------- 1. When did the damage or injury occur? (Give exact date and hour) �M—------------------------------ 2. Where did the damage or injury occur? (Include city and county) r ` --�--�- - co _ �------------------------- 3. How did &e damage or injury occur? (Give full details; use extra paper if required) L) ---- _ -------- ------------- --------------------------------------- 4. What, particular act or. omission on the part of county or district officers, servants or employ' s. caused the.-injury or damage? mo Lo�f- .-+6; /Ii�,9 _ (over) 5. what are the names of county or district officers, servants or employees cauling the damage or injury? ----------------------------------------------------------- - 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed.. Attach two estimates for auto -damage. l� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) _ ..�.r s ---------- -------------------------------- $. Names and addresses of witnesses, doctors and hosp72, y 9. List the expenditures you made on 'account of this accident or injury: DATE ITEM AMOUNT * . . * Gov. Code Sec. 910.2 provides: "The claim must be sign Eby the claimant SEND NOTICES TO: (Attorney) orb erson on.hi half." Name and Address of Attorney laimant s Signature (Address) Telephone No. Telephone No ✓ �� NOTICE Section 72 of the Penal Code provides: ' "Every person who, with intent to.defraud, presents for allowance or for payment to any state board or officer, or to any county, 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),'lor 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. ESTIMATE �= CONCORD SAFETY CENTER, INC. 1130 Detroit Ave. FL 1-0 CONCORD, CALIFORNIA 94520 BEAR (415) 682-9459 BAR I#AD 017303 2162 �I NAME PHONE DA i STREE /.V Y LOR M MODEL y� REGI TRATION NO. SERI NO. ODOIv]ET ESTIMATE PREPARED BY Z5 1 ANC O. <2 7 V ADJUSTOR /J i tLJI'/� i REPLACE REPAIR DESCRIPTION PARTS LABOR REFINISH SUBLET lloor � 12— r� v I 02 i f w 01I TOTALS The above is an estimate based on our inspection and does not cover TOTAL PARTS $ lef(0 any additional parts or labor which may be required after the work has been started.Occasionally,worn or damaged parts are discovered which TOTAL LABOR $ may not be evident on the first inspection. Because of this, the above V prices are not guaranteed.Quotations on part's and labor are current and subject to change. TOTAL REFINISH $ AUTHORIZATION F P You are hereby authorized to make the TOTAL SUBLET $ above repairs: TAX $ �, SIGNED: DATE: s '- TOTAL PRODUCT NO.712-2 McBee-1055 EAST STATE ST.-ATHENS,OHIO 45701 ORIGINAL To Reorder Call Toll-Free 1-800-526-1272 l ` CLAIM 1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 10, 1991 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 11,�g1ow), given pursuant to Government Code Amount: $15,000,000.00 Sect0f.)Ir Z15.4, Please note all "Warnings". �sAf%0 CLAIMANT: CARASIS, George and' Christina ATTORNEY: Curtis L. Johnson Curtis L. Johnson and Associates Date r ,ved ADDRESS: 3240 Lone Tree Way, "Suite 202 BY DELIVERY TO CLERK ON November 12, 1991 Antioch, CA 94509 '., BY MAIL POSTMARKED: Hand delivered via Risk Mgmt. Envelope Postmarked November 8, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 13, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy 0,IJ-41 A ,1 II. FROM: County Counsel T0: 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: i Dated: 1'1 91 _ BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admim strator (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. .I ( ) Other: I certify that this is a'true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 10 1991.; PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 1 0 1991: BY: PHIL BATCHELOR by AA 01 idAi g?.,,Deputy Clerk CC: County Counsel County Administrator LA CURTIS L. JOHNSON AND ASSOCIATES ATTORNEYS AT LAW Vkof\ November 8, 1991 Npv 1 C� 1991 Risk Management CONTRA COSTA COUNTY 651 Pine Street Martinez, CA 94553 To Whom it May Concern: Enclosed please find my client's claims against Contra Costa County fo review. Yours t ly, `f RECEIVED CURTIS L. JOHNSON AND ASSOCIATES NOV 121991 oaP.vy% CURTI / L. JOHNSON CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLJ/ s 3240 LONE TREE WAY,SUITE 202 TELEPHONE:(510)779-9456 ANTIOCH,CA 94509 FACSIMILE:(510)779-1973 CURTIS L. JOHNSON AND ASSOCIATES LLJ ATTORNEYS AT LAW Claim Against Public Entity Government Code §910.4 In the Matter of the Claim of George Carasis and Christina Carasis Claimants, VS. Department of Transportation; California Highway Patrol, Contra Costa County Public entities, Claimants hereby present this claim to the public entity known as CONTRA COSTA COUNTY, pursuant to Section 910 of the California Government Code. 1. The name and address of claimants attorney is as follows: Curtis L. Johnson, CURTIS L. JOHNSON AND ASSOCIATES, 3240 Lone Tree Way, Suite 202, Antioch, CA 94509. 2 . The address to which claimants desire notice of this claim to be sent is as follows: Curtis L. Johnson, CURTIS L. JOHNSON AND ASSOCIATES, 3240 Lone Tree Way, Suite 202, Antioch, CA 94509. 3 . On May 13, 1991, at appoximately 12 : 30 a.m. an automobile/motorcycle accident occured at the location of Kirker Pass Road in Pittburg California, Contra Costa County. As a result of said accident Alexandria Carasis (Roark) died when the motorcycle struck an unoccupied vehicle left in the middle of the roadway. The decedent was a passenger on said motorcycle. The decedent is survived by her father, George Carasis and her minor child, Christina Carasis. Said claim is presented on 3240 LONE TREE WAY,SUITE 202 TELEPHONE:(510)779-9456 ANTIOCH,CA 94509 FACSIMILE:(510)779-1973 both of the claimants behalf. 4. Claimants allege that Contra Costa County is liable for the wrongful death of the decedent and the damages resulting therefrom as a result of its acts and ommisions. Said acts and omissions include but are not limited to its negligent maintenence, design, grading, and lighting of said roadway known as Kirker Pass Road. 5. At the time of presentation of this claim to this public entitiy, claimant Christina Carasis (Roark) claims general and special damages in the amount of $10, 000, 000. 00 dollars. Claimant George Carasis claims general and special damages in the amount of $5, 000, 000. 00. Said amounts are computed on the basis of the following which include but are not limited to: funeral expenses, burial expenses, decedents contribution to the family, dependency, and pain and suffering. DATED: NO V Q 1991 CURTIS L JOHNSON AND ASSOCIATES BY: 11 Z�UR—TIP L. JOHNSON Atto ey or Claimants oa a � d r cn a H N � G} O n! 7y r 0' 0cn � C ­3 zwCo c�ia o �° Ln tTl dz o n z n y cin o � wz mz N m Q N N C7 ^-I --i 7= :P .P t•- o cn cst 2? W D 3 Z PRESORTED FIRST CLASS tin X , o Z, C Cr� t m cm l M 1 CLAIM X� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ""t"F''OVED Claim Against the County, or District governed by) B{TAWAIT61991 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December-obPry C&MA and Board Action. All Section references are to ) The copy of this document mailed to you NU3Rb1fflM M}#,ce of California Government Codes. ) the action taken on your claim by the Board of Supervisors e" (Paragraph IV below), given pursuant to Government Code Amount: $100, 000. 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CHILES, Samuel a ATTORNEY: Keith Brooks Attorney at Law Date received ADDRESS: 1440 Broadway, Suite 608 BY DELIVERY TO CLERK ON November 14 , 1991 Oakland, CA 946;12 BY MAIL POSTMARKED: November 13, 1991 Certified P 888 200 862 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 15 , 19,9l gYIL BATCHELOR, Clerk eputy1 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 file"tl. 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). r; y ( ) Other: " Dated: BY: Q_/__) Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present i Z) This Claim is rejected 'n full. ( ) Other: �I I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated: DEC 10 1991 PHIL BATCHELOR, Clerk, By , Deputy Clerk I WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or 11 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. �I 1' 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 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 Noti a to Claimant, addressed to the claimant as shown above. Dated: DEQ 10 1991 BY: PHIL BATCHELOR by b eputy Clerk CC: County Counsel County Administrator �I it r v KEITH BROOKS ATTORNEY A-f L,\w 1440 BROADWAY Sui i t:608 OAKLAND. CALIFORNIA 94612 RECEIVED (415) 465-5567 ?' TRANSMITTAL MEMO NOV 1 41991 I� TO: Clerk of the Board of Sunervisors CLERK BOARD OFSUPERV ,, CONTRA COSTA CO.. Contra Costa Countv 651 Pine StIreet, Room 1.06 .Martinez, �CA 94.553 RE: Claim of Samuel Chiles jl DATED: November li 1991 Enclosure: original and one cot)v, Claim of Samuel Chiles SASE Please file's the Original, and :return the coxes with your received-date stamp in the enclosed SASE. Thank you for your anticipated cooperation. Action requested: Please sign and return Enclosed for your information PleaseI'. telephone me after reviewing the enclosed Enclosed pursuant to your request Please' file Original and return endorsed copies Please record and return Pleaselpresent to Judge for signature Your cooperation is appreciated. , Thank you. Very truly yours , 1' KEITH BROOKS a a, I' �I KEITH BROOKS ATTORNEY AT LAWRECEIV ED 1440 BROADWAY SUITE 608 OAKLAND, CALIFORNIA 94612 NOV 14 iggi I (415) 465-5567 CLERK BOARD OF SUPERVI CONTRA COSTA Clerk of the Board of Supervisors Contra Costa Countv 651 Pine Street., Room 106 Martinez, CA 94553 TO: CONTRA COSTA COUNTY SAMUEL CHILES hereby makes claim against the county of Contra Costa for the sum of $.100 ,060, and makes the following statements in support of his claim: 1. Claimant's address isl478 Rumrill Blvd. , San Pablo 2. Notices concerning this claim should be sent to: Keith Brooks, Esc . Attorney at Law 1440 Broadway, Suite 608 Oakland, CA 94612 Tele (510) 465-5567 3. The date and place of the occurrence giving °rise to the claim is May 15 , 1991, at Martinez, California. 4. The circumstances giving rise to the claim are as follows: While incarcerated in the-main jail, claimant was taken to the F Module, and given medication for high blood pressure. Claimant was re-dosed repeatedly because his blood pressure did not respond to the medication. Finally, claimant was unable to stand, suffered blackouts, and fell several times. Claimant was taken to Martinez Hospital, where he was treated for low blood pressure. 5. Claimants injuries are low .blood pressure emergency and headaches. 6 . The name of the person responsible for claimant' s injuries is unknown to claimant. 7. The basis for the computation of the claim is general damages in the amount of $100 ,000. Dated: November 13 , 1991 4T3rooks .Keit Attorney for Claimant O n �jiO � ti M Ct (t N nr o fi fi ',-PO n O ct � �14 O 05 rb o rs C p K N r. t YR -77 t' O Gig r� ILIy i • k�--..,.-"" �{�� 7�- + i.� �x��k•«"�" i � c a t 7 .. i y �t q 'r�,y[ f,.�*�: 4Vy� Qm t { f ` .61 f `* R fi 'dYk CL' c 00 f f t t- nEe T u T F^ , r l d a /w r. .✓JP. I/ ks- t CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Y Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 10, 1991 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: $600.38 Section 913 and 915.4. Please note all "Warnings". '23CLAIMANT: CURRIE, Charles G. �sNnoo NUN o T� ATTORNEY: Date frOceived ADDRESS: 244 Panorama Drive ERY TO CLERK ON November 12, 1991 Benicia, CA 94510 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 13, 1991 gaIL gAATTCYELOR, Clerkepu a 11. FROM: County Counsel TO: Clerk of the Board of Supervisors 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: i Dated: 1( ly 91 BY: I J _ W_JA Deputy County Counsel V — III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned at 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. O Dated: PHIL BATCHELOR, Clerk, By v 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 aacertified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. C Dated: DEC 10 1991 BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims.-relating- to causes of, action'-for death or. for -injury to person or to personal property or growing crops and which accrue .on or••after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year.,.after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• a C. If claim is against" a district governed by the Board of Supervisors, rather than the County, the name of. the District should be filled in. .. . D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE:, Claim By ) Reserved for Clerk's filing stamp ) CHARLES G. CURR,IE ) : " RECEIVE® Against the County "of Contra Costa ) NOV 1 2 1991 or if.. CLERK BOARD OF SUPERVIS RS District) CONTRA COSTA CO. Fill in name ) The undersigned-claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $600. 38 and in support of this -claim represents as follows: ..N--M----N---NN-N----- MN--NN--N--N-N-N---N--N-----N-----N---- 1. When did the damage or injury occur? (Give exact date and hour) OCTOBER .23, 19.91 1 17P ----------------------=------------------------------------------------------------- 2. Where did the damage or injury occur? (Include city 'and county) CORNER OF SANPABLO AVE AND 23RD ST SAN PABLO, CA 94806 --N--.�----N------N ----NNNN--NNN--w--NN-N--N--N-----N-------------- 3. How did the damage,or injury occur? (Give full details; use extra paper if required) I WAS IN THE RIGHT. HAND LANE .GOING STRAIGHT. .NICOLE POOLE, WHO WAS DRIVING THE COUNTY VAN, TRIED. TO •MAKE A RIGHT TURN FROM THE .MIDDLE LANE. SHE -TURNED INTO THE SIDE OF MY CAR. --- - ----------------------- .--NNN-N- ----------------------------------- 4. What particular. act .or omission on the part of county or district officers, servants.*or employees caused the injury or damage?. INATTENTION. ANOTHER VEHICLE MADE THE- TURN FROM THE MIDDLE LANE AND MS POOLE SAID SHE WAS FOLLOWING THE TRUCK THAT MADE THE ILLEGAL TURN. (over) R 5. What are the names of county or district officers, servants or employees causing the damage or injury? NICOLE GREENHOUSE-POOLE I- ASSUME THAT THIS IS CORRECT, BECAUSE SHE HAD NO LICENSE OR ID ON HER PERSON. ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full- extent of injuries or damages claimed. Attach two estimates for auto damage. NONE ' ---------------------- - ---- --- ----------------- --- --------------- How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) --------------------- ------------------------------------------------------------ $. Names and addresses. of witnesses, doctors and hospitals. SHERRI ALPHON50 2462 DOIDGE. PINOLE, CA 94564 STACY D. CURRIE 244 PANORAMA DR BENICIA, CA 94510 -N-m -----m-------- -mmmmm..mm-mN---mm--N-..NmmmmN-m-m--mmm--m--m-mmm-mmm-mmmm- 9. List the expenditures you made on account of this accident or injury: ' DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or b o e- er_son n..his ehalf." Name and Address of Attorney VL(-ClaimantIs Signature 244 PANORAMA DR Address BENICIA, CA 94510. Telephone No. Telephone`No. WK (510) 235-0114 NOTICE Section 72 of the Penal Code provides: - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a'fine of not exceeding one thousand ($1,000),; or by both such imprisonment and fine; or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ESTIMATE saaeeme 04mto 80dy of BODY&FENDER REPAIRING—AUTO PAINTING REPAIR =`= 628-23RD STREET RICHMOND,CA 94804 Phone(415)234-7344 . ornia Bureau of Auto.Repair Lic. #AE 18 82 OWNER �a PHONE / ADDRESS r Al FILE NO. K YEARODY MODEL L CENSE/NPS MILEAGE nalam' �7 Symbol FRONT Labor Hrs. Parts JjSymbol LEFT Labor Mrs. Parts Symbol RIGHT Labor Hrs. Parts Bumper(U) Ex-New Fender, Frt. 8 Ext. Fender Frt. 8 Ext. Bumper Brkt. R. L. Fender In-Out, Shield Fender In-Out, Shield Bumper Gd. R. L. Fender Mldg. W./O. Fender Midg. W./0. Fender Mldg. Side Fender Mldg. Side Fender Mldg. Peak Fender Mldg. Peak Frt. System Headlamp H-low Headlamp H - Low Frame Headlamp Door Headlamp Door Cross Member Sealed Beam In-Out Sealed Beam In-Out Cowl-Screen Cowl - Screen Front Door Front Door Door Door Hub 8 Drum Door Key Lock Door Key Lock Door G-loss-T--CL Door Gloss T -CL Door Mldg. Door Mldg. Spindle R. L. Door Handle In-Out Door Handle In-Out Center Post Center Post Lr. Cont. Arm R. L. Rear Door Rear Door Door Door Shock Door Glass T -Cl. Door Glass T-Cl. Tie Rod L-CR Door Mid .8 Jamb Door Midg. 8 Jamb Steering Arm R. L. Rocker Panel Rocker Panel Steering Wheel Rocker Mldg. Rocker Mld . Horn Ring Quar. Inner Const. Quor. Inner Const. Gravel Shield-Air Quar.-Ext. L-C-Up Quar.-Ext. L-C-Up Park Lite R. L. Quar. Quar. Quar. Mldgs. Quar. Mldgs. Quar. Pillar Quar. Pillar Rad, Grille R. L. C. Quar. Mldgs.W/O Quar. Mldgs. W/O Rad.Grille Side R. L. R MISC. Grille Brace eum Ex. ew Hub Cap S-L Grille Shell W t% Mk lot Fender Tie Bar Bumper Brkt. L. Front Seat Bumper Gd. L. R. Front Seat Tracks R-L Gravel Shield Hood Lock IRLower Panel Hood Top , S Top Hood Hinge-Orn. Tire % Worn Hood Mldg. Floor Pan Rod. Sup. Trunk Lid Battery Rad. Trunk Lid—Orn. Antenna Trunk Mldgs. Up Low Mirror- Remote Rad. Core A/C Point$ Material (� Coolant Tail Light L-R Under Seal `f Stripe Fan Blade 4567 $ Back U Light L. R. TOW& STORAGE Clutch Fon P 9 Water Pump- Pulley Frame L. R. Lao H Air Cond. Core Y— Parts 8 $ Dehydrator Gas Tank-Filler Mat'I. Less Disc. a Recharge A/C Wheel-13-11-15 Sublet 8 Net Items $ Trans. Linkage Tail Gate Sales Tax $ ( 0 Agreed With TOTAL $400 A—Align N—New OH—Overhaul S—Straighten or Repair EX—Exchange RC—Rechrome U—Used Items not covered by estimate or hidden will be additional. } CLAIM RECEIVED BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA N O v 18 1991 Claim Against the County, or District governed by) BOA I the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT D e c e m e MAR z, �1 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 Supervisor; (Paragraph IV below), given pursuant to Government Code Amount: Indemnity Section 913 and 915.4. Please rote all "Warnings". CLAIMANT: DIAMOND, Bert OPTIMA FINANCIAL SERVICES, INC . ATTORNEY: William E. Joost , Jr. D Mayo, Rogers '& Joost ate received ADDRESS: 100 Bush Street, 21st FlogY_DELIVERY TO CLERK ON November 13, 1991 San Francisco, CA 94104 November 12 1991 BY MAIL POSTMARKED: , I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 15 1991 PpHHIL ATCHELOR, Clerk BY: Deputy CL L,, 09 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: I. BY:� S Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis ator (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:®E Q 0 1991 ` PHIL BATCHELOR, Clerk, By d Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was.personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC I BY: PHIL BATCHELOR by d Deputy Clerk CC: County Counsel County Administrator MAYO, ROGERS & JOOST WILLIAM E.JOOST,JR. ATTORNEYS AT LAW TELEPHONE TERENCE O.MAYO 100 BUSH STREET, 21st FLOOR (415)788.1717 RICHARD M.ROGERS SAN FRANCISCO, CALIFORNIA 94104 FAX(415)397-1540 November 12, 1991 RECEIVED NOV 13 1991 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Clerk, Board of Supervisors Contra Costa County 651 Pine Street Martinez, California 94553 Re: Johnson:Miraglia v. Contra Costa County, et al. Contra Costa Superior Court No. : C91-03883 Dear Clerk: Our firm represents Optima Financial Insurance Services and Bert Diamond in the above-referenced matter. Please accept the following on behalf of our clients and acknowledge receipt at your first convenience: CLAIM FOR INDEMNITY/CONTRIBUTION AGAINST COUNTY OF CONTRA COSTA ON BEHALF OF OPTIMA FINANCIAL SERVICES, INC. AND BERT DIAMOND A. The names and addresses of the claimants are as follows: Bert Diamond Optima Financial Services, Inc. Pier 26 San Francisco, California 94105 B. All notices regarding this claim should be sent to the attorneys representing the claimants, as follows: William E. Joost, Jr. Mayo, Rogers & Joost 100 Bush Street, 21st Floor San Francisco, California 94104 (415) 788-1717 C. The date, place, and circumstances of the occurrences which give rise to the claim are as follows: Receipt of plaintiff's Complaint for Damages on or after August 14, 1991 Clerk, Board of Supervisors Re: Johnson-Miraglia v. Contra Costa County, et al. November 12, 1991 ' Page 2 and plaintiff's First Amended Complaint for Damages on or after September 18, 1991. See First Amended Complaint for damages, enclosed, for plaintiff's allegations. D. The damages and other losses incurred to date and anticipated in the future include the following: 1. Past, present and future attorneys' fees and other litigation expenses in defense of plaintiff's lawsuit; 2 . ; Exposure to plaintiff for damages and possible payments therefore, whether via judgment, settlement, or otherwise. E. The names of the public employees who allegedly caused the damages and ,other losses alleged by plaintiff are Harry Cisterman, Eileen' Bitten, Phil Batchelor, and others unknown at this time. The monetary; value of claimants' past, present, and future losses have not been determined at this time, but are expected to exceed $10,000.00iand the jurisdictional limits of the Municipal Court; therefore, this claim is within the jurisdiction of the Superior Court. Very truly yours, MAYO, ROGERS & J ST William E. Jo s Jr WEJ:rb Enclosure cc: Sanford Rosen, Esq. William R. Hartman, Esq. I _^ RECEI1/ MARTIN FASSLER PRISCILLA Si WINSLOW SEP S CATHERINE A' PORTER WINSLOW & FASSLER LAW OFRCFS (% 405 14th Street - Suite 1100 THOMAS0. MkoOakland, California 94612 4 Telephone: (415) 839-2543 5 Attorneys for Plaintiff, Peggy Johnson-Miraglia 6 7 8 9 SUPERIOR COURT OF THE STATE OF CALIFORNIA 10 IN THE COUNTY OF CONTRA COSTA 11 12 13 PEGGY JOHNSON-MIRAGLIA NO. C91-03883 14 Plaintiff, FIRST AMENDED COMPLAINT FOR 15 DAMAGES FOR VIOLATION OF Vs. GOVERNMENT CODE SECTION 16 53298 ; SEX DISCRIMINATION; CONTRA COSTA COUNTY ; PHIL DEFAMATION; RETALIATION IN 17 BATCHELOR, in his official VIOLATION OF PUBLIC POLICY; capacity a s County INTENTIONAL INTERFERENCE WITH 18 Administrator of the County of PROSPECTIVE ECONOMIC Contra Costa; HARRY CISTERMAN, ADVANTAGE ; NEGLIGENT 19 in his official capacity as INTERFERENCE WITH PROSPECTIVE Personnel! Director a n d ECONOMIC ADVANTAGE 20 Assistant County Administrator of the County of Contra Costa; 21 EILEEN BITTEN, in her official capacity , as Assistant 22 Personnel Director of the County of Contra Costa ; 23 OPTIMA FINANCIAL, a California Corporation ; SYNERGETIC 24 INSURANCE!` ADMINISTRATIVE SERVICES , a California 25 Corporation; BERT DIAMOND; DOES I through V; ROES VI 26 through X, 27 'Defendants. 28 � I . 1 INTRODUCTION 2 From August of 1986 until June of 1991, plaintiff held 3 the position of Manager of Employee Benefits for the County of Contra Costa. In that position, it was her responsibility to 5 oversee the operation, of the County government's employee benefit programs, including medical insurance, dental 7 insurance, and deferred compensation. $ Over ',the course of more than two years, from early 1988 until late 1990, plaintiff made persistent efforts to protect 10 the interests of the County and of the County's employees in 11 the operation and integrity of trust funds and insurance plans 1 12 that were designed to benefit the county' s employees. At the I 13- core of these actions were plaintiff 's effort to obtain 14 -- reports, information and explanations from defendant SYNERGETIC 15 INSURANCE ADMINISTRATIVE SERVICES, the private business that 16 handled and paid county employee claims for medical insurance 17 payments. Plaintiff was seeking information concerning (1) 18 payments made by defendant SYNERGETIC to various medical, 19 providers - doctors, hospitals and pharmacies; (2) policies and 20 procedures used by defendant SYNERGETIC in determining whether 21 to make such payments, and the amounts to be paid; and (3) .22 r methods employed by SYNERGETIC to determine increases in the '23 rates paid ' to SYNERGETIC by the - defendant COUNTY OF CONTRA 4,24 COSTA. 25 The County and plaintiff, as the County's Manager of 26 Employee Benefits, were entitled to receive such reports, 27 28 2 1 information sand explanations from defendant SYNERGETIC on a 2 timely basis',. 3 Defendants CISTERMAN, BITTEN, DIAMOND, AND SYNERGETIC 4 all refused' to provide the information sought and instead 5 actively hindered plaintiff' s efforts to obtain the reports, 6 inf ormationli and explanations she sought. Defendants 7 CISTERMAN, BITTEN & DIAMOND actively discouraged defendant ------------------- 8 SYNERGETIC from providing the information. Further, as a g direct consequence of plaintiff ' s efforts, plaintiff suffered J 10 continual retaliation at the hands of her direct supervisors, defendants GISTERMAN and BITTEN; was systematically denied •y 2 relevant information within her areas of responsibility by✓ ✓ -�. =defenda�t� 1defendants; , was systematically excluded by from ` I' 14 management-level meetings concerning her . areas of U � �15 responsibility; and in numerous ways was prevented by I 16 efendan£�- rom carrying out her responsibilities on behalf of 17 the County. All, efforts by plaintiff to improve matters were i } 18 rebuffed b, ,defendants. I ' 19 In Augus of 1990, plaintiff sent to each of the County 20 Supervisors a lengthy letter advising the supervisors of gross 21 mismanagement, waste of funds and abuse of authority by the 22 County's Director of Personnel and Assistant Director of 23 Personnel, specifically with respect to the County' s employee 24 benefit programs. In the months that followed, until June of 25 1991, when plaintiff resigned her position, she was subjected 26 to increased harassment and retaliation by defendants 27 CISTERMAN, BITTEN, BATCHELOR and COUNTY OF CONTRA COSTA, all in 28 Vim' 3 \ / 1 violation of Government Code Section 53296 et. seq. , the 2 California law designed to protect local government employee 3 "whistle-blowers. " 4 PARTIES 5 1. Plaintiff PEGGY JOHNSON-MIRAGLIA is and at all 6 times relevant herein was a resident of Contra Costa County. 7 From June of 1987 until her resignation in June of 1991, 8 JOHNSON-MIRAGLIA was employed by the County of Contra Costa as 9 Manager of" Employee Benefits. During the ten months 10 immediately ',preceding her appointment as Manager of Employee 11 Benefits, JOHNSON-MIRAGLIA was employed by the County of 12 Contra Costa as Coordinator of Employee Benefits, performing 13 the same functions that she would later perform as Manager. 14 2 . Defendant COUNTY OF CONTRA COSTA is a political 15 subdivision of the State of California. It is a "local agency" 16 within the meaning of Government Code Section 53296 et. al. 17 3 . 'Defendant PHIL BATCHELOR is and at all relevant 18 times herein was the County Administrator of the County of . i 19 Contra Costa. As such, he is and was the chief administrative 20 officer of the defendant County of Contra Costa. He is a 21 manager within the meaning of Government Code Section 22 53296 (f) . 23 4 . Defendant HARRY CISTERMAN is and at all relevant 24 times herein was both Personnel Director and Assistant County 25 Administrator of the defendant COUNTY OF CONTRA COSTA. At all 26 relevant times, as the head of the county department in which 27 plaintiff worked, defendant CISTERMAN took an active day-to- 28 4 1 day role in overseeing plaintiff 's area of responsibility, 2 employee benefits. At relevant times, he was also plaintiff's 3 immediate supervisor. He is a manager within the meaning of 4 Government Code Section 53296 (f) . 5 5. Defendant EILEEN BITTEN was, from on or about March 6 1, 1990 until the present time, Assistant Personnel Director 7 and Personnel Department Operations Manager for defendant 8 CONTRA COSTA COUNTY. As such, she reported directly to 9 defendant CISTERMAN and was, ostensibly, given the 10 responsibility to be plaintiff 's immediate supervisor. She is 11 a supervisor, or manager within the meaning of Government Code 12 Section 53296. 13 6. Plaintiff is informed and believes and on that 14 basis alleges that Defendant BERT DIAMOND is a resident of the 15 County of Marin, and at all relevant times was president and 16 chief executive officer of defendant OPTIMA FINANCIAL. At all 17 relevant times herein, defendant DIAMOND was a "consultant" or i 18 "advisor" to; the defendant COUNTY OF CONTRA COSTA with respect 19 to employee benefits. As such, DIAMOND was an agent and acted I 20 on behalf of the defendant COUNTY OF CONTRA COSTA with respect 21 to those matters. 22 7 . Defendant OPTIMA FINANCIAL is a California 23 corporation ( doing business in the County of Contra Costa as i 24 well as in other counties of the State of California. At all 25 relevant times herein, defendant OPTIMA FINANCIAL was a 26 "consultant"'' or "advisor" to the defendant COUNTY OF CONTRA G 27 COSTA with respect to employee benefits. As such, OPTIMA F 28 5 FINANCIAL was an agent and acted on behalf of the defendant G 2 COUNTY OF CONTRA COSTA with respect to those matters. 3 8 . Defendant SYNERGETIC INSURANCE ADMINISTRATIVE 4 SERVICES is , a California corporation, doing business in the 5 County of Contra Costa as well as in other counties of the 6 State of California. Prior to January of 1991 SYNERGETIC was 7 known as and did business as "Stateco Administrative Services. " 8 9 . Plaintiff is informed and believes and on that 9 basis alleges that defendants Does I through V are individual 10 California residents whose names are now unknown to the 11 Plaintiff. In the event that the identities of these 12 individuals become known to plaintiff, she will seek leave of i 13 court. to amend this Complaint to properly identify them. 14 lo. Plaintiff is informed and believes and on that 15 basis alleges that Roes VI through X are business entities 16 whose names and forms are currently unknown to plaintiff. In 17 the event that the identities and forms of these business 18 entities become known to plaintiff, she will seek leave of 19 court to amend this Complaint to properly identify them. `1 20 FIRST CAUSE OF ACTION (Retaliation for Refusal to Participate in Illegal Action) 21 11. In or about January 1988, the defendant COUNTY OF � 22 CONTRA COSTA created a self-insured medical insurance plan /�0 23 known as "First Choice, " available to those county, employees 24 who wished to enroll in it. To finance the "First Choice" 25 plan, the County committed itself to allocating a certain 26 amount of money per employee to a trust fund. In addition, 27 each employee who chose to be insured through the First Choice 28 6 �r Plan made a monthly contribution to the trust fund. The costs 2 of providing medical care to these employees and their 3 dependents were to be paid out of this trust fund. 4 12. In or about January of 1988 defendant COUNTY OF 5 CONTRA COSTA entered into an agreement with defendant 6 SYNERGETIC (which was then known as "Stateco Administrative 7 Services") to act as administrator of the "First Choice" plan. 8 Under terms of that agreement, defendant SYNERGETIC was to 9 receive and ' review claims for payment or reimbursement for 10 medical services, paying only those claims that were valid and 11 covered by the terms of the insurance plan; and perform other 12 services for. the defendant COUNTY OF CONTRA COSTA. Under terms 13 of said agreement, SYNERGETIC was to be paid by the defendant 1 14 COUNTY OF CONTRA COSTA nine per cent of the dollar value of the 15 payments made by SYNERGETIC to or on behalf of County 16 employees. 17 13 . Beginning in or about January of 1988 defendant 18 COUNTY OF CONTRA COSTA had an unwritten agreement with 19 defendants DIAMOND and OPTIMA FINANCIAL under which defendants 20 DIAMOND and ' OPTIMA FINANCIAL were to act as advisors to the 21 county with respect to the County' s dealings with defendant 22 SYNERGETIC and with respect to other providers of employee 23 benefits (e I g. dental insurance and 'deferred compensation 24 accounts) . 25 14 . Plaintiff is informed and believes and on that 26 basis alleges that during the same period of time referred to 27 in paragraph 13 above, defendants DIAMOND and OPTIMA FINANCIAL 28 7 1 had an agreement with defendant SYNERGETIC under which 2 defendants DIAMOND and OPTIMA FINANCIAL would receive at least 3 one-sixth of the payments made to SYNERGETIC by the defendant 4 COUNTY OF CONTRA COSTA. That agreement between SYNERGETIC, 5 OPTIMA FINANCIAL and DIAMOND was known � to all other 6 defendants. 7 15. Beginning in or about January of 1988 and 8 continuing iuntil in or about December of 1990 plaintiff 9 JOHNSON-MIRAGLIA on numerous occasions requested from defendant 10 SYNERGETIC reports, information and explanations regarding X11 the following: (1) payments made by defendant SYNERGETIC to X12 county employees and to various medical providers - doctors, 13 hospitals and pharmacies - on behalf of county employees; (2) 14 policies , procedures used by defendant SYNERGETIC in i } 15 determining ;whether to make such payments and the amounts to 15 be paid; and (3) methods employed by SYNERGETIC to determine 17 increases in the rates paid to SYNERGETIC by the defendant . '. 18 COUNTY OF CONTRA COSTA. Defendant COUNTY OF CONTRA COSTA and r 19 Plaintiff, as Manager of Employee Benefits, were entitled to 20 receive these reports, information and explanations from 21 defendant SYNERGETIC. 22 16. Plaintiff sought such reports, information and 23 explanations because the County needed these reports, 24 information 11 and explanations to determine whether SYNERGETIC. 25 was complying with the terms of. the agreement between COUNTY OF 26 CONTRA COSTA and SYNERGETIC and to verify that County funds 27 were being properly spent by SYNERGETIC. 28 8 I _:Y 1 17. ;Defendant COUNTY OF CONTRA COSTA and plaintiff, as 2 the county executive with responsibility for overseeing 3 employee benefits, was entitled to receive the reports, 4 information and explanations which plaintiff sought under the 5 terms of the contract between the COUNTY OF CONTRA COSTA and 6 defendant SYNERGETIC. 7 18 . Further, defendant COUNTY OF CONTRA COSTA and 8 plaintiff were entitled to receive the reports, information and 9 explanations': sought by plaintiff, as a consequence of their 10 responsibility to prevent fraud and waste of both county funds 11 and contributions made by employee, and to oversee the proper 12 operation of' the trust fund, referred to in paragraph 11, from 13 which defendant SYNERGETIC was paid. 14 19 f Throughout the period of time referred to in 15 paragraph 15, defendan SYNERGETIC refused to provide to 16 plaintiff, or refused in provide in a timely fashion, the 17 reports, information and explanations sought by plaintiff. 18 20./ ,Throughout the period of time referred to in ' 19 paragraph 15, defendants CISTERMAN, BITTEN' DIAMOD and OP NTIMA '� 20 FINANCIAL�1refused to- a e any steps to assist plaintiff) in 21 obtaining the appropriate information, reports and explanations 22 from defendant SYNERGETIC. Instead, defendants CISTERMAN, 23 BITTEN DIAMOND, and OPS ssisted SYNERGETIC in evading 1, 24 laintiff ' s efforts -o obtain the information sought. 25 21. During the period beginning in or about January of .j �26 1988 nd continuing until December of 1990 defendants ? 27 CISTERMAN, BITTEN, DIAMOND, OPTIMA FINANCIAL an d SYNERGETIC 28 9 7rfetalia:ted:),gainst plaintiff for her efforts to prevent the 2 misuse of county funds and her efforts to obtain the reports, 3 information and explanations referred to in paragraph 15. This 4 retaliation took the form of: 5 a. Systematically excluding plaintiff from meetings 6 attended by defendants SYNERGETIC, DIAMOND, CISTERMAN, and 7 BITTEN concerning the operation of the First Choice plan. % 8 b. Systematically denying plaintiff access to i g reports, information and explanations needed to carry out her 10 responsibilities as manager of employee benefits. c. Systematically refusing to assign to plaintiff 12 sufficient clerical and administrative staff to enable her to 113 carry out her responsibilities as manager of employee benefits. 14 d. Assigning to plaintiff, ostensibly for her 15 assistance, clerical and administrative staff known or believed �t 16 by defendants to be incapable of carrying out the duties to be `-' � 17 assigned to them. �18 In so doing, defendants CISTERMAN, BITTEN and 1 DIAMOND acting in concert with defendants SYNERGETIC and 20 ::::!::;:�e NANCIAL, cted in violation of the public policy of 21 of California. 22 SECOND CAUSE OF ACTION 23 (Retaliation in- Violation of Government Code Sections 53296 et. al. ) 24 23 . Plaintiff hereby re-alleges and incorporates herein 25 the allegations of paragraphs 1 through 22 . 26 24 . On or about. August 17, 1990, plaintiff sent to each 27 member of the County Board of Supervisors a statement under 28 10 I penalty of perjury, in the form of a letter disclosing 2 mismanagement, ' abuse of authority, and apparent significant 3 waste of funds. One copy of said letter is attached hereto as 4 Exhibit l and incorporated herein as if fully set forth. 5 U Beginning on August 20, 1990 and continuing until 6 the time of plaintiff's resignation on June 21, 1991, 7 defendants CISTERMAN, BITTEN, BATCHELO , MO DIAND, OPTIMA, 8 SYNERGETIC, and COUNTY OF CONTRA COSTA retaliat against �q plaintiff for the actions described in paragraph 24 above, in 10 violation of Government Code Section 53298 , and did so with 11 malicious intent within the meaning of Section 53298 . 5. 12 26 Said retaliation included the following forms of 13 retaliation,, among others,;__ j� 14a. Defendants systematically excluded plaints' f 15 from meetings at y defendants SYNERGETIC, DIAMOND, 16 CISTERMAN, and BITTEN and other county administrators 17 concerning the operation of both the First Choice plan and 18 other employee benefit plans:• 19 ( b. Defendants systematically denied plaintiff 2 access to reports, information and explanations needed to carry 21 out her resp'onsibilities.._as manager of employee benefits. 22 Defendants systematically refused to assign to 23 plaintiff sufficient clerical and administrative staff to 24 enable her to carry out her responsibilities as manager of 25 employee benefits 26 * Defendant assigned to plaintiff, ostensibly I 27 for her asss clerical and administrative staff known or 28 11 ' 1 believed by' defendants to be incapable of carrying out the 2 duties to be a to them. 3 e. �Defenda s assigned to plaintiff additional duties i 4 and responsibilities in a manner so as to maximize the 5 likelihood she would not be able to complete the tasks assigned 6 to her. ;f. In or about the month of December of 1990 8 defendants COUNTY OF CONTRA COSTA, BATCHELOR, CISTERMAN and 9 BITTEN removed from plaintiff 's responsibilities all aspects of 10 the operation of the First Choice Plan, as well as other X11 aspects of her work as Manager of Employee Benefits. 12 cDef endants published to county employees 13 and other persons s �ements wnto be false by those making 1 14 the statements concerning the plaintiff, her professional 15 abilities and her performance. 16 27 • The retaliation described in paragraphs 21, 25 and 17 26 above amounted to imposition on plaintiff of intolerable 18 working conditions, amounting to constructive discharge f om 19 her position as Manager of Employee Bene 20 THIRD CAUSE OF ACTION (Defamation) 21 28 . plaintiff hereby re-alleges and incorporates herein 22 the allegations of paragraphs 1 through 26 above. 23 29 . By the knowing distribution of the false 24 statements %aracterizations referred to in paragraph 26g 25 above defendantave defamed plaintiff JOHNSON-MIRAGLIA. 26 27 28 12 1 FOURTH CAUSE OF ACTION (Sex discrimination in violation of Government Code 2 Section 12940 et. seq. ) 3 30. Plaintiff hereby re-alleges and incorporates herein 4 the allegations of paragraphs 1 through 29 above. 5 31. In her position as Manager of Employee Benefits, 6 plaintiff was the only female among six division heads within 7 the Personnel Department. Throughout the period of time that 8 plaintiff held her position as Manager of Employee Benefits, g she was treated in a discriminatory fashion by efendant 1 "CISTERMAN nd then by defendan BITTEN. This discriminatory 11 treatment included: J12 a. imposition of more onerous job requirements on 113 Plaintiff than on other male managerial employees in comparable 114 Positions; 15 'b . Imposition on plaintiff of menial job 16 requirements not imposed on male managerial employees in X17 comparable positions; 18 'c. refusal to allow plaintiff to exercise her own i 19 judgment in the choice of employees assigned to subordinate 20 clerical and administrative positions, although male managerial 21 employees in comparable positions were permitted to do so; . 22 d . refusal to allow plaintiff to attend 23 professional conferences related to her areas of 24 responsibility, although male managerial employees in X25 comparable positions were permitted to do so; u26 e. By means of jokes and comments about women, J ) 27 creating a hostile working environment for plaintiff; V 28 13 1 f. Other forms of discrimination. 2 32 . By acting in the ways described in paragraph 31 above, 3 defendants COUNTY OF CONTRA COSTA, CISTERMAN, and BITTEN 4 discriminated against plaintiff on the basis of her sex, in 5 violation of Government Code Section 12940. 6 33 . Within the year prior to the filing of this Complaint, 7 plaintiff received from the California Department of Fair <_8 Employment and Housing a right-to-sue letter pursuant to 9 Government Code Section 12965. 10 FIFTH CAUSE OF ACTION (Sex Discrimination in Violation of the California Constitution) 11 34 . Plaintiff hereby re-alleges and incorporates herein the 12 allegations of paragraphs 1 through 33 . 13 35. By discriminating against plaintiff on the basis of her 14 s defendant have violated Article I, Section 8 of the 15 Cali is Constitution. 16 SIXTH CAUSE OF ACTION 17 (Intentional Interference with Prospective Economic Advantage by 18 Defendants OPTIMA, DIAMOND, and SYNERGETICS) 19 36 . Plaintiff re-alleges and incorporates herein the 20 allegations of paragraphs 1 through 35. 21 37 . At all relevant times herein, defendants DIAMOND, 22 OPTIMA, and SYNERGETICS were aware .of all the following facts: 23 a. Plaintiff was employed by the County of Contra Costa 24 first as Coordinator of Employee Benefits, . and then as Manager 25 of Employee Benefits. 26 b. In her position as Coordinator, and then as Manager 27 of Employee Benefits , plaintiff had the following 28 14 • /..>>'' �1 responsibilities, among others: (1) to oversee the operation of 2 the County's First Choice plan; (2) to assure that funds 3 deposited in the First Choice trust fund by both the county and 4 its employees were used only for legitimate purposes related to 5 the provision of medical services to the county's employees and 6 dependents, as limited by the terms of the plan; (3) to see 7 that none of said funds were expended improperly by SYNERGETIC; x 8 (4) to see that the rates charged to the county by SYNERGETIC 9 were authorized by the contract between the County and 1110 SYNERGETIC; (5) to see that SYNERGETIC provided to the County, i 11 and to the County' s employees and dependents in a timely and 112 effective fashion, all services set out in the contract between i 1113 SYNERGETIC and the County; and (6) to see that SYNERGETIC 14 Provided to the county in a timely and effective fashion all `,15 appropriate 'information and reports required by the county. 16 38 . By the actions described in paragraphs 19, 20, 21, 25, --'� 17 26 and 29 , defendants DIAMOND, OPTIMA and SYNERGETIC acted in 18 a way calculated to interfere with and disrupt the relationship 19 between plaintiff and Contra Costa County, plaintiff 's 20 employer. 21 39 . By the actions described in paragraphs 19, 20, 21, 25, 22 26 and 29 defendants DIAMOND, OPTIMA and SYNERGETIC did in 23 fact interfere with and disrupt the relationship between 24 plaintiff and Contra Costa County, plaintiff ' s employer. 25 40. As a direct and foreseeable consequence of the acts of 26 defendants DIAMOND, OPTIMA, and SYNERGETIC, plaintiff 27 suffered damages as alleged in paragraphs 40 through 45 below. 28 15 1 SEVENTH CAUSE OF ACTION (Negligent Interference with Plaintiff 's Prospective Economic 2 advantage', by Defendants OPTIMA, DIAMOND, and SYNERGETICS) 3 41 . Plaintiff re-alleges and incorporates herein the 4 allegations: of paragraphs 1 through 39. 5 42. Defendants DIAMOND, OPTIMA and SYNERGETICS knew or 6 should have known that the actions of defendants described in 7 paragraphs ' 19, 20, 21, 25, 26 and 29, would result in g interference and disruption of the relationship between 9 plaintiff and Contra Costa County, plaintiff's employer, to the 10 point where plaintiff would be unable to function in her 11 position as Manager of Employee Benefits, and would have to 12 leave her position. 13 43 . By the actions described in paragraphs 19, 20, 21, 25, 14 26 and 29, defendants DIAMOND, OPTIMA and SYNERGETIC did in 15 fact interfere with and disrupt the relationship between 16 plaintiff and Contra Costa County, plaintiff's employer to the 17 extent that plaintiff found it impossible to carry out the 18 duties of her position as Manager of Employee Benefits and was 19 eventually forced to leave her position 20 44 . As a direct and foreseeable consequence of the acts of 21 defendants DIAMOND, OPTIMA, and SYNERGETIC, plaintiff 22 suffered damages as alleged in paragraphs 45 through 50 below. 23 DAMAGES 24 45. As a proximate result of the aforementioned acts of the 25 defendants and each of them, as set out in paragraphs 11 20 through 44 , plaintiff has suffered damages in the form of lost -- 27 earnings, in an amount to be determined at trial. 28 16 1 46. As a further proximate result of the aforementioned 2 acts of the defendants and each of them, as set out in 3 paragraphs 11 through 44 , plaintiff has suffered loss of 4 employment benefits, including retirement benefits, accorded to 5 employees of the County of Contra Costa, in an amount to be 6 determined at trial. 7 47. As a further proximate result of the aforementioned 8 acts of the defendants and each of them, as set out in 9 paragraphs 11 through 44 , plaintiff has suffered loss of / 10 respect and prestige, and dim' d—r- u, at o_L in her 11 Professional field; 12 48 . As a further proximate result of the aforementioned acts 13 of the defendants and each of them, as set out in paragraphs 11 14 through 44 , plaintiff has suffered an impairment of her future 15 earning ability, in an amount to be determined at trial. 16 49 . As a further proximate result of the aforementioned 17 acts of the defendants and each of them, as set out in 18 paragraphs 11 through 44 , plaintiff has suffered emotional 19 distress, humiliation and anxiety in ways and to the extent to 20 be established at trial. 21 50. As a further proximate result of the aforementioned 22 acts of the defendants and each of them, as set out in 23 Paragraphs 11 through 44 , plaintiff has been forced to incur 24 attorneys fees ' and costs in the prosecution of this law suit. 25 Plaintiff prays leave to amend this Complaint when the total 26 amount of said fees and costs are known. 27 28 17 1 WHEREFORE, plaintiff prays for judgment against 2 defendants and each of them and respectfully requests that this 3 court award her: 4 1. Damages for lost wages and for impairment of future 5 earning capacity according to proof; 6 2 . Damages for the loss of the value of employee 7 benefits of which plaintiff was deprived by reason of the 8 defendants ' unlawful action; 9 3 . General damages and damages for emotional distress 10 in an amount exceeding the jurisdictional minimum for actions 11 filed in this court. 12 4 . Damages for the loss of professional reputation and 13 respect in her field of work; 14 5. Reasonable attorneys' fees , and costs of suit 15 incurred herein; 16 6 . Punitive damages, to be paid by defendants 17 CISTERMAN, BITTEN, and BATCHELOR, as authorized by Government 18 Code Section 53298.5. 19 7 . Such other relief as the Court may deem just and 20 Proper. 21 WINSLOW & FASSLER 22 23 Dated: September , 1991 MARTIN FASSLER 24 25 26 27 28 18 ,rye 1 PROOF OF SERVICE BY MAIL 2 3 I, Candice Pacheco, hereby declare and state: 4 I am over the age of eighteen years, employed in the 5 County of Alameda, State of California and am not a party to 6 the within ' named action. My business address is 405 14th 7 Street, Suite 1100, Oakland, CA 94612. I am readily familiar 8 with the ordinary practice of the business in collecting, 9 processing and depositing correspondence in the United States 10 Postal Service and that the correspondence will be deposited 11 the same day with postage thereon fully prepaid. 12 On September 17, 1991, I served the within First Amended 13 Complaint for Damages for Violation of Government Code Section 14 53298; Sex Discrimination; Defamation; Retaliation in Violation 15 of Public Policy; Intentional Interference with Prospective 16 Economic Advantage; Negligent Interference with Prospective 17 Economic Advantage on the parties in said cause by , placing a 18 true copy thereof enclosed in a sealed envelope with postage 19 prepaid thereon in the United States Post Office mail at 20 Oakland, California, addressed as follows: 21 Sanford Rosen Michael Ney Rosen, Bien[ & Asaro- McNamara, Houston, Dodge, 22 155 Montgomery Street - 8th. Floor McClure & Ney San Francisco, CA 94104 P.O. Box 5288 23 1 Walnut Creek, CA 94596 Leonard Cook 24 Law Office of Thomas Marple 1939 Harrison Street 25 Oakland, CA, 94612 26 27 28 I I declare under penalty of perjury that the foregoing is 2 true and correct. 3 Executed on September 17, 1991, at Oakland, California. 4 5 Candice Pacheco 6 7 8 9 10 11 12 13 r 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 r _ CLAIM A S BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 10, 1991 and Board Action. All Section references are to ) The.copy of this document mailed to you is your notice of CalJornia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $125,000.00 Ift and 915.4. Please note all "Warnings". CLAIMANT: not specified) ATTORNEY: Michael D. Goforth, Esq.. COUN'n�CALIF. Goforth & Lucas NNWVrece;ved ADDRESS: 2300 Clayton Road, Suite 520 BY DELIVERY TO CLERK ON November 12, 1991 Concord, CA 94520 BY MAIL POSTMARKED: November 8, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 13, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy 't.,IJ II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. N ) 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: 11 14 191 BY: ; ,_ 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 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: AEC 1 0 1991 PHIL BATCHELOR, Clerk, By_rf00,-4.21D , 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 515.6. 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. (1Dated: DEC 10 1991 BY: PHIL BATCHELOR by If Deputy Clerk M � CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Michael D. Goforth; Esq. GOFORTH & LUCAS . 2300 Clayton Road, Suite 520 Concord, California 94520 Re: Claim of UNSTATED and UNKNOWN Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: X 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 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 Istate the name(s) of the public employee(s ) causing the injury, damage, or loss, if known . 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ( $10, 000 )., the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, o� the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: ► �� ' Deputy unty Counsel�j CERTIFICATE OF SERVICE BY MAIL C.C.P. §9 1012, 1013a, 2015 . 5 ; Evid. C. 99 641 , 664 My business addres's is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen' of the United States, over 18 years of. age, employed in Contra' Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s ) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter wase, on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct . Dated: � at Martinez, Californi cc: Clerk of the Board of Supervisors ( iginal ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 21 920 . 41 910 . 8) Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code _:§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against'a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) NOV 1 2 1991 or ) CLERK BOARD OF SUPE District) CONTRA COSTA cn. Fill in name ) - The undersigned claimant hereby makes claim against the County o Contra Costa or the above-named District in the sump of $ 125,000.00 general dc-@Mefh support of this claim represents as follows: $Special damages: Pending ------------------------------------------------------------------------------------- 1. When did the damage .or injury occur? (Give exact date and hour) On or about September 30, 1991, at approximately 11:35 a.m. ------------------------------------------------------------------------------------ 2. Where did the damage or injury occur? (Include city and county), at the premises located at 600 F Street, Martinez, California, County of Contra Costa 3. How did the damage or injury occur? (Give full details; use extra paper if required) Minor tripped over an unattended lawn mower causing her sustain second degree burns to her left leg.-. ------------------------ What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? . County employees left a gas powered lawn mower unattended and in dangerous proximity to a footpath which was in use by juvenile day care students. As a proximate result, claimant, while leaving her day care class, was severely burned when she came into contact with the mower engine which was hot. (over) N m Soo "A o Q° oN o 2 O N �tr O C7m / ti` �Od'QJG c9� • X09 t5' 00 K N a�.'1x b.� O N Q, 0 Sv CD �+ vi LP i S M rv1 CLAIM RECEIVED /Is • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA N O V 18 1991 Claim Against the County, or District governed by) BOARR&MpIOUNSEt the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 1Vfj;NEZ1q,,9q. and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GORMAN, Jerry Dwayne, GORMAN, Cheri , GORMAN, Crystal Diane ATTORNEY: Jon P. Tonsing, Esq. Tonsing & Tonsing Date received ADDRESS: 500 Ygnacio Valley Road BY DELIVERY TO CLERK ON November 13, 1991 Suite 300 November 12 1991 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Certified P 725 310 423 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 15 1991 EVIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim isnot 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: h /11 BY: Jc r A Deputy County Counsel I / i �T \Vi 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. CL 0" Dated: DEC 10 1991, PHIL BATCHELOR, Clerk, By N"L.... 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 (a�bgove. Dated: DEC 1 Q 19Q I BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator 1 Irven L. Grant, Esq. Jon P. Tonsing, Esq. 2 TONSING & TONSING _ 500 Ygnacio Valley Rd. , Suite 300 RECEIVEDp 3 Walnut Creek, California 94596 s=_ (510) 947-1600 4 NOV 1 3 1996 Attorneys for Claimants 5 CLERK E; ")r SUPER 7 8 In the matter of the claim of ) 9 JERRY DEWAYNE GORMAN, CHERI GORMAN ) and CRYSTAL DIANE GORMAN, a minor, ) NOTICE OF CLAIM AGAINST 10 ) THE COUNTY OF CONTRA COSTA Claimants, ) 11 ) V. ) 12 ) THE COUNTY OF CONTRA COSTA, and ) 13 Public Employees designated as ) DOES 1-20. ) 14 ) 15 Claimants hereby present this claim to the County of Contra 16 Costa pursuant to section 910 of the California Government Code. 17 1. The names and addresses of claimants and the address to 18 which all communications regarding this claim should be sent is to 19 JERRY DEWAYNE GORMAN, CHERI GORMAN and CRYSTAL DIANE GORMAN, a minor, 20 c/o Jon P. Tonsing, Tonsing & Tonsing, 500 Ygnacio Valley Road, Suite 21 300, Walnut Creek, California 94596. Claimants are informed and 22 believe that DOES 1-20 are employees of CONTRA COSTA COUNTY who are 23 responsible for the negligent acts described below. Claimants have 24 not yet ascertained the names of DOES 1-20. 25 2 . On May 13 , 1991, at some time between the hours of 12 : 00 26 a.m. and 12 :40 a.m. , DEWAYNE GORMAN was traveling southbound over 27 Kirker Pass Road, at or near the intersection of Kirker Pass Road and 28 c:\wp51\HERNANDEZ/COCOGORM.CLM/567.1/dmc 1 1 North Hess Road, City of Pittsburg, County of Contra Costa, State of 2 California. 3 3 . At approximately the above time, the described roadway, 4 roadway shoulder, and surrounding location were so negligently, 5 improperly, inadequately and defectively constructed, maintained, 6 patrolled, and designed, and without proper speed control and lighting 7 as to render the roadway unsafe for travel . Such defects and 8 inadequacies include, but are not limited to, conditions that fail to 9 provide nighttime travelers with proper road conditions, lighting, 10 time, and space to recognize and avoid roadway hazards. 11 4 . As a direct result of the above negligence, JERRY 12 DEWAYNE GORMAN, at the time and place described, collided with a 13 vehicle on Kirker Pass Road located at or near the intersection at 14 Kirker Pass Road and North Hess. 15 5. As a further result of the above-described negligent 16 acts, claimants JERRY GORMAN, CHERI GORMAN, and CRYSTAL DIANE GORMAN, 17 a minor, and each of them, have suffered, and will continue to suffer, 18 general damages, loss of consortium, loss of affection, medical 19 expenses, emotional distress, economic losses, loss of wages, loss of 20 earning capacity, and property damage. 21 6. The amount hereby claimed as damages sought by claimants 22 is believed to be sufficient that the proper court having jurisdiction 23 over their claim is the Superior Court of California. 24 Dated: November 11, 1991 TONSING & TONSING 25 By: 26 DENNIS T09SWI Attorn s for tilmants 27 JERRY DEWAYNE GORMAN, CHERI GORMAN, CRYSTAL DIANE 28 GORMAN, a minor c:\wp51\HERNANDEZ/COCOGORM.CLM/567.1/dmc 2 1 PROOF OF SERVICE BY MAIL - CCP 1013a. 2015.5 2 3 I declare that I am employed in the County of Contra Costa, 4 California. I am over the age of eighteen years, and not a party to the within cause; my business address is Tonsing & Tonsing 500 Ygnacio 5 Valley Road, Suite 300 Walnut Creek, California 94596. 6 On November 12 , 1991, I served the: 7 1. NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA 8 by placing a true copy thereof enclosed in a sealed envelope marked for Certified Mail, Return Receipt Requested, postage fully prepaid, 9 in the ordinary course of business, for collection and mailing that same day at the law office of Tonsing & Tonsing, 500 Ygnacio Valley 10 Road, Suite 300, Walnut Creek, California 94596 addressed as follows: 11 Clerk of the Board of Supervisors County Administration Building 12 651 Pine Street, Room 106 Martinez, CA 94553 13 I declare that I am readily familiar with the business practice of 14 Tonsing & Tonsing for collection and processing of correspondence for mailing with the United States Postal Service and that the 15 correspondence would be deposited with the United States Postal Service that same day in the ordinary course of business. 16 I declare under penalty of perjury under the laws of the State of 17 California that the foregoing is true and correct and that this proof of service by mail was executed on November 12, 1991, at Walnut Creek, 18 California. 19 vxc- Inc�ak 20 DEBORAH L. MCPEAK 21 22 23 24 25 26 27 28 D t5�{ ZZi Z m n x ° z s oD O y m zn O. °. m 0 I c� W ni Ln w i 0 ti w rn n n fv Ln O N rt � � N. rb rt x (D z 0 N tD > its fz co ;Ef rt a c7 rt N• ::r > * :J tD N. 0o drttO b. 0 " w Ul Lnn � rt �L w N- O t 0 d'o o :jr-t, Lo En 4 Aa dad� �.MAl PI ) N j »#........... 1 Irven L. Grant, Esq. Jon P.2 TONSINGT&nTONSINGsq. RECEIVED 500 Ygnacio Valley Rd. , Suite 300 3 Walnut Creek, California 94596 NOV 12 1991 (510) 947-1600 4 t - 44 s �,p,,,,, Attorneys for Claimants CLERK BOARD OF SUPERVISORS 5 CONTRA COSTA CO. 6 7 8 In the matter of the claim of ) 9 JERRY DEWAYNE GORMAN, CHERI GORMAN ) and CRYSTAL DIANE GORMAN, a minor, ) NOTICE OF CLAIM AGAINST 10 ) THE COUNTY OF CONTRA COSTA Claimants, ) 11 ) V. ) 12 ) THE COUNTY OF CONTRA COSTA, and ) 13 Public Employees designated as ) DOES 1-20. ) 14 ) 15 Claimants hereby present this claim to the County of Contra 16 Costa pursuant to section 910 of the California' Government Code. 17 1. The names and addresses of claimants and the address to 18 which all communications regarding this claim should be sent is to 19 JERRY DEWAYNE GORMAN, CHERI GORMAN and CRYSTAL DIANE GORMAN, a minor, 20 c/o Jon P. Tonsing, Tonsing & Tonsing, 500 Ygnacio Valley Road, Suite 21 300, Walnut Creek, California 94596. Claimants are informed and 22 believe that DOES 1-20 are employees of CONTRA COSTA COUNTY who are 23 responsible for the negligent acts described below. Claimants have 24 not yet ascertained the names of DOES 1-20. 25 2 . On May 13 , 1991, at some time between the hours of 12 : 00 26 a.m. and 12 : 40 a.m. , DEWAYNE GORMAN was traveling southbound over 27 Kirker Pass Road, at or near the intersection of Kirker Pass Road and 28 c:\wp51\HERNANDEZ/COCOGORM.CLM/567.1/dmc 1 1 North Hess Road, City of Pittsburg, County of Contra Costa, State of 2 California. 3 3 . At approximately the above time, the described roadway, 4 roadway shoulder, and surrounding location were so negligently, 5 improperly, inadequately and defectively constructed, maintained, 6 patrolled, and designed, and without proper speed control and lighting 7 as to render the roadway unsafe for travel. Such defects and 8 inadequacies include, but are not limited to, conditions that fail to 9 provide nighttime travelers with proper road conditions, lighting, 10 time, and space to recognize and avoid roadway hazards. 11 4 . As a direct result of the above negligence, JERRY 12 DEWAYNE GORMAN, at the time and place described, collided with a 13 vehicle on Kirker Pass Road located at or near the intersection at 14 Kirker Pass Road and North Hess. 15 5. As a further result of the above-described negligent 16 acts, claimants JERRY GORMAN, CHERI GORMAN, and CRYSTAL DIANE GORMAN, 17 a minor, and each of them, have suffered, and will continue to suffer, 18 general damages, loss of consortium, loss of affection, medical 19 expenses, emotional distress, economic losses, loss of wages, loss of 20 earning capacity, and property damage. 21 6. The amount hereby claimed as damages sought by claimants 2.2 is believed to be sufficient that the proper court having jurisdiction 23 over their claim is the Superior Court of California. 24 Dated: November 11, 1991 TONSING & TONSING 25 By: 26 DENNIS TONS Attorn s for 1 imants 27 JERRY DEWAYNE GORMAN, CHERI GORMAN, CRYSTAL DIANE 28 GORMAN, a minor c:\wp51\HERNANDEZ/COCOGORM.CLM/567.1/dmc 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOA TION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Deloer�ka��1991 and Board Action. All Section references are to ) The copy of this document mailed to you i u ` otice of California Government Codes. r" ) the action taken on your claim by th� rt of r.rvisors (Paragraph IV below), given pursuant o G,Nrtigep**Code Amount: Unspecified �' ���� Section 913 and 915.4. Please note al� wings". CLAIMANT: GORMAN, Jerry De a, SY \J, Cheri , GORMAN, Crystal Diane (a minor) ATTORNEY: Jon P. Tonsing, Esq. Tonsing & Tonsing Date received ADDRESS: 500 Ygnacio. Valley Road, Suite 300 BY DELIVERY TO CLERK ON November. 12, 1991 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH g DATED: November 13, 1991 BYIL Deputy OR, Clerk 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). f( ) 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: al BY: I As"-) Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). .IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Ord entered in its minutes for this date. Dated: DEC 1 Q 1991 PHIL BATCHELOR, Clerk, By i A. r Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a'court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and No ice to Claimant, addressed to the claimant as shown above. Dated: DEC1 0 19911991 BY: PHIL BATCHELOR by " Deputy Clerk .4v CC: County Counsel County Administrator 1 PROOF OF SERVICE BY MAIL - CCP 1013a, 2015. 5 2 3 I declare that I am employed in the County of Contra Costa, 4 California. I am over the age of eighteen years, and not a party to the within cause; my business address is Tonsing & Tonsing 500 Ygnacio 5 Valley Road, Suite 300 Walnut Creek, California 94596. 6 On November 12 , 1991, I served the: 7 1. NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA 8 by placing a true copy thereof enclosed in a sealed envelope marked for Certified Mail, Return Receipt Requested, postage fully prepaid, 9 in the ordinary course of business, for collection and mailing that same day at the law office of Tonsing &Tonsing, 500 Ygnacio Valley 10 Road, Suite 300, Walnut Creek, California 94596 addressed as follows: 11 Clerk of the Board of Supervisors County Administration Building 12 651 Pine Street, Room 106 Martinez, CA 94553 13 I declare that I am readily familiar with the business practice of 14 Tonsing & Tonsing for collection and processing of correspondence for mailing with the United States Postal Service and that the 15 correspondence would be deposited with the United States Postal Service that same day in the ordinary course of business. 16 I declare under penalty of perjury under the laws of the State of 17 California that the foregoing is true and correct and that this proof of service by mail was executed on November 12 , 1991, at Walnut Creek, 18 California. 19 Z'--t'4'A x2 20 DEBORAH L. MCPEAK 21 22 23 24 25 26 27 28 ;..,.<_ CLAIM 6 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 'Rfi..` I +°l Claim Against the County, or District governed by) BOAR G#IIN8 1091 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT D e c e mb e rC�l � and Board Action. All Section references are to ) The copy of this document mailed to you is OAVi f F. California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10, 000. 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: JENKINS, Maury Jay ATTORNEY: Date received ADDRESS: 728 Salt Lake Drive BY DELIVERY TO CLERK ON November 14, 1991 San Jose, CA 95133 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHHIL BATCHELOR, Clerk DATED: November 15 . 1991 BY: Deputy (L 4 1 A"0(.6, 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 XJ_ 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 ( vr 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: .Q C 1 0 1991. 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 io 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 Noti a to Claimant, addressed to the claimant as shown above. Dated: ®EQ 1 1991�p BY: PHIL BATCHELOR by a eputy Clerk CC: County Counsel County Administrator BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 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 ?—Or—m. RE: Claim By ) ReSsiervq f r Clerk's filing stamp RECEIVED Against the County of Contra Costa ) a NOV 1 41991 or ) District) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. AA A Fill in name } , The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 10, 0,0 V and in support of this claim represents as follows: ------------------------- - -1. When did the damage or injury occur? (Give exact date and hour) c� -- , -cc 1 O t3 o-0------ -------- -- ------ I N_M 1�,e- N---------- - -------------------- 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) A 3czo�g:-, �PP�e �e_o.. s� , �4aeeec� Me in +h'e L em I Lx> �) Ct IoL 2 nom, CA i mac, Se L,e-i6P dck_macge ----------------------- �__�� ------ ---- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage?—,�,e t,o0.S (L)LA OPE?✓D�-}c V 2� >� V--p-tS ec�l A UicuVO Md S ,.A/ AO (over) 5. What are the names of county or district officers, servants or employees -causing • the damage or injury? ----------------------------------------------------------I ------------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. -r rye-e-C mL u --- Gc vc,e----------------------------------------------------- 7. How was the amount claimed above computed? (Include the est1mated amount of any prospective injury or damage.) < <m� �� u� K, '-P—'e1-a-1,fi� A&� Ora Cep�rz,, �,-3 V:--eOc c GLb� ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Coc- uW�n sow - � i Y�`ems S-�t�� � ��S i�►�, fYA f-1\-� �'vvs ��-4 �c��ne -S eyed VInactoSSpvtau/ - O e ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT c, DOD co z ac -o See CmC o c c c� L ll e Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature C)a L,�e Address � JOS L r_%- n; C► � )�, Telephone No. Telephone No.Y—O'9" PZSI ; j * * * * * * * * * * * * N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. fou Deteion Fa rty * INCIDENT REPORT tOF 107_ ` INCIDENT / INCIDENT: :5 KKI'I`NTU2E17 Fo(Z FACILITY: fA(.>7r- REPORT #: 11 DATE/TIME 9/3-9 / DATE/TIME LOCATION:a fg01)UDE Qn-g� -L-Z OCCURRED:13.36 - REPORTED: HOUSING INMATE:*�5'6N Ktt-15 MalUky -S- BOOKING#: 00SSIGNMENT: A::2 S Last First Middle WITNESSES) --LIST-- Name - Address If an inmate, give booking #: �,►MATS W1t_So�J , C'�6�NE-�L (3 SYNOPSIS: ?ENKINS H:VP-"T �AtS�3 CLA (Mt O `i�i� f3€ P{1RA�.`1ZE � oAND WAS 7H--E 6mE eGe_oQC�1 R L Qt-t . NARRATIVE: A f A PPJZ bk i m Aa:e u_V t M o `Qu tz l r,,j t-, D (Nn1 t—J?__ S,E2 Q� c— "C' WAS c#1 L. E f) 12.? RooY-,\ -Zg S`( 2 NMA:T-6 W(L-SO f--J. I t S A r D —=r-Jt< r r\!5 N U fZ'(' HIS BACK e,)IJ -ro UePE2 I3U "(< "i 2Aujf-P_ A(_(r. *AID WAS "',-r Atll G tJ rI N A S V E -1 Ff Ps P L4\C_-"E T —T_t)t_O SE u`1 K I iii J<, 1 WOULD C f4 L L— F—o feZ— A rU O R 5 6 '`TIS _.. l'NEC Y N15 "LrySUR2 J . HE SA (I) 1r TSO ionlNR SUE -rf--t-E CoyNT'`f ArJ D W A-nl r A1M1 Aria UL r/GE RIC H 'T 1%lo o '`. Ny R 5 E E DD l E RE s Po N Pf D Ari l::> lex tart f(y C C> �NKiN� wt-It7 NfSw et,�tNt.�� 'Ta DE Pfl��Uy� � r2aNt '"fl-I-£ I�GK DOc," N . NQkr r- DDtr pqa D LEFT To Caw T� 1 c` 1 �3d oc) P_s4�5 EDUtE TI7 f3 '/ _roe_ `�o� L N K t r.1 S `f2�F��5E (t+e �X ©n! Re PO U1\jOS A"D 72!� SEF T a c_Tz3 e E t ,4t­S6 Je F05E D -M f�t 6 N i!jll� wt—T t+O UT FA I S &1_rofe&W-YS " V1 GE-. ACTION TAKEN/RECOMMENDED: REPORTING RmPLbYEE # SUPERVISOR # OP TIONS DfRECTOR # O.D. ROUTING INSTRUCTIONS: White to Facility Administrator -Yellow to Booking File - Goldenrod to Inmate By: - Pink to Lineup Board Page One of DET 058:FRM Rev. 1/9/91 t , , S a Costa Counof Detention Fa * INC (DENT ktPORT SUPPLEMENT iL� l U2 Q DATE OF INCIDENT DATE: /" ORIGINAL: g�/�{— �? / INCIDENT: A7 QF 10 2 REPORT #: Q / HOUSING INMATE:S£NbC((-32 M i'i U(2`t BOOKING#: /ZO D. S,f ASSIGNMENT Last First Middle CONTINUATION SUPPLEMENT STATEMENT DISCIPLINARY INVESTIGATION NARRATIVE/INVESTIGATION: Nv2SE nfllF f -E P-"E D A-t'' APP20k jM$ Ly ao 45 f=02 Pi t-t, CALL— Ai' ''t T► M E L 0 u s� STiR-ru s Ont SeN K=t aJ sIZZ N ES"i e A N v 1R.5* D o I -!n-,A I n thr c,�n L R TU2�1 ��..�tTH 'rtH� C'-H��26� hJure�� at3n Nvf25F 5 eDge At--,1D VICTo72c4 clgm� `7"U F-kA:nl iuuR SE :z c o-bs?a T A L_ x�o 2 A SA \Z�> i--y e O U c_D t J a W boJE Kt ', LiPPE-_g- &00,y BuT STt L-t1 Gepu t-b Ilar Mn vim'" -A c�DaE ZG (3 U l,,�itl C_�c t,y 5 C a4 �� D mn -mAz Pa „7E?\J K-r nl 5 GET Oil 7`1-� COMMENTS & CONCLUSIONS: ACTION TAKEN: TIPN K ItJ5, t� e—C:- -1 'TO e—M90�GE,,jC�-\ Kttrt M C_�CaMil 4 1C K WAI K (N� 0 rdDIE P— k-c\5 ow r.l `maw i REPORTING 'EMPLOYEE # S RVISOR # OPE TIONS DIRECTOR # O.D. ROUTING INSTRUCTIONS: White to Facility Administrator -Yellow to Booking File - Goldenrod to Inmate - Pink to Lineup Board Page of DET 059:FRM Rev. 1/9/91 z i J E N X INS nAUM r , r .,� M lidAT Sl,-0646 -4495 J0. O'� 028 Sb - i CONTRA COSTA COUNTY HEALTH SERVICES 1 /06 / 10, 63 E ni 13 / 9 .1 . ER DAN 02 ; CONSENT TO SERVICES AND CONDITIONS � '� "� OF SERVICES'AND OF ADMISSION. Patient ID MEDICAL/SURGICAL TREATMENT CONSENT: The undersigned consents_to;any medical treatment;;including but not limited to x-ray examinations,laboratory procedures,medical/surgical procedures,injections,and blood transfusioris,eonsidered advisable or necessary by the attending physician or by other of the hospital's medical staff,including physician residents and independent contract physicians;and further agrees to the provisions expressed on the reverse side of this form. TEACHING PROGRAM:The undersigned understands that Contra Costa County Health Services,Merrithew Memorial Hospital and Clinics,is a teaching institution and that residents,interns,and healthcare students,under the supervision of professional staff,may be involved in providing medical and/or health care. CONSENT TO RELEASE MEDI=CAL LABELS:The undersigned authorizes the Contra Costa County Department of Social Services to release information concerning the status of the patient's Medi-Cal application,and to send the patient's Medi-Cal labels to the Contra Costa County Health Services Department. FINANCIAL AGREEMENT:The undersigned promises to reimburse the County of Contra Costa for any hospital care and/or medical services provided to the patient that are not covered by Medicare,Medi-Cal,insurance or any other health care compensation carrier,at the rates established by the Contra Costa County Board of Supervisors.The undersigned further agrees to use any damages or indemnity paid to or on behalf of the patient as a result of the injury or illness which necessitated this care to reimburse the County up to the amount billed,but not to exceed,the rates set by the Board of Supervisors. The undersigned waives the statute of limitations an this matter for a period of 10 years,This agreement and waiver is binding on the undersigned,his or her heirs,assigns,administrators,and executors. ,. j ASSIGNMENT OF BENEFITS:The undersigned authorizes,whether he/she signs as agent or as patient,direct payment to Contra Costa County of any ` insurance benefits otherwise payable to or on behalf of the patient for this hospitalization and/or these outpatient services,including emergency services if i rendered,in an amount not to exceed the County's regular charges.A photocopy of this authorization shall be considered as effective and valid as the original. The undersigned authorizes and directs the attorney,claims adjustor,insurance company and any person(s),company or corporation who may effect a settlement or payment of any claim for damages or indemnity that the patient may have arising from the injury or illness which necessitated this hospital care and/or outpatient services,to deduct the amount of the charges of these services from any sum due the patient and to pay that amount directly to Contra Costa County and the undersigned hereby assigns that amount to Contra Costa County. C RELEASE OF INFORMATION FOR REIMBURSEMENT:The undersigned agrees that,to the extent necessary to determine liability for payment and to obtain reimbursement,Contra Costa County may disclose portions of the patient's record,including his/her medical and psychiatric records,to any person or corporation which is or may be liable for all or any portion of the charges,including but not limited to insurance companies,health care service plans,workers' compensation carriers,Social-Security Administration,and peer review organizations. { The undersigned certifies that he/she has read both sides of this document,received a copy thereof,and is the patient,the patient's legal ! representa,ive,or is duly authorised by the patient as the patient's general agent to execute this document and accept its terms. i SIGNATURE OF PATIENT OR PATIENT'S REPRESENTATIVE Z4 /� IF PATIENTS REPRESENTATIVE, ___Wi NESS' i SIGN TUtt�,, L RELATIONSHIP TO PATIENT i If patient unable to sign,STATE REASON: Date: By: MEDICARE PATIENT STATEMENT OF FACTS i ❑ Patient is years of age. ❑ This visit is not the result of any kind of accident I - ❑ Patient is not employed. ❑ No other individual is responsible for the patient's medical bills. ❑ Patient's spouse is not employed. ❑ INPATIENT:I have received the Medicare Notification entitled ❑ Patient is not covered by Worker's Compensation,The Black Lung "AN IMPORTANT MESSAGE FROM MEDICARE." Program or a large group health plan. I certify that all of the above statements are true. DATE SIGNATURE OF PATIENT OR PATIENT'S REPRESENTATIVE IF PATIENTS REPRESENTATIVE, RELATIONSHIP TO PATIENT WITNESS TO SIGNATURE UNIFORM METHOD OF DETERMINING ABILITY TO PAY—MENTAL HEALTH SERVICES The Uniform Method of Determining Ability to Pay(UMDAP)has been explained to the undersigned.By signing this statement I acknowledge that $ is owed as my/the patient's annual liability for the period of DATE to oars DATE SIGNATURE OF PATIENT OR PATIENT'S REPRESENTATIVE IF PATIENTS REPRESENTATIVE, RELATIONSHIP TO PATIENT WITNESS TO SIGNATURE MR463•1(11/90)Side I ORIGINAL—CHART COPYt—FINANCIAUPATIENT ACCTG• COPY 2—PATIENT i s CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ). NOTICE TO CLAIMANT December 10, 1991 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnipjs". CLAIMANT: RIBEIRO, James M. Jr. Estate of, HERNANDEZ, Barbara, HERNANDEZ, �� ��F RIBEIRO, James, Sr. ' ATTORNEY: Dennis J. Tonsing NAV Tonsing &' Tonsing Date received ' ADDRESS: 500 Ygnaci o Valley Road, Suite 300 BY DELIVERY TO CLERK ON November 1�� Walnut Creek, CA 94596 Hand delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 13, 1991 gqL DeputyLOR, ClerkQMM of '4A do 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: _ ly �� BY: _ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is atrue and correct copy of the Board's Order entered in its minutes for .this date. 11 0 Dated: D E C J 0 1 1991 PHIL BATCHELOR, Clerk, By otj 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 thaf today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 1 0 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 Irven L. Grant, Esq. Jon P. Tonsing, Esq. 2 TONSONSING Valley Rd. , Suite 300 R`CEII�E® 500Ygnacio 3 Walnut Creek, California 94596 (510) 947-1600 NOV 12 1991 Attorneys for Claimants 1 CLERK BOARD OFSl1PERVI 5 CONTRA COSTA CO. 6 7 8 In the matter of the claim of ) 9 The Estate of JAMES M. RIBEIRO, JR. , ) BARBARA HERNANDEZ, mother of JAMES M. ) NOTICE OF CLAIM AGAINST 10 RIBEIRO, JR. , JESS HERNANDEZ, step- ) THE COUNTY OF CONTRA father of JAMES M. RIBEIRO, JR. , ) COSTA 11 JAMES RIBEIRO, SR. , natural father ) OF JAMES M. RIBEIRO, JR. ) 12 ) Claimants, ) 13 ) V. ) 14 ) THE COUNTY OF CONTRA COSTA, and ) 15 Public Employees designated as ) DOES 1-20. ) 16 ) 17 Claimants hereby present this claim to the County of Contra 18 Costa pursuant to section 910 of' the California Government Code. 19 1. The names and addresses of claimants and the address to 20 which all communications regarding this claim should be sent are The 21 Estate of JAMES M. RIBEIRO, JR. , BARBARA HERNANDEZ, mother of JAMES M. 22 RIBEIRO, JR. , JESS HERNANDEZ, step-father of JAMES M. RIBEIRO, JR. , 23 JAMES M. RIBEIRO, SR. , natural father of JAMES M. RIBEIRO, c/o Jon P. 24 Tonsing, Tonsing & Tonsing, 500 Ygnacio Valley Road, Suite 300, Walnut 25 Creek, California 94596. Claimants are informed and believe that 26 DOES 1-20 are employees of CONTRA COSTA COUNTY who are responsible for 27 the negligent acts described below. Claimants have not yet 28 ascertained the names of DOES 1-20. c:\wp51\HERNANDEZ/COCORIB_CLM/567.1/dmc 1 1 2 . On May 13 , 1991, at some time between the hours of 12 :00 2 a.m. and 12 :40 a.m. , JAMES M. RIBEIRO, JR. was traveling southbound 3 over Kirker Pass Road, at or near the intersection of Kirker Pass Road 4 and North Hess Road, City of Pittsburg, County of Contra Costa, State 5 of California. 6 3 . At approximately the above time, the described roadway, 7 roadway shoulder, and surrounding location were so negligently, 8 improperly, inadequately and defectively constructed, maintained, 9 patrolled, and designed, and without proper speed control and lighting 10 as to render the roadway unsafe for travel. Such defects and 11 inadequacies include, but are not limited to, conditions that fail to 12 provide nighttime travelers with proper road conditions, lighting, 13 time, and space to recognize and avoid roadway hazards. 14 4. As a direct result of the above negligence, JAMES M. 15 RIBEIRO, JR. , at the time and place described, collided with a vehicle 16 on Kirker Pass Road located at or near the intersection at Kirker Pass 17 Road and North Hess, which collision resulted in the death of JAMES M. 18 RIBEIRO, JR. on May 14, 1991. 19 5. As a further result of the above-described negligent 20 acts, claimants the Estate of JAMES M. RIBEIRO, JR. , BARBARA 21 HERNANDEZ, JESS HERNANDEZ, JAMES M. RIBEIRO, SR. , and each of them, 22 have incurred substantial medical, economic, and funeral expenses. 23 6. As a further result of the above-described negligent 24 acts, claimants, and each of them, have suffered, and will continue to 25 suffer, general damages, loss of consortium, loss of affection, 26 medical expenses, emotional distress, economic losses, loss of wages, 27 loss of earning capacity, and property damage. 28 c:\wp51\HERNANDEZ/COCORIB.CLM/567.1/dmc 2 1 8. The amount hereby claimed as damages sought by claimants 2 is believed to be sufficient that the proper court having jurisdiction 3 over their claim is the Superior Court of California. 4 Dated: November 11, 1991 TONSING & TONSING 5 6 By: mow! DENNIS Jl-."ITONSIgG 7 Attorne for Clam is The Estate of JAMES M. 8 RIBEIRO, JR. , BARBARA HERNANDEZ, mother of JAMES M. RIBEIRO, JR. , 9 JESS HERNANDEZ, step-father of JAMES M. RIBEIRO, JR. , JAMES M. 10 RIBEIRO, SR. , natural father of JAMES M. RIBEIRO, JR. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 c:\wp51\HERNANDEZ/COCORIB.CLM/567.1/dmc 3 1 PROOF OF SERVICE BY MAIL - CCP 1013a, 2015.5 2 3 I declare that I am employed in the County of Contra Costa, 4 California. I am over the age of eighteen years, and not a party to the within cause; my business address is Tonsing & Tonsing 500 Ygnacio 5 Valley Road, Suite 300 Walnut Creek, California 94596. 6 On November 12, 1991, I served the: 7 1. NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA 8 by placing a true copy thereof enclosed in a sealed envelope marked for Certified Mail, Return Receipt Requested, postage fully prepaid, 9 in the ordinary course of business., for collection and mailing that same day at the law office of Tonsing & Tonsing, 500 Ygnacio Valley 10 Road, Suite 300, Walnut Creek, California 94596 addressed as follows: 11 Clerk of the Board of Supervisors County Administration Building 12 651 Pine Street, Room 106 Martinez, CA 94553 13 I declare that I am readily familiar with the business practice of 14 Tonsing & Tonsing for collection and processing of correspondence for mailing with the United States Postal Service and that the 15 correspondence would be deposited with the United States Postal Service that same day in the ordinary course of business. 16 I declare under penalty of perjury under the laws of the State of 17 California that the foregoing is true and correct and that this proof of service by mail was executed on November 12 , 1991, at Walnut Creek, 18 California. ` 19 01 /)/C/,pa 20 DEBORAH L. MCPEAK 21 22 23 24 25 26 27 28 DRIVER... . RECEIPT ROUND TRIP IV COURIERS, INC, lova SAME-DAY (415) 945-4994 4 H R.DEL.BY: DATE 1-800-4-COURIER REFERENCE, .,,,,,D/RIVEER PIECES WEIGHT AUTHORIZED BY 1/'' CONTACT f i•iJ - ROOM '—�4l FLOOR SHIPPER rt-� tI ADDRESS CIN !') CONTACT ROOM FLOOR DELIVER TO ADDRESS f CITY RECEIVED BY: gip/ TIME r24,1 PRINT NAME `{ [��j p � �d. 114 I�Gt �G � �Q M s y ✓ SECOND SIGNATURE PRINT NAME WHITE-Shipper CANARY-File PINK-Consignee In Tendering this shipment,Shipper agrees that CCX Couriers,Inc.shall not be liable for special, incidental or consequential damages arising from the carriage hereof.CCX Couriers,Inc.disclaims all warranties,expressed or implied,with respect to this shipment. The liability of CCX Couriers,Inc.for any loss or damage shall be limited to$50.00. Additional insurance available upon request. QUICK • RELIABLE • SECURE • CLAIM 0101.,FIVIV BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA NOV 18 1931 Claim Against the County, or District governed by) BOARD. ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANTU^^N� D e c e mb e r MARft1yEZ,l�i� and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: ESTATE OF JAMES M. RIBEIRO, JR. , HERNANDEZ, Barbara, HERNANDEZ, Jess RIBEIRO, James M. Sr . ATTORNEY: Jon P. Tonsing, 'Esq . Tonsing and Tonsing Date received ADDRESS: 500 Ygnacio Valley Road BY DELIVERY TO CLERK ON November 13 , 1991 Suite 300 November 12 1991 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Certified P 725 310 424 I. FROM: Clerk of the Board of Supervisors TO: County Counsel. Attached is a copy of the above-noted claim. IL BgATCHELOR, Clerk DATED: November 15 , 1991 �d: Deputy 00i 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: 11 I BY: �^ /J Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V,,) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: DEC 10 1991 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 t)is 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 Not'ce to Claimant, addressed to the claimant as shown above. 111 Dated: DEQ 1 I� BY: PHIL BATCHELOR by Lo Deputy Clerk CC: County Counsel County Administrator 1 Irven L. Grant, Esq. Jon P. Tonsing, Esq. RECEIVED 2 TONSING & TONSING 500 Ygnacio Valley Rd. , Suite 300 NOV 1 3 199) 3 Walnut Creek, California 94596 (510) 947-1600 ' 4 CLERK BOARD OF SUPERVI Attorneys for Claimants CONTRA COSTA C . 5 6 7 8 In the matter of the claim of ) 9 The Estate of JAMES M. RIBEIRO, JR. , ) BARBARA HERNANDEZ, mother of JAMES M. ) NOTICE OF CLAIM AGAINST 10 RIBEIRO, JR. , JESS HERNANDEZ, step- ) THE COUNTY OF CONTRA father of JAMES M. RIBEIRO, JR. , ) COSTA 11 JAMES RIBEIRO, SR. , natural father ) OF JAMES M. RIBEIRO, JR. ) 12 ) Claimants, ) 13 ) V. ) 14 ) THE COUNTY OF CONTRA COSTA, and ) 15 Public Employees designated as ) DOES 1-20. ) 16 ) 17 Claimants hereby present this claim to the County of Contra 18 Costa pursuant to section 910 of the California Government Code. 19 1. The names and addresses of claimants and the address to 20 which all communications regarding this claim should be sent are The 21 Estate of JAMES M. RIBEIRO, JR. , BARBARA HERNANDEZ, mother of JAMES M. 22 RIBEIRO, JR. , JESS HERNANDEZ, step-father of JAMES M. RIBEIRO, JR. , 23 JAMES M. RIBEIRO, SR. , natural father of JAMES M. RIBEIRO, c/o Jon P. 24 Tonsing, Tonsing & Tonsing, 500 Ygnacio Valley Road, Suite 300, Walnut 25 Creek, California 94596. Claimants are informed and believe that 26 DOES 1-20 are employees of CONTRA COSTA COUNTY who are responsible for 27 the negligent acts described below. Claimants have not yet 28 ascertained the names of DOES 1-20. c:\wp51\HERNANDEZ/COCORIB.CLM/567.1/dmc 1 1 2 . On May 13 , 1991, at some time between the hours of 12 : 00 2 a.m. and 12 : 40 a.m. , JAMES M. RIBEIRO, JR. was traveling southbound 3 over Kirker Pass Road, at or near the intersection of Kirker Pass Road 4 and North Hess Road, City of Pittsburg, County of Contra Costa, State 5 of California. 6 3 . At approximately the above time, the described roadway, 7 roadway shoulder, and surrounding location were so negligently, 8 improperly, inadequately and defectively constructed, maintained, 9 patrolled, and designed, and without proper speed control and lighting 10 as to render the roadway unsafe for travel. Such defects and 11 inadequacies include, but are not limited to, conditions that fail to 12 provide nighttime travelers with proper road conditions, lighting, 13 time, and space to recognize and avoid roadway hazards. 14 4 . As a direct result of the above negligence, JAMES M. 15 RIBEIRO, JR. , at the time and place described, collided with a vehicle 16 on Kirker Pass Road located at or near the intersection at Kirker Pass 17 Road and North Hess, which collision resulted in the death of JAMES M. 18 RIBEIRO, JR. on May 14, 1991. 19 5. As a further result of the above-described negligent 20 acts, claimants the Estate of JAMES M. RIBEIRO, JR. , BARBARA 21 HERNANDEZ, JESS HERNANDEZ, JAMES M. RIBEIRO, SR. , and each of them, 22 have incurred substantial medical, economic, and funeral expenses. 23 6. As a further result of the above-described negligent 24 acts, claimants, and each of them, have suffered, and will continue to 25 suffer, general damages, loss of consortium, loss of affection, 26 medical expenses, emotional distress, economic losses, loss of wages, 27 loss of earning capacity, and property damage. 28 c:\wp51\HERNANDEZ/COCORIB.CLM/567.1/dmc 2 1 8 . The amount hereby claimed as damages sought by claimants 2 is believed to be sufficient that the proper court having jurisdiction 3 over their claim is the Superior Court of California. 4 Dated: November 11, 1991 TONSING & TONSING 5 6 By: DENNIS J. ONSI G 7 Attorne for Cla m is The Estate of JAMES M. 8 RIBEIRO, JR. , BARBARA HERNANDEZ, mother of JAMES M. RIBEIRO, JR. , 9 JESS HERNANDEZ, step-father of JAMES M. RIBEIRO, JR. , JAMES M. 10 RIBEIRO, SR. , natural father of JAMES M. RIBEIRO, JR. 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 c:\wp51\HERNANDEZ/COCOR I B.CLM/567.1/dmc 3 1 PROOF OF SERVICE BY MAIL - CCP 1013a, 2015. 5 2 3 I declare that I am employed in the County of Contra Costa, 4 California. I ,am over the age of eighteen years, and not a party to the within cause; my business address is Tonsing & Tonsing 500 Ygnacio 5 Valley Road, Suite 300 Walnut Creek, California 94596. 6 On November 12, 1991, I served the: 7 1. NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA 8 by placing a true copy thereof enclosed in a sealed envelope marked for Certified Mail, Return Receipt Requested, postage fully prepaid, 9 in the ordinary course of business, for collection and mailing that same day at the law office of Tonsing & Tonsing, 500 Ygnacio Valley 10 Road, Suite 300, Walnut Creek, California 94596 addressed as follows: 11 Clerk of the Board of Supervisors County Administration Building 12 651 'Pine Street, Room 106 Martinez, CA 94553 13 I declare that I am readily familiar with the business practice of 14 Tonsing & Tonsing for collection and processing of correspondence for mailing with the United States Postal Service and that the 15 correspondence would be deposited with the United States Postal Service that same day in the ordinary course of business. 16 I declare under penalty of perjury under the laws of the State of 17 California that the foregoing is true and correct and that this proof of service by mail was executed on November 12, 1991, at Walnut Creek, 18 California. 19 iLl! /c 01 /XC Po,� 20 DEBORAH L. MCPEAK 21 22 23 24 25 26 27 28 a Ir 0 C—) N m �4 t 0 ,9 A 00 N 0 l cl N cam°� � 0 ( ', C3 w ru o� � ONo � o ro CD Ct N "—'- 0. ro y `3i O �P O is p :p � W F, wW+ � �� .•��t L gam. ON p TA *y 4 k l 1 A ELLIOTT M. PISOR, INC. ' - ATTORNEYS AT LAW TELEPHONE INJURY LAW CENTER - (415) 763-4800 ONE KAISER PLAZA, SUITE 1585 CLAIM UNDER GOVERNMENT OAKLAND, CA 94612 CODE SECTIONS 905 and 910 ECEIV - NAME (S) OF DEFENDANT ENTITIES: COUNTY OF CONTRA COSTA NOV 81991 CLAIMANT'S NAME: ENRIQUE VALDATTI CLAIMANT' S ADDRESS: 2747 Scotch Heather Street CLERK BOARD pSUPERVISORS Las Vegas, Nevada 89122 CONTtA COSTA Cp, SEND NOTICES TO:. ELLIOTT M. PISOR Attorney at Law One Kaiser Plaza, Suite 1585 Oakland, CA 94612 DESCRIPTION OF ACCIDENT: On or about October 29, 1991, claimant was struck by an automobile driven by a County of Contra Costa employee, in .the course of her employment, at the intersection of Highway 4 and Interstate Highway 80 . It is alleged said collision was caused by negligent operation of the vehicle driven by said County. employee. TYPE OF DAMAGE: Personal Injuries. NAME (S) OF PUBLIC EMPLOYEES INVOLVED: Believed to be J. M. Casttano AMOUNT CLAIMED: Sufficient to fall within the jurisdiction of Superior Court. DATED: November 7, 1991 ELLIOT M. PISOR Attorney for Claimant C� O r� Z p m o A xl t� It zn N A G 0 � 0 0 cIr b x m � o � .� ct �, w O W fi (D ri G o °-o v 'q� 10 A% CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the ,,ty, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT December 10, 1991 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 I�Va below), given pursuant to Government Code Amount: Unspecified Sechw01i nd 915.4. Please note all "Warnings". CLAIMANT: VALADATTI, Enrique ATTORNEY: Elliott M. Pi sor Attorney at Law DaY"e"received ADDRESS: One Kaiser Plaza, Suite 1585 BY DELIVERY TO CLERK ON November 8. 1991 Oakland, CA 94612 BY MAIL POSTMARKED: November 7. 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 13, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: DeputyA.L4 Ob4 g-00 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: �� �ly / �� BY: )J. 3. 411- A Deputy County Counsel �—r 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 ( 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: ®� 1 0 1891 PHIL BATCHELOR, Clerk, Byganna 01 AA., 0 Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: DEC 10 1991 .._: BY: PHIL BATCHELOR by J Deputy Clerk CC: County Counsel County Administrator CLAIM F. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA NOV 18 1991 Claim Against the County, or District governed by) BO RDr ALWN OUNSa the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT DecemberMA-ROJEL10,W and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: VALADATTI, Enriques/California State Automobile Association ATTORNEY: California State Automobile Assn. Inter—Insurance Bureau Date received ADDRESS: 266 C Park Lake Circle BY DELIVERY TO CLERK ON November 14, 1991 Walnut Creek, CA 94598 BY MAIL POSTMARKED: Hand delivered via Risk Mgmt . I. FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 15 1991 PpHHIL BATCHELOR, Clerk c; DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: l) I QO BY: I✓ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant,(Section 911.3),. IV. BOARD ORDER: By unanimous vote of the Supervisors present (V-,r This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Or er entered in its minutes for this date. Dated: D E C 10 PHIL BATCHELOR, Clerk, B AA 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 )45.6. 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 Claim nt, addressed to the claimant Cas shown above. Dated: ®E C1 O ���1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel e County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM California State Automobile Association TO: Inter-Insurance Bureau 266 C Park Lake Circle Walnut Creek, CA 94553 Re: Claim of Enriques Valdatti Reference File #01413689-9 Please Take Notice As Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910. 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. X 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known. X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000 ) . If the claim totals less than ten thousand dollars ( $10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: '� U Deputy C unty Coun el CERTIFICATE OF SERVICE BY MAIL C.C.P. SS 1012, 1013a, 2015 .5; Evid. C. 5§ 641, 664 ) My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box , 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: // /,0( , at Martinez, alifornia. cc: Clerk of the Board cf Supervisors (or' nal ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8) Claim For Damages 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. Date: October 31, 199, Attn: Julie Aumock • Risk Management Concord . 651 Pint Street California Martinez, CA 94553 Claim is hereby made and filed against the Contra. Costa County Sheriff as follows: Insured/Claimant's: Valdatti, Enriques California State Automobile Association Inter-Insurance Bureau Address of Claimant: Claimant's permanent address is in Nevada, currently using: (Send notices to this address) 266 C Park Lake Circle, Walnut Creek, CA 94598 Reference File 01—V13689-9 Date of Occurrence: 10-29-91 Place of Occurrence: Hercules, I-80, Highway 4 E/B Nature and Amount of Damages Insured's vehicle is a total loss, have no dollar amount as of above date. Items Making up said Amount: Not available Name of Public Employee(s) causing said Damage(if known): Cynthia Kirby Moore Facts & Details: Our insured was traveling eastbound on Highway 4, your vehicle was exiting I-80 entering Highway 4; made a U-turn on Highway 4 in front of our insured. L' California State Automobile Association Inter-Insurance Bureau NOV 1 41991 By F1688( dot BOARD OF SUPERVISORS CONTRA COSTA CO. AMENDED /13— CLAIM y BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA IClaim'Against the County, or District governed by) IV44' D A ION; the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Decer► �,-Iu and Board Action. All Section references are to ) The copy of this document mailed to 9bapo� notice of California Government Codes. ) the action taken on your claim by the Boar Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Exceeding $10,000 Section 913 and 915.4. Please note all "Wernings". CLAIMANT: GALLAGHER, William and Loweta ATTORNEY: Nanette Zavala, Attorney 207 37th Street Date received ADDRESS: Richmond, CA 94805 BY DELIVERY TO CLERK ON November 12, 1991 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 21, 1991 PPHHIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 11 BY: S Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( 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: ®!eC 0 1991 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 deposite.i 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: ®E C 10 1991 BY: PHIL BATCHELOR by 4�0Deputy Clerk CC: County Counsel County Administrator BOARn OF SUPERVISORS ur �u . .,.. Instructions to Claimant Return original application t; Y ) Clerk of the Board 651 Pine St., Room 106 Martinez, CA 94553 A. Claims relating to causes of action for death or­for Injury to person or to personal property or. growing crops must be presented not later than the 100th day after the accrual of the cause of action. - Claims relating to any other cause of action must be presented not later than one year after the accrual of the -cause . ,of action. (Sec. 911.2, Govt. Code) S. Claims must be filed with the Clerk of the Board of supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez , California 94553. C: If claim is against a district governed by the Board of Supervisors; rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. . E. Fraud. See penalty for fraudulent claims , Penal Code Sec. 72 at end oT_t i s form. ♦#############tk*#!t#!## R*Irt##1R+It#ik##########ir##Rt!##tk##yR#####+!#1r#######t# ttlk RE: Claim by )Reserved for Clerk's filing stamps R`GEIVE f' Cla le a .P ;• ) Against the COUNTY OF CONTRA COSTA) NOV 1 21991 or (A � DISTRICT) CLERK:60,ARDOF St:'ERVISORS (Fillin name) } "'_` s` �'� The undersigned claimant hereby makes claim against the County of Contra Costa or the above-;gamed District in the sum of $ and in support of this claim represents as follows: r w wr wr w r r r r w w w w r wr r r w w rw r r r rr r ww r r w r wr rr w r w wr rw w r r wwr r rr wrrrw r�rr S. When did the damage or injury occur? Give exact dare ani hour] rr r rrw r r r r ww w wr T r wr rr r w r r r r r w r r r rr r w r�. Fn r wr r��r�Fiere 3i�-tFi`ewaamage oz nJury occur? �Inc�ude city and coun ] r�rwwwrwwrrwrwrrwrw rw wrr w ri.rr wrr:rrwrrrrrrrrwwrrrrrrrwrrrr 3. How did the damage or-injury occur? (GiveuII �etai.�"s, use extra sheets if required) 11. `(43{ice 2 0 LAJ of &r!,•e 2 cE1.Et;r tN �t�Q uj )f l�J 4o (ea_v e d+ Kg • 6t [ l 1_5 Le..v a l s0 k 11 W k+ !e 4'r`�r' rwr rwwr rTwww�.r wwwrrrrww4 ;1 .S.rr�.r rrrwrrrwrrwrrrrrwrrwrrrrwrrrTwsr rrs�rr. what particular act or omission on the part of county or distr�et officers`, servants or employees caused the injury or damage? � �tll�,v G ITQ t1v�h �£.0 j .e w, WuQ e, a-4 �"; . . ( Bina Jc v i S �I le St 1 t\d I Caf-� � .1,•r + L ccccerss is . (over) r, 5. What are the nam,-2,s of county or district otticers, verva,A— %a A. employees causing th,._ iamage or injury? '4k� '-�. "( 40 P V-J 6.--What��amage�or injuries do CL CC C S S -t7D b VA A you c1HFn-resulted?--1Give full of injuries or damages claimed. -5-ttach two estimates for auto damage) LL). 61aK&-1ko-4, 4�kv-b('tis, %, Se f km(-r I (* 1,1 C' or) U-f rI'q tif- lel I b m4i'� - --- - -- ---- ; - ; ------ 7. How was the amK;EZ1a1med .abovbomputed ( nlaiR; ; E1;ated amount of any prospective injury or damage. ) (Avg JC C+0 V` --------------- ------------ 8. Names and addresses of witnesses, and hospitals. ef.-P-cf) 8(V\rno iid (A f3oy CDCLr-Z_T f-a- �.- List the expenditures you made on account of this accident or injury: . DATE ITEM AMOUNT r eO v J-d wi'l/ 4101 t'Wd, p--e Ge \!-Pd Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) orb some person on his behalf. " Claim" ' Slrni-�RrLe -- Name and Address of -Attorney ant -k R 1-01 -7Aadress o- el t-f fZ C4-Sf 'S, V\. ohh)0 Telephone No. 41W 3 3 - Telephone. No. -23(v --73(J7 NOTICE Section 72 of the Penal Code provides: *Zvery person wholl' 'with intent to defraud, presents forall-owance or for payment to any state board or,officer, or to any county, town, city district, ward or village board or officerr, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher,,, or writing, is guilty of a felony. " RECEIVED NOV 19.1091 CLERK SWO OF SUPERVISORS rnNTRA COSTA CO. J ty NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM Nanette Zavala, Attorney TO: 207 37th Street Richmond, California 94805 Re: Claim of William and Loweta Gallagher Please Take Notice As Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910. 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . if the claim totals less than ten thousand dollars ($10r000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed.' If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. ,6 . The claim is not signed by the claimant or by some person on his behalf. 7 . Other: VICTOR J. WESTMAN, County Counsel ' By: lx Deputy Conty Counsel\ I CERTIFICATE OF SERVICE BY MAIL C.C.P. 59 1012, 1013a., 2015.5; Evid. C. S5 641, 6641 My business address is the County Counsel's office of Contra Costa County, Co. Admin, Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, ,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: at Martinez California cc: Clerk of the Board Of Supervisors nal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM; GOV.C.S§ 920, 910. 21 920.41 910. 8) ,p CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT December 10, 1991 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GALLAGHER, William and Loweta gtlo wo ATTORNEY: Nanette Zavala, Attorney N0413 1051 207 37th Street C,,w4aeau{aftived ADDRESS: Richmond, CA 94805' i pW1W1D0+*RY TO CLERK ON November 12, 1991 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. November 13, 1991 EVIL BATCHELOR, Clerk a DATED: BY: Deputy44of 0_1 II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1 BY: /)XJ Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 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: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM Nanette Zavala, Attorney TO: . 207 37th Street Richmond, California 94805 Re: Claim of William and Loweta Gallagher Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910. 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise toithe claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known . X 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000 ) , the claim fails to state the amount claimed as of the date of. presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel Y' Deputy CdJnty Counse CERTIFICATE OF SERVICE BY MAIL C.C.P. SS 1012 , 1013a, 2015 .5 ; Evid. C. SS 641 , 664 ) . My business address is the County Counsel's Office of Contra Costa County, .Co. Admin. Bldg. , P.O. Box 69 , Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Maid ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S . Mail at Martinez/Concord, `Contra Costa County, California . I certify under penalty of perjury that the foregoing is true and correct. Dated:.6 /�V, at Martinez California cc: Clerk of theBoard of Supervisors ( ginal ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8 ) CLAIM TC: - BOARD OF SUPERVISORS OF CONTRA COSTA CUUIN11 ° 'r Instructions to Claimant Return original application t.,- Clerk cClerk of the Board 551 Pine St., Room 106 Martinez, CA 94553 A. Claims relating to causes of action for death oi"16r Injury to person or to personal property or growing crops must be presented not later than the 100th day after the accrual of the cause of action. - Claims relating to any other cause of action must be presented not later than one year after the accrual of the -cause of action. (Sec. 911. 2 , Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 551 Pine Street, Martinez, California 94553. C. If claim is against a district governed by the Board of Supervisors; rather than the County, the name of the District should be filled in. D. If the claim is &gainst more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for„ fraudulent- claims , Penal Code Sec. 72 at end of this form. ,- RE: Claim by )Reserved for Clerk' s filing stamps I NEIVED L� + } Against the COUNTY OF CONTRA COSTA) "°Yl NOV 1 21991 Or DISTRICT) CLERK BOARD OFSUP ER�01sOR k Lin name) ) CONTRA COSTA C'O The undersigned claimant hereby makes claim against the County of Contra Costa or the above-;gamed District in the sum of $ and in support of this claim represents as follows: When did the damage or �n'jury`occur? -Give-exact date anrhour� 7 Y (Inciude`city-and county 0�tt5 i lA e �e. r-3 e.k/y. e�' t C;e ct{ vUr ~ Gt v U . 16A �1 C�Y VI Gv-v d } CA- , 3. How did the damage or injury occur? (Give �u�I`�etails,-use extra sheets if required) �r -�.�. r.r.r---�._�.-rr-__ir_-=T--..r - 4, what particular act or omission on the part of county or dxstrlct officers , servants or employees caused the injury ordamage? lure ye lli�+ PW �,a*vGcaf acf�e_cs is (over) 5. What are the names of county or district officers, servaiiln employees causing the damage or injury? ' WkibAIM GCleSS 6jv; _ (� .,.r--- ..,r- ..... .. ......�..,�..�..,r�.-.�-__�.,..-�._ - _-. _ 6 .--What damage or injures do you claim resulted? (Give-full extent - -� of injuries or damages claimed. P.ttach two estimates for auto damage) GLCPN e. 'br V 5� , V' c r 1('v� � On -f f erJ LV's` G,+ le � ��"cn�'Se� ��(�- t--` 6 q(( cc.5l,W braise"-( se"-( C-I v � I°S1 Y1 ..-----------------•----------- - `— 7 .- How was the amount claimed .above computed? (Include the estimated- amount of any prospective injury or damage. ) t X- Y^a c~0 r r 8.--Names and addresses of-witnesses-,doctors and-hospitals. -- - -_ - 5M CO t L t F 5 Vvt L. A 0 t E :--List the expenditures-you-made-on-account-of this accident or injury. DATE ITEM AMOUNT Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf. " Name and Address of Attorney A �Yip C' Y Claimant s Sa fina re 02-01 x"111" �a�d ress w�v'rI ,� rn Telephone No. 2-33 - 1 '� Telephone No. 23(o -2307 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or -officer, or to any county, town, city district* ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill* account, voucher or writing, is guilty of a felony. "