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HomeMy WebLinkAboutMINUTES - 01081991 - 1.34 CLAIM ► BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA I J V A Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) , NOTICE TO CLAIMANT JANUARY 18, 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: Unknown Section 913 and 915.4. Please note all, °Warnings". CLAIMANT: ACE ALUMINUM COMPANY RKENW ATTORNEY: Stuart Silman, Esq. DEC 17 1990 Maloney and Associates Date received ADDRESS: 201 N. Civic:'Dr. , Ste. 210 BY DELIVERY TO CLERK ON A4, 1990 (via P.O. Box) Walnut Creek, CA 94596 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy-of the above-noted claim. DATED: December 17, 1990 Ia1L DeputyLOR, C1 JI. FROM: County Counsel TO: Clerk of the Board upervisors ) 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: z BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 8 ( PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek. the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING 1 declare under penalty.of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN S 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 MALONEY AND ASSOCIATES STUART SILMAN, ESQ. 2 201 N. Civic Drive, Suite 210 Box 0 3 WalnutCreek, 94596 RECEIVED (415) 947-6499 4 Attorneys for Claimant, DEC + 41M 5 ACE ALUMINUM COMPANY iH .O. �Dic CLERK BOARD OF SU 6 CONTRA COSTA CO 7 NOTICE OF CLAIM 8 9 ACE ALUMINUM COMPANY, 10 Claimant, CLAIM FOR EQUITABLE 11 AND COMPARATIVE V. INDEMNITY AND 12 CONTRIBUTION, AND CONTRA COSTA COUNTY and DECLARATORY RELIEF 13 WESTERN CONTRA COSTA COUNTY (Government Code TRANSIT AUTHORITY, Section 910) 14 Respondents. 15 / 16 17 TO: THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY and 18 THE BOARD OF DIRECTORS OF WESTERN CONTRA COSTA COUNTY TRANSIT 19 AUTHORITY: 20 YOU ARE HEREBY NOTIFIED that ACE ALUMINUM COMPANY, whose 21 address is 1939 East Olive, Fresno, California 93701, claims 22 indemnity from WESTERN CONTRA COSTA COUNTY TRANSIT AUTHORITY 23 (WCCCTA) and CONTRA COSTA COUNTY for claims arising from the 24 Contra Costa County Superior Court action, Case No. 25 C90-03494, entitled Pearl West Waldron v. Western Contra 26 Costa Transit Authority, et al. A copy of said Complaint is 27 attached hereto marked "Exhibit All and is fully incorporated 28 herein by this reference. 1 The exact extent and nature of Plaintiff 's injuries and 2 the amount of damages incurred are unknown at this time. 3 Pursuant to said Notice, Claimant hereby demands that 4 Contra Costa County and the Central Contra Costa County. 5 Transit Authority defend and indemnify Claimant from any and 6 all loss resulting from the Pearl West Waldron lawsuit. 7 Service on Claimant of the subject lawsuit occurred on 8 October 8, 1990 pursuant to Acknowledgement of Receipt 9 executed on behalf of ACE ALUMINUM COMPANY, a copy of which 10 is attached hereto and marked as "Exhibit B" . 11 This Notice will also serve as a tender of defense 12 demand pursuant to Code of Civil Procedure Section 1021. 6 and 13 Claimant hereby demands all attorneys' fees incurred in this 14 matter from this date on. 15 All notices or communications with regard to this claim 16 should be sent to Claimant at the offices of its attorney, 17 MALONEY AND ASSOCIATES, 201 North Civic Drive, Suite 210, 18 P. O. Box 8090, Walnut Creek, California 94596, Attention: 19 Stuart Silman, Attorney for Claimant, ACE ALUMINUM COMPANY. 20 DATED: December �, 1990 21 MALONEY AND AS OC ATES 22 23 ' STA' SVN,—Attorney for 24 Claimant, ACE ALUMINUM COMPANY 25 26 27 28 -2- r,S i • tj k 1 i . SKIN, ?�SQ. 1 BARRFILED ETT R. BA MILLER► BRODSItX & BASKIN, INC• AUC 1990 2 221 Main Streeet, Suite 451Q41 San Francis , Telephone: ( 415)543-1111 S•. 3 "A IAOq+� pn�ry.. NDLOC i 4 AttorneY for Plaintiff ► PEARS WEST WALDRON 5 NOTICE. (i.t:;.`.t kui.[ 5} r 6 AND co .,)rtt t;,,yc ',* RENT CODE 68600 7 8 SUPERIOR COURT OF THE S'T'ATE OF CALIFORNIA _..FOR THE COUNTY OF CONTRA COSTA 10 I1 PEARL WEST WALDRON, } } NO. : 12 plaintiff , ; C go - 03494 13 V. } COMPLAINT FOR DAMAGES FOR PERSONAL INJURIES 14 WESTERN CONTRA COSTA TRANSIT ) AUTHORITY, aka WEST CONTRA COSTA ) 15 TRANSIT AUTVORITY, ALAMEDA/CONTRA } COSTA TRANSIT DISTRICT, BAY AREA ) 16 RAPID TRANSIT DISTRICT, COAST UNITED) ADVERTISING, ACE ALUMINUM COMPANY, ) 17 CONTRA COSTA COUNTY, CONTRA COUNTY } COSTA TRANSIT DISTRICT., and DOES I ) 18 through 30, } 1 19 Defendants. } 20 21 Plaintiff , PEARL WEST WALDRON, alleges: 22 1. -Plaintiff does not know the true names and/or 23 capacities , whether corporate, associate or individual, of 24 the defendants sued herein under the fictitious names of 25 DOES 1 through 30 , and plaintiff prays leave to amend this 26 complaint to allege the true names and capacities when 27 ascertained. 28 2 . pl,ai:ztiff :.s informed and beiieves, and "EXHIBIT A" 1 thereon alleges, r.hat c_�;jnii of t.tzc defendants designated 2 herein as "DOE" is ncglig(!nc. t,y Lc sponsiblc in some manner 3 for the events hereinafter ►-afcrreci to, and negligently 4 contributed to plaintiff ' s injuries and damages as set 5 forth. 6 3 . At all times prior to august 29 , 1989 , 7 defendants , and each of them, manufactured, designed, did 8 own, possess, construct, erect, maintain, repair , inspect, 9 and control that certain bus stop and bench at the corner 10 of San Pablo Avenue and Tara Hills , in the City of San 11 Pablo, County of Contra Costa, State of California. 12 4 . At all times herein defendants, and each of 13 them, were the agents , servants, employees and/or 14 representatives of each other and were acting within the 15 course and scope of such capacity. 16 5 . At all times herein mentioned, defendant 17 WESTERN CONTRA COSTA TRANSIT AUTHORITY aka WEST CONTRA 18 COSTA TRANSIT AUTHORITY, was a transit authority in the 19 County of Contra Costa, State of California, engaged in 20 operating buses for t.hc use by the general public. 21 6 . At all times herein mentioned, defendant, 22 ALAMEDA/CONTRA COSTA TRANSIT DISTRICT, was a transit 23 district engaged in operating buses for the use of the 24 general public in Contra Costa County, State of California. 25 7 . At all times herein mentioned, defendant, BAY 26 AREA RAPID TRANSIT DISTRICT, was a. transit district engaged 27 in operating buses for the use by the general public in 28 Contra Costa County, State of Calitcrnia. 1 8 . At all c i+Tir.s hc.i.cin incntioned, defendant, 2 COAST UNITED Lu,i.Lnc:ss organization 3 existing under and by v JLrtuc: of ttic laws cf the State of 4 California located at 6045 Scott Way, Commerce, California, 5 which conducts business in the County of Contra Costa, 6 State of California. 7 9 . At all times herein mentioned, defendant, 8 ACE ALUMINUM COMPANY, was a business organization existing 9 under and by virtue of the laws of the State of California 10 located at 1939 East Olive, Fresno, California, which 11 conducts business in the County of Contra Costa, State of 12 California. 13 10. At all times herein mentioned, defendant, 14 CONTRA COSTA TRANSIT DISTRICT, was a transit district 15 engaged in operating louses for the use by the general public 16 in Contra Costa County, State of California. 17 11. A claim, in accordance with the Government 18 Code, was filed with the County of Contra County on 19 February 14 , 1990 , and denied by operation of law as of 20 April 2 , 1990 . 21 12 . A claim, in accordance with the Government 22 Code , was filed with the Contra Costa County Transit 23 District on February 14.4 , 1990 , and denied by operation of 24 law as of Arpil 2 , 090 . 25 13 . On or about August 2: , 1989, plaintiff , 26 PEARL WEST WALDRON, was lawfully sitting upon the above- 27 described bus stop bench. At said time and place the 28 defendants , and cath )t t_ ;cm, were nagligent in and about a i fE I the manufacture, dc:.,z;ign, ownci.::h. r), rc,nstructi,on, erection, 2 possession, maintenance , rcpa ir , in,-pcction, safety and 3 control of said bus stop bencti, thus exposing plaintiff to 4 unreasonable risks of harm and injury. As a direct and 5 legal result thereof , plaintiff was caused to and did 6 sustain injuries as hereinafter alleged when the bench 7 collapsed causing plaintiff to fal.1 to t..hc ground. 8 14 . As a direct and legal result of the 9 negligence of defendants, p:laintifi was caused to and did 14 sustain injuries to her ankle, kne , back, coccyx, hip, and 11 leg, shock to her nervous system and other injuries not 12 fully ascertainable at this time. Plaintiff prays leave 13 to amend this complaint to ai.l.cge the full extent of her 14 injuries and disabilities when ascertained. 15 15 . As a further and direct and legal result of 16 the negligence of defendants, plaintiff was caused to engage 17 the services of physicians , therapists and technicians for 18 the proper care and treatment of her injuries. Plaintiff 19 does not know the reasonable value ci said care and 20 treatment rendered to date, or to be rcrndorcd in the future. 21 Plaintiff prays leave to amend this complaint to allege 22 the full extent of same wizen they arc, ascertained. 23 16 . As a further direct and legal result of the 24 negligence of defendants , pl.aintitf. has been unable to 25 engage in her usual employment and activities and will in 20 the future be prevented from attending to same for an 27 undetermined amount of time, all to hor damage and detriment 23 in a sum presently unknown. i.a�n�?�! prays icave to amend i e • -b 1 this complaint to allL!,gc the f till. cxtent •f same when they 2 are ascertained. 3 WHEREFORE, plaintiff prays judgment against 4 defendants as follows : 5 ( 1) For gencral damages in a sum in excess of 6 $25 , 000. 00; 7 ( 2 ) For special damages to be shown according 8 to the proof; 9 ( 3 ) For prejudgment interest at the legal 10 rate ; 11 ( 4) For costs of suit; and 12 ( 6 ) For such other and further relief as the 13 court may deem proper. 14 DATED: August 8, 1990 . 15 MILLER, BRODSKY & BASKIN, INC. 16 i BARRETT R. BASKIN, 18 Attorneys for Plaintiff , PEARL WEST WALDRON 10 20 21 22 23 24 25 26 27 28 SUPERIOR CONTRA COSTA . , COURT OF CALIFORNIA, COUNTY OF ,,,111E I•IUNIf 1nAL Oil .'LP`11CF COUnI p151111f.1 UN Or UnANcll COUni. I! ANY •TOrT COURT l' •E ONLY UI Contra Costa County Superior Court, P.O. Box 911 , Martinez, California 94553 TITLE Or CASE (aH811EvIAtf0) PEARL WEST WALDRON, Plaintiff , v. WESTERN CONTRA COSTA TRANSIT AUTHORITY, et al . , Iu.taE.ADORE 55. At1O TE_LE pTA NE NU_U01R OF SENDER BARRETT 11. BASKIN , ESQ. MILLER, BRODSKY iz BASKIN , 1NC. 221 Main Street , Suite 1001. San Francisco , California 94.105 CASE: Numoen — Telephone: (415) 543- lilt - C90 03494 NOTICE ACE ALUMINUM COMPANY: TO: . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . (Insert name of individual being sen This summons and other document(s) indicated below are being serv. Code of Civil Procedure. Your failure to complete this form and return i' party on whose behall you are being served) to liability lot the pa ment V on you in any other manner permitted by law. yfAac2 : 11 you are being served on behalf of a corporation, unincorporated entity. Ihl,, form ,must be signed by you in the name of such entity or process on behalf of such erltily. In all other cases, this form must be sig, by you to acknowledge receipt of summons Section 415.30 provides I deemed scived on the dale you sign the Acknowledgement of Receipt b' Daled September. 21 , 1990. l (Signalurof sender) / I BARRU R. BASKIN ACK14OWLEDGMENT OF RECEIPT This acknowledges receipt of: (To be completed by sender belore malling) 1XXX A copy of the summons and of the complaint; (3) N-HICE OF FIRST STATUS CON 7ERL.NCE (12/21/90); 2. [; A copy of the summons and of the f etitlon(Marrlage)and: (4) CONTRA 00STA GOIRTrY FAST TRACK [j Blank Confidential Counseling Statement (h1amlage) (AR 3300) PROG'RAP1 CHANGES; and [-] Order to Show Cause (Marriage) (5) STATUS CONFERENCE QUESTIONNAIRE. Li Blank Responsive Declaration (Blank) Blank Financial Declaration () Other: (Specify) (TO be completed by reclptanl) Date of receipt: / / (Signature of person acknowledging receipt•with title of acknowledgment Is made on behalf of another person) Gale this I(ITri, 1s signed- /r/U�A/0 (Type or print your nerve and name of entity, it any, on whose behalf this form is signed) 4 c'v 41S 30.417.to: I�d•c.� ,�r..r•' �• 1�•:� ^••, NOTICE AND ACKNOWLEDGMENT OF RECEIPT Cr1 p"'.+ of courl "EXHIBIT Bit 1 PROOF OF SERVICE BY MAIL 2 The undersigned declares: 3 I am a citizen of the United States and am employed in 4 the County of Contra Costa, State of California. I am over 5 the age of 18 years and not a party to the within action. My 6 business address is 201 North Civic Drive, Suite 210, Walnut 7 Creek, California 94596. 8 On December 7, 1990, I served the attached NOTICE OF 9 CLAIM on the parties to said action by depositing a true copy 10 thereof in a sealed envelope with postage thereon fully 11 pre-paid, in the United States mail in Walnut Creek, 12 California addressed as follows: 13 Clerk Board of Supervisors 14 Room 106 County Administration Building 15 651 Pine Street P. O. Box 911 16 Martinez, CA 94553 17 I declare under penalty of perjury that the foregoing is 18 true and correct. 19 Executed on December 7, 1990 at Walnut Creek, 20 California. 21 22 23 24 Margaret F. Grocholski 25 26 27 28 m�S? � 7 , \ 1 \ r R » 4 / � �0U6 0 o f 0 k ik■k � q0 t / � / co P / % & n 0 Ul ° $ » @ tp ON , C \�\. - $ . � LP % � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County,,,,gr,_Distri,;t..gove,rned by) BOARD ACTION the Board of Supervisors,.,Routi;ng Endorsements, ) NOTICE TO CLAIMANT JANUARY 8 , 1990 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. • ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $ 200 . 00 Section 913 and 915.4. Please note all "Warn ings".RKEIVI® ` CLAIMANT: BAKER, Douglas Steven DEC 111990 36 Valley View Court COUNTY COUNSEL ATTORNEY: Danville , CA 94526 MARTINEZ, CALIF. Date received ADDRESS: BY DELIVERY TO CLERK ON December 6, 1990 (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, Cler DATED: December 11 , 1990 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( . ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: —AplDated: (2 � 12��(, 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. B;) Th D 0 By unanimous vote of the Supervisors present isClaim is rejected in full . ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. tip Dated: JAN . 8 199 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. codes ti 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 atall 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 showgn above. Dated: J A N 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator LOST PROPERTY CLAIM Return original application to: Clerk of the Board PO Box 911 Martinez, CA 94553 A. Claims relating to causes of action for death or.for injury to person or to personal property or growing crops must b.e .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 it's office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If cla1m 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 bel-filed against each public entity. E. Fraud - Section 7Y'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 of officer, authorized to allow:or pay the same if genuine, any false of fradulent claim, bill, account, voucher, or writing,- is riting,is g6ilty of a felony. " JJ J.J.J.J.J J J.J.J.J J.J.J.iC�iC iC iC iC iC n•JiCJG.�iC iC.JG>�.7G iC�C D'Ch JG iCXXiC i.;C::Jc':::sC•;C;c•,�.::;tiTa:''cJc%�:%c%c):D'c•h::*'�c�t'':Jc;:s'co'c:t�Y;:�':9:.7:D:>:1:'"c'Y•n't RE: ` y Reserved for Clerk's.:.filing stamps IED - � 2G Against the COUNTY OF C N RA -COSTA =. or 2` DISTRICT- SU VISORS (Fill in name) CONTRA COSTA CO. -The undersigned claimant hereby .makes claim against the 'County of Contra. Costa or the above-named District in the sum of $ Q __s- and' in support of,this claim re presents: as follows: 1. When did the damage or .injury occur? . (Give exact. date• and hour) 2. Where did the damage or injury occur: (Include city and county.) TO dz�ld/G� :l ,�� � mit��� �� .. • How did the dama;e or injury oc ur? Give full details; use extra sheets if required.) 4. What par,,Cictflar act or/omission on the part of county or dis rict officers, servants, or employees caused the injuryor damage? over - i .gh,.yw u'}^`�.'�'a,.,y"'+""Y�'rr'r i�'�rxwr'•s^i�rF�a•.a•-?,- ,.•r^^-.�+ w. Yc•...,,_,: _. ... _> - :.ti^r,a.:•,,,;:.Mr' w' + - .. , ... �.,, _.. .�,. V * INCIDENT RCRORT N. 1 1,> CONTIRA COSTA COUNTY SHERIFF 'S. DEPARTMENT INCIDENT INCIDENT: 1�,1 ..r: !'`''Nzr'� FACILITY: REPORT #, -- r - f� DATE/TIME DATE/TIME LOCATION: OCCURRED: Q//s` /zREPORTED: f?//s' 12 .1-1- 0 / HOUSING �- INMATE: _ j�¢�/ "�� ncl`rL.iC .5'71-.--- BOOKING # : '/�j- , j+/l ;`� ASSIGNMENT: Last 6/ rst Middle WITNESS(ES) -- LIST -- Name - Address If an inmate, give booking #: SYNOPSIS: NARRATIVE: r �rJ 5 � �.�r7d� T`r•!,�"' r ur„�; /.% ,�.�'.�IS ii"E,�.�,�;� .�.V ,� ..cif s••r'' ,i�i1/�',/_.= ✓�,TSI G.�,�'�' f��''�i"`�re�i.�G �_�,��'O/1"' /�,. /�r�,��.. T�l�" �is''�G. GtJt7r1 '4 3,rgIiJ i lr-12 Z,C G�e.�.�r`/'r.r/'/ /54/ °le . P3.1 If i7 Ga/AS /,„ ..✓ ii' /`/.+l/,->'l ACTION TAKEN/RECOMMENDED:_ L''�[. REP=RTING EMPLOYEE # SUPERVISOR # OPERATIONS DIRECTOR # O.D. ROUTING INSTRUCTIONS: White to Facility Manager - Yellow to Booking File - Goldenrod to Inmate By: Pink to Lineup Board Page one of / Rev. 3/85 3y' • �' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8 1990 and Board Action. All Section references are to ) The copy of this document mailed to you is your not{ce of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Cod Amount: Undetermined Section 913 and 915.4. ! Please note all 11Warnings1!whVED CLAIMANT: BEZDEK, George D. DEC 11. 1990 COUNSEL ATTORNEY: Stanley J. Bell, Esq . COUNTY MARTINEZ, CALIF. Law Offices , Date received ADDRESS: Two Transamerica Center BY DELIVERY TO CLERK ON December 6 , 1990 550 Sansome St, , 18th Floor Cert . P144 409 862 .San Francisco , CA 94111 BY MAIL POSTMARKED: December 5 , 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: December 11 , 1990 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Su isors ' _"(v ) This claim complies substantially with Sections 910 and 910.2. ( . ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910:8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 12 12 190 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 ORD 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: q JAN. 8 19911 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code ct 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County. Counsel County Administrator 1 CLAIM FOR DAMAGES FOR PERSONAL INJURIES 2 TO: STATE BOARD OF CONTROL R ECEI Y GD STATE OF CALIFORNIA 3770 "L" Street Sacramento, California 95812 DEG 6 M 4 BOARD OF SUPERVISORS CLERK BOARD OF SUPERVIS 5 COUNTY OF CONTRA COSTA CONTRA COSTA COr' 651 Pine Street, Room 107 6 Martinez, California 94553 7 CONTRA COSTA COUNTY FLOOD CONTROL & WATER CONSERVATION DISTRICT 8651 Pine Street, Room 106 ` Martinez, California 94553 9 EAST BAY MUNICIPAL UTILITIES DISTRICT 10 2130 Adeline Street Oakland, California 94607 ''aow °oa 11 W FF� e ' CENTRAL CONTRA COSTA COUNTY SANITARY DISTRICT 5 u z 12 .5019 Imhoff Place Martinez, California 94553 13 )PQ ozmow CITY COUNCIL a�90U, 14 CITY OF WALNUT CREEK dooz� 1666 N. Main Street 15 Walnut Creek, California 94596 �< M � 16 CITY COUNCIL CITY OF CONCORD 17 1950 Parkside Drive Concord, California 94519 18 CITY COUNCIL 19 CITY OF PLEASANT HILL 3300 N. Main 20 Pleasant Hill, California 94523 21 PLEASE TAKE NOTICE that the undersigned hereby serves 22 and makes demand upon you for the cause and amounts set forth 23 in the following claim: 24 Claimant ' s name and address : 25 GEORGE D. BEZDEK 3143 Hacienda Drive 26 Concord, California 95482 Claimant ' s mailing address to which notices are to be 1 sent: 2 Stanley J. Bell, Esquire, LAW OFFICES OF STANLEY J. BELL 3 A Professional Corporation Two Transamerica Center 4 505 Sansome Street, 18th Floor San Francisco, California 94111 5 Amount of Claim: 6 . Special damages and expenses proximately caused by the 7 occurrence described below and general damages are in excess of 8 the jurisdictional minimum of the Superior Court. 9 Date and Place of Occurrence giving rise to the Claim 10 asserted: ao� ooao 11 On or about the 2nd day of October, 1990 construction WFZa < 8 o = 12 site of the San Ramon B ypass Channel, Walnut Creek Project in 13 the City of Walnut Creek, County of Contra Costa, State of o WozwUz a �ao �a 14 California . � a °< "' 15 Description of Occurrence: 16 That on or about the aforementioned date and for some 17 time prior thereto, the above-named public entities, by and 18 through their agents, servants and employees, negligently and 19 car.elessly owned, possessed, operated, constructed, inspected, 20 maintained, contracted, subcontracted, supervised, controlled 21 and had a right to control, engineered, designed, performed and 22 planned construction work and supplied men . and materials to the 23 construction site referred to herein in that they failed to 24 properly and safely control and supervise the installation of 25 support walls and . rebar on said construction site, thereby 26 creating a risk of injury to men working on said job site; and -2- I further in that they negligently and carelessly allowed the 2 area where claimant and others were working to exist and remain 3 in a dangerous condition; and further in that they failed to 4 provide claimant with a safe, proepr and adequate access to the 5 areas where he was working, thereby creating a risk of injury 6 to men working on said job site; and further in that they .knew, 7 or in the exercise of ordinary care should have known of the 8 unsafe work practices being conducted on said job site and 9 failed to remedy said conditions, having a reasonable 10 opportunity to do so; that said public entities, and each of 1-4 a . them, knew or in the exercise or ordinary care should have a0LU0 11 WF `- � 4 - known that the work in which claimant and others were engaged � o" maa 12 u'-Z02F: would necessarily create during the course of its progress a U C < ^ 'W"Us 13 sW ozW°o condition involving peculiar risk of bodily harm to others ;a z0U ld Ez�-+ < <zF 1$ unless special precautions were taken and that said public entities and others failed to take such special precautions or 16 to otherwise remedy said conditions, having a reasonable 17 opportunity to do so; that said public entities, and each of 18 them, were further negligent and careless in that they failed 19 to exercise ordinary care in order to avoid exposing persons 20 thereon to an unreasonable risk of harm; that as a direct and 21 proximate result of the negligence and carelessness of said 22 public entities, and each of them, as aforesaid, while claimant 23 was helping to install some support walls, he was caused to 24 fall from where he was working onto rebar dowels, thereby 25 26 -3- I causing him to sustain severe personal injuries . 2 DATED: November 210 1990 . 3 LAW OFF -C S OF STANLEY J. BELL 4 By 4C'T�' 5 / J. BELL Atto neys for Claimant 6 7 8 9 10 z o 11 )� O U m OC a 12 U 0: m � a 13 +a� ao�d 14 zorz , � 0 15 < oz 16 17 18 19 20 21 22 23 24 25 26 -4- RE: CLAIM OF GEORGE D. BEZDEK ACTION NO. PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015 . 5 I , the undersigned, hereby declare that I am a citizen of the United States, over the age of eighteen years, and not a party to the within action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome Street, 18th Floor, San Francisco, California, 94111 . I served a true copy of CLAIM OF DAMAGES FOR PERSONAL INJURIES by - mail, by placing the same in an envelope, sealing, - fully prepaying postage thereon and depositing said envelope in the U.S. Mail at San Francisco, California on December 5, 1990 . STATE BOARD OF CONTROL EAST BAY MUNICIPAL UTILITIES STATE OF CALIFORNIA DISTRICT 770 "L" Street 2130 Adeline Street Sacramento, California 95812 Oakland, California 94607 BOARD OF SUPERVISORS CENTRAL CONTRA COSTA SANITARY COUNTY OF CONTRA COSTA DISTRICT 651 Pine Street, Room 107 5019 Imhoff Place . Martinez, California 94553 Martinez, California 94553 CONTRA COSTA COUNTY FLOOD CONTROL & WATER CONSERVATION DISTRICT 651 Pine Street, Room 106 Martinez, California 94553 CITY COUNCIL CITY COUNCIL CITY OF WALNUT CREEK CITY OF PLEASANT HILL 1666 N. Main Street 3300 N. Main Walnut Creek, California 94596 Pleasant Hill, California 94523 CITY COUNCIL CITY OF CONCORD 1950 Parkside Drive Concord, California 94519 I declare under penalty of perjury that the foregoing is true and correct . Executed in San Francisco, California, on December 5, 1990 . Donna L. Kotake > o a z 9 T a z �4 ` or z r o > o n m m f') . 0 ( -1 • 0 a T m O /� z A ow Z? m g3 DQ 00 0"" �►► M9 O c J Q L! 0 O c(n 0 a M Q 1-1 ni rt ~ H F'- ro � tl• H (D �% M N (D rd (7 Q U) () m { Q3 " Z > Imo• (D LTJ (� +-, rt �Uo o , cc M > z � o � Pi o o r - - zI"li to t� b o lf�b o H 0 ul o) U} d i Ln y (> F s U.) 0 t• t t CLAIM FOR DAMAGES FOR PERSONAL INJURIES 1 2 TO: STATE BOARD OF CONTROL STATE OF CALIFORNIA 3 (RECEIVE® 770 "L" Street Sacramento, California 95812 4 1 DEC 71990 BOARD OF SUPERVISORS " 5COUNTY OF CONTRA COSTA CLERK BpARD F ERVIS RS 651 Pine Street, Room 107 Cpm C TACO. 6 Martinez, California 94553 7 CONTRA COSTA COUNTY FLOOD CONTROL & WATER CONSERVATION DISTRICT 8 651 Pine Street, .* Room 106 Martinez, California 94553 9 EAST BAY MUNICIPAL UTILITIES DISTRICT 10 2130 Adeline Street Oakland, California 94607 aoWooa 11 � r-Wr " CENTRAL CONTRA COSTA COUNTY SANITARY DISTRICT 12 5019 Imhoff Place Martinez, California 94553 U sW4 13 ) Z< M 0 PQ 02. 5Z CITY COUNCIL ;aWaoua 14 CITY OF WALNUT CREEK Zioo< W 1666 N. Main Street z" 15 Walnut Creek, California 94596 '. H 16 CITY COUNCIL CITY OF CONCORD 17 1950 Parkside Drive Concord, California 94519 18 CITY COUNCIL 19 CITY OF PLEASANT HILL 3300 N. Main 20 Pleasant Hill, California 94523 21 PLEASE TAKE NOTICE that the undersigned hereby serves 22 and makes demand upon you for the cause and amounts set forth 23 in the following claim: 24 Claimant ' s name and address : 25 GEORGE D. BEZDEK 3143 Hacienda Drive 26 Concord, California 95482 Claimant ' s mailing address to which notices are to be 1 sent: 2 Stanley J. Bell, Esquire LAW OFFICES OF STANLEY J. BELL 3 A Professional Corporation Two Transamerica Center 4 505 Sansome Street, 18th Floor San Francisco, California 94111 5 Amount of -Claim: 6 Special damages and expenses proximately caused by the 7 occurrence described below and general damages are in excess of 8 the jurisdictional minimum of the Superior Court. 9 Date and Place of Occurrence giving rise to the Claim 10 asserted: ao � °oa 11 On or about the 2nd day of October, 1990 construction G�Fzw< � oum = 12 site of the San Ramon B � < _ o ^ ypass Channel, Walnut Creek Project in 3'-zo2H.Jam:Owl - < � 13 the City of Walnut Creek, County of Contra Costa, State of > zN �oz )PQ o aW� ooa 14 California . zot'z�� Q' xo < a + 15 Description of Occurrence: 16 That on or about the aforementioned date and for some 17 time prior thereto, the above-named public entities, by and 18 through their agents, servants and employees, negligently and 19 carelessly owned, possessed, operated; constructed, inspected, 20 maintained, contracted, subcontracted, supervised, controlled 21 and had a right to control, engineered, designed, performed and 22 planned construction work and supplied men and materials to the 23 construction site referred to herein in that they failed to 24 properly and ' safely control and supervise the installation of 25 support walls and rebar on said construction site, thereby 26 creating a risk of injury to men working on said job site; and -2- 4 1 further in that they negligently and carelessly allowed the 2 area where claimant and others were working to exist and remain 3 in a dangerous condition; and further in that they failed to 4 provide claimant with a safe, proepr and adequate access to the 5 areas where he was working, thereby creating a risk of injury 6 to men working on said job site; and further in that they knew, 7 or in the exercise of ordinary care should have known of the 8 unsafe work practices being conducted on said job site and 9 failed to remedy said conditions, having a reasonable 10 opportunity to do so; that said public entities, and each of a a = them, knew or in the exercise or ordinary care should have ao�o° a 11 known that the work in which claimant and others were engaged 12 � oUm�a 3►�o�r ,, would necessarily create during the course of its 13 y g progress a � < FU + _.. �W0ZL0 condition involving peculiar risk of bodily harm to others ;a W; 14 Fa �zF 15 unless special precautions were taken and that said public v� entities and others failed to take such special precautions or 16 to otherwise remedy said conditions, having a reasonable 17 opportunity to do so; that said public entities, and each of 18 them, were further negligent and careless in that they failed 19 to exercise ordinary care in order to avoid exposing persons 20 thereon to an unreasonable risk of harm; that as a direct and 21 proximate result of the negligence and carelessness of said 22 public entities, and each of them, as aforesaid, while claimant 23 was helping to install some support walls, he was caused to 24 fall from where he was working onto rebar dowels, thereby 25 26 -3- y 1 causing him to sustain severe personal injuries . 2 DATED: November 2YO , . 1990 . 3 LAW OF.'F1t S OF STANLEY J. BELL 4 i" 5 B�� j STA �EJ. BELL Atto neys for Claimant 6 7 8 9 10 zoo ' 11 �oa GM�l r zZ- M � mr� r 12 U � p�. < Tog 13 �W0 U z� z ;a aou ,z 14 -+00zzda Q' a:3 /� eFNzF 15 H 16 17 18 19 20 21 22 23 24 25 26 -4- h RE: CLAIM OF GEORGE D. BEZDEK t ACTION NO. PROOF OF SERVICE BY MAIL - C.C.P. Sections 1013a, 2015 . 5 I, the undersigned, hereby declare that I am a citizen of the United States, over the age of eighteen years, and not a party to the within ' action. I am employed by the LAW OFFICES OF STANLEY J. BELL. My business address is 505 Sansome Street, 18th Floor, San Francisco, California, 94111 . I served a true copy of CLAIM OF DAMAGES FOR PERSONAL INJURIES by - mail, by placing the same in an envelope, sealing, - fully prepaying postage thereon and depositing said envelope in the U.S. Mail at -San Francisco, California on December 5, 1990. STATE BOARD OF CONTROL EAST BAY MUNICIPAL UTILITIES STATE OF CALIFORNIA DISTRICT 770 "L" Street 2130 Adeline Street Sacramento, California 95812 Oakland, California 94607 BOARD OF SUPERVISORS CENTRAL CONTRA COSTA SANITARY COUNTY OF CONTRA COSTA DISTRICT 651 Pine Street, Room 107 5019 Imhoff Place Martinez, California 94553 Martinez, California 94553 CONTRA COSTA COUNTY FLOOD CONTROL & WATER CONSERVATION DISTRICT 651 Pine Street, Room 106 Martinez, California 94553 CITY COUNCIL CITY COUNCIL CITY OF WALNUT CREEK CITY OF PLEASANT HILL 1666 N. Main Street 3300 N. Main Walnut Creek, California 94596 Pleasant Hill, California 94523 CITY COUNCIL CITY OF CONCORD 1950 Parkside Drive Concord, California 94519 I declare under penalty of perjury that the foregoing is true and correct. Executed in San Francisco, California, on December 5, 1990 . Donna .L. Kotake { U� t > 0 o a r > r M z 8 a 3� C t—A V nie i ..0 Q EP Er (D N (D 0 Cf� � 0 mH � j O `i ~ { cn i no o � =° j � .:.,.. � k Ul �ti1 � tfny � flays a �d��r 0 14 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors,. Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8, 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: Undetermined Section 913 and 915.4. Please note all "Warn $" CLAIMANT: BRUNO, Rachelle L. DEC 04 1990 ATTORNEY: John S. May, Esq. COUNTY UNSEL 2700 Ygnacio Valley Raod, Ste. 370 Date received MARTINEZ, CALIF ADDRESS: walnut Creek, CA 94598 BY DELIVERY TO CLERK ON December 3, 1990 (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: December 4, 1990 EVIL BATCHELOR, Clerk — yt 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). 2 ( ) 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: `z c d BY: I �• Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER:. By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 8 1991 PHIL BATCHELOR, Clerk, B a, 1 Deputy Clerk WARNING (Gov. code s 913) Subject to certain exceptions, you have only-six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM OF RACHELLE L. BRUNO, Claimant, CLAIM AGAINST PUBLIC ENTITY V s. COUNTY OF CONTRA COSTA RECEIVED TO THE COUNTY OF CONTRA COSTA AND THE DEC - 3 CONTRA COSTA COUNTY BOARD OF SUPERVISORS CLERK BOARD OF SUPERVISORS 1. Claimant's name and post office address: I CONTRA COSTA CO. RACHELLE LYNNE BRUNO 4085 Woodhaven Lane Oakley, CA 94561 2 . I desire notice to be sent to the following post office address: JOHN S. MAY Attorney at Law 2700 Ygnacio Valley Road, Suite 370 Walnut Creek, CA 94598 3 . The date, place, and other circumstances of the occurrence or transaction that gave rise to the claim are as follows: On July 15, 1990, Claimant was injured in an automobile collision which occurred on Neroly Road in an unincorporated area of the County of Contra Costa. Neroly Road is a street designed, constructed, controlled, and maintained by the County of Contra Costa. Claimant was a passenger in a vehicle being driven by Stephanie L. Dimaggio east bound on Neroly Road. Claimant was injured when a 1982 Toyota automobile driven by Timothy White crossed over the center line and struck the vehicle in which Claimant was a passenger head on. Claimant is informed and believes and thereon alleges that her injuries are as a result of the negligence of the County of Contra Costa in failing to properly design, construct, maintain, or give adequate warning to approaching traffic of a dangerous condition which had been allowed to exist on Neroly Road; namely, a sharp "s" curve. Said roadway was in a dangerous condition when used in the manner in which it was reasonably foreseeable it would be used. 4. The injuries sustained by Claimant so far as known as of the date of presentation of this claim consist of extensive facial lacerations, loss of teeth, damage to teeth, torn aorta which required open heart surgery, fractured left femoral head and displaced left hip, knee lacerations, broken right arm with residual loss of use of the arm and radial nerve palsy, multiple bruises and contusions, side effects from injuries, disfiguration and scaring. 5. Claimant's medical expenses to date as far as known are as follows: (a) John Muir Hospital $ 83,072 .25 (b) Drs. Sigel and Wixton $ 5,250. 00 (c) Blood Bank of America $ 585 .00 (d) Kaiser Foundation Hospital $ 22,690.00 as of 10/22/90 Total $111,597 .25 Claimant is still treating. 6 . Claimant's total wage losses are unknown but are continuing. Claimant was employed at Wells Fargo Bank receiving a salary of $500 per month on the date of the injury. Claimant has been hired for a new position at $1,500 per month, but has not yet started in the new position. Claimant's wage losses are continuing. 7 . The names and identities of the public employee or employees responsible for the said dangerous and defective condition of public property are unknown to Claimant. DATED: Respectfully submitted, LAW OFFICES OF JOHN S. MAY ss:�— JO S. MAY Attorney for claimant . _ Sy. CLAIM BOARD OF SUPERVISORS OF CONTRA .COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY--"8 1993- 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 ervisors (Paragraph IV below), given pursuant to Go�vyernment.Code Amount: . $850.00 Section 913 and 915.4. Please note all °W 117,0 go.A. q. qn CLAIMANT• DEES, Randy and Linda C9�ty1Y � u,Ly�ti CQIIF. 504 Sunny lane ATTORNEY: El Sobrante, CA 94803 Date received ADDRESS: BY DELIVERY TO CLERK ON December 3, 1990 (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: December 4, 1990 EVIL BATCHELOR, Clerk p y _ 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: iZtic 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 ORD R: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full, ( ) Other: I certify that this is a true and correct.copy of the Board's Order entered in its minutes for this date. Dated: JAN 8 1991 PHIL BATCHELOR, Clerk, B Deputy Clerk WARNING (Gov. code s 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 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: l, 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. . .-. �•.:_.�.._. . -.:<,...::- - :..�..�i.-�_�-h---...;::.cr��.�::. -;�.:t._:�.-.:-�., --•.y; �-,:� :.:€:-s. .-.=ter.. D. If theclaim is against more than one public entitys,:separate claims must be a filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the .end of this form. F. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED ba Against `th(kCounty of Contra' Costa ) ;DFS ._ 3 090 District) SU SOBS" Fill in name ) ACO. The undersigned claimant hereby makes claim alnst ,the County of Contra Costa br the ;above-named District in the. sum.of $ C� ..C� and in support of this claim represents as follows.:. ----------------------------------- =----=---------=-------------------------------- 1. When. did the damage or inj, ny occur? (Give exact date and hour) ..-,. �.r.. -L=.,,y.�;y;l t;,_.y,,. -`--�, i' -r-•-.psi,•�� Z,14 -.;� ...�ts���,,,_..:,.,.:i _,.,,a:� : -- „t'° -. ___;..�-•_ �-- „� -- - -- 2. Where Pid t1le damage or injury 'occur? (Include city. ar,..: county)- __ P6 L �U RS U1 L (Z-R�_ k C-- 3. How did the damage or injury occur? (Give full details;. use extra paper if required) P__�C l< Lew, 4 4. What What particular act or omission on the part.of county or district officers, servants or employees caused the• injury'or damage? i v i (over) 5. What are the names of county or distr,ict,officers,. servants or employees causing_.; the damage or injury? 5: What`damageror-injuries"do,you claim resulted?; " ( ive full extent of -injuries or damages claimed. ' Attach two, estimates for auto d e r 7. How 'was the amount claimed above computed? (Include the=estimated unt' of any prospective injury or" damage.) 8. Names and addresses of witnesses, doctors and-hospitals.? --------------------- ---- -- -- ---------- `------------------------ -----: 9.' List the expenditures you made. on account of this accident or injury: DATE _ ITEM AMOUNT S.`naaCS��pryCCLfSw".LA i3a� r, a� va Gov'. Code'Sec. 910}:2 provides: The claim must be signed by the claimant SEND NOTICES TO: ,a,(?1f"ft rnex) s orb ome erson on h s,behalf." Name and Address;ofrAAttor-n�- ''� j (Claimant's. Signature) µ Address'. o _ Telephone No. Telephone 'No. N O T I C E Section 72 of the. Penal Code provides: ' "Every person who, with intent- to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent :> claim, bill, account, voucher, or writing, is punishable either by imprisonment in the 'county jail for a period of not more. than one year, by a fine of not exceeding . one thousand ($1,000), or by both such imprisonment "and fine, or by imprisonment in the state prison, by a fine of 'not '`exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CLAIM . BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1,3 y Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8, 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: $49.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GEARIN, Carl Lee . 1555 - 2nd Street DEC 17 1990 ATTORNEY: Richmond, CA 94801 Date received COUNTY COUNSEL ADDRESS: BY DELIVERY TO CLERK ONINEei3�er 14, 1990 (via P.O. Box) BY MAIL POSTMARKED: December. 3, 1990 1. FROM: Clerk.of the Board of Supervisors TO: County Counsel Attached is a copy. of the above-noted claim. �H{ BATCHELOR, Do DATED December 17, 1990+ C1'1L Clerk - 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with .Sections 910 and 910.2. ( ) This claim FAIIs 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: iZ 17 190 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: — I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. n Dated: JAN 8 199 1 PHIL BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov. code se - 913) Subject to certain exceptions, you have only si.x (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 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN g 1991 BY. PHIL BATCHELOR by _ Deputy Clerk CC: County Counsel County Administrator LOST PROPERTY CLAIM = Return original application to: Clerk of the Board .PO Box 911 Martinez, CA 94553 FIL A. Claims 'relating to causes of action for death or for injury to person or to personal property or growing 'crops must be presented not later than - the 100th day after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of ' the cause of action. (Sec. 911.2, Govt. Code) B. Claims must be filed with the Clerk of the Board of Supervisors at it's 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 - 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 of fradulent claim, bill, account, voucher, or writing, is guilty of a felony. " ��.J,..A.JJJ.J.J.J.1••r_•r..r.J.J J.J J.J.J.J.J..r_ J.�..�.r,.iC�C�C J.r'JS'�if irf:c;:;;;rJci'c-::i:%:ci�.::iki:i:::nJ'C:c:C:Ci:)ck4c s:3ci'c 7Y Jt Jc ice.i'c�k*n�1:�i:is n::ni'Fn* ray _ RE: Claim By Reserved for Clerk's..filing stamps - RECEIVED DEC 1 4 1990 Against the COUNTY OF CONTRA COSTA I 10. �v or DISTRICT- L04 LERK SOARD OFSUPERV (Fill in naive) CONTRA COSTA CO. The undersigned claimant hereby .makes claim against the 'County , ontra. Costa or the above-named District in- the sum of $ 41S60 and in support, of this claim re presents as follows: _ 1. When did the damage or injury.occur? (Give exact. date and hour) _ 10 C0 5Wil© t _ 2. Idhere did the damage or injury occur: (Include city and county.) 3. How did the. dama;e or injury occur? (Give Cull details; use extra sheets if required.) 4. What particular act or omission on the' part of conn y or district officers, servants, or employees caused the injury or damage? k ,L Q 7 _ over - 5.. What are the names or county or district officers ,. servants, or' empl.oyees causing the damage or injury?. 6. What damage or injuries do you c aim resultedT- (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount lzlaimedabove computed? (Include the estimated amount of any prospective injury .or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: .V 9. List the expenditures you made on 'account of this .accident or injury: DATE ITl..`I AMOUNT iC)-Ia-�o C'RGx� T.�. C:Rtil� x,0. 00 Govt. Code Sec. 910.2 provides: "The claim signed by the claimant or by some person on his behalf." SEND NOTICES TO (Attorney) . Name and Address, of Attorney JJ�QQ, j�, Claimants Signature n .4i _ Address Telephone Number: 'Telephone Number: : ._,-r-...r..e e.__- .. -..—..+....w-,..-+'--�+•r.'rfvr.r'i..www'!,+:wr!�i..yy;'..—++�--.._..:.r✓r+.wr ., , PROPERTY/CLOTHING RECEIPT COSTA COUNTY ' - ' F Uo114179. DATE: �f RACK+P MDF "' TIME: ,F, i h s'b.. ..-./�✓'' f� PRUP BOX= �W FxC �� � NAME:..- 7i.l , ... C'E "y JCp BOOKING N r OTHERt CASH $ r ❑ SHIRT ❑ DRESS 0 coAr/JACKET ❑ TIE/SCARF,, ❑ SHORTS/PANTIES E-1JEWELRY' SOCKS/NYLONS SWEATER/SWT.SHIRT i❑ WATCH Q�IAELT �. PANTS/SNRT '^ •----- MSHOES/FrTs� `:"-rr t T-SHIRT/M A"" WALLET`' E E-1HAT/PURSKEYS \ r t ❑ KNIFE ❑.;GLASSES C� OTH R ,,,j/ �` _ 'F f 1 , BKG OFC: INMATE SIGNATURE have received all of my per- DATE: sonal property and clothing. REL OFC: X INMATE SIGNATURE. :. R # Yt 3 L "^�'^ f f ,X�'. G 1r.� • pr ky#(s1Y�4��5���. Xie y Y fi A n�i-' '' •kNi"h 7r .a. •t' iii-. 'r.�r"�I r* 'r 4 k {� � -y• frrft....rr^�!e ah.r a' +,'. +` ,NTRA�C®SSTt�t�®ETEi•I.10N,F/�CILIaT�lr-!�r� �� M. NOW, trt�4���# s��. i ROPRER f !r} DAT E.�` f°f�Y � � � eT4"� •��'�"7 M�}t I � i � -1a.Ec�:�.yxwF'e R MMAME Mrd �z,, n _ M• r ,$� E ENV .y ,S ,{r ,o'Sr, ' 'z Tr'`,�.�,'P� ap �� 0• .0 . r� 5. - '- . D O ,'WEBB 1 a% r � BOOKING�NOR'. 3�u .� �. S `, A zr` ... r i M is^' ro.x �,: rfip.�n'i £,€bh5 +,y,".'wq'o �� -.� ``,' ' '� k' ITEM UNDER�GOU TER Y ,ORer�N x a r ° ',tYa3i tL r s r 1� � n •� A ki ra PM '�'Y" ] q i+y[y rY.rca�54,t JEWELRY �,it1r���,.,r ,� `DES�„C^���r �� ` ��� � �������, �L`�� � ���� �r°. �'��s��k�'. • .,h y �r r'i"'r5 �'tyy t`"' 1:4 •ktj,c° ,K -s� , WATCH a l � t s •5,to sn. RxdA y - 9rY Sv rNO x .yo-fyA, s� �. s ni9fbrry , aka ��, }y5�eyr g LIGHTER x WRY.,« >, � ,� e L- ,e a etW+l�'4 ' e I£WALLET PURSE �J fi #� g •� r a YI� j� $'r, / °4x'kc"'rtPe� a+ 1z tv was az, a Utz .� l six i, ;) x ;t rl i IC/ F5 h ` r mol }� � ���� t QBE T.- �,r '=,, I �. k •yr.F,7tra.§•�. k"p�,;: .3 'y+, t#,�r a'� '� + 4�lu r0l.�2.t� to ,'Srp�� r mg S.` :"f �stw- n51 �.L'�G. N '.+ R'`'ice'£.r°« 5 *"' A�"Y z*,wa,�a ��G et [` ,.-r"" '•l 'S�+ fd.1.19'r''> .. h,{.�` � �1 �.#,ea}�'� �F'r -'.;,�.�?i'�ra£�xr+t{�'y";€* �'"��a.3r' 3�' ��tY"r`•1 r��'•T{ r'�` z• .r i'S•�, n. `�.3t�'"' Yi cl BOTHER „ E �k� /�'G I� � ar t � , rk- sm - ^ts. ,w�a3 to,�i'S K ,erre f'�,R � xk"���'§' 'ii��N Li(,'r'~•„STM �.i��`,w �'qtc� -y`�, .�,�',,,,,�' � r,� 5�. `pv rsi a°3" x sa " 'a ,' .lic'.k G�:eY:•. �'' t y"��r r'•�X7a'r', ,�r,,�. l,as',a '�k'�,� a . �+'fit .Fr,'��'' a"�,t arr 'T a �s"�s'��`s��r,. '�� � >� �r•F'2 '� .- O y'�crP+£U'ry r" 'r"'� � W�r^'t ys, ' VIPj "'9 �f "'L• x a de R s '. t ,1' I Yk � 3' j two y T �i � s r w£t�y..dkt 5pea�.uSu.. ''�°;# �'�'S t£ «. aa.'yca . 'u' 6�, X 4rr7s x � �ry� r,�,�, £r• ,-'� � a ka4 tiIrl, �'>�, ��L„x �x� . MATE SIGNATURE � i���G �X#�u� FyM�e4S5.+ra�`�� < ta� r� L a5:�y .�s�j:3 �tit9y�a ;y rt y `� �Y.,�Pi. . ung r2,�it.'s pk t �`l kr Fr.a� 'fi�w•n.,k'rdF"t§L'1Y dN�.Y3 y$+ -42F! '�rri5 Ott ",+�•A�j, .�F'p� `''�'E"A$� ` DAT:E "��_ I{FiA�E RECE MED A L OF MY } w � PERSO,NAL�rP'll Pith,numa wL � 'n '6 a S,a d (s- ';y/ 'r'" 3"t+. USS �.qtr v'rt' F p��y'n�r{R j�� ��}wsn .,y rr s BREL OFC g � � � rtn` ' '+.nro.'�7 < 5 -T, t x ." '{+-r i S i .c .ter 'u e 43 ww4 e#��y' a&•' ,. 3r�t y Yh�x ,� y�i'�as =x>, aTP �t+ �� t.tr ��:� � a �,hi+3���'"kf� �e� j'��, : 4 xL t1' `# Cn 'dHk�`t` t{o xr'i '�� rt,� y"� �,t.�rry ' � }a St,+ `y,,-�ar!/1;�,�4sU iSIR'sS txa; �*x"+a. �.s I� ,. - j^ s o- � iIg� ,g�NMATEr51GNATURE t n oaM�3 fr 2t f' SSr .. S ;.Jki•*:�!+d�x'�'�r', t'a y�,yatGt¢i,,fi i rvr f q..y,a�^.aFd ^vki 7}s.'dt'r���a�$43�5� . zr t ;"vrt t ,tr}�,wys)ye 't' .' 7 Sag «4'a R?+SCMt i S8 w rj" rRkr yrY 1� Age#,,a" rS� d+lr^ { .!, '{ j1�.3A� �r,_ �'� CLOTHII�IGlIR�ECEIPT� �1)l�,aa',� ��j >�•`�, ,rxw '� >F fix° x" a�s xe t �t P�+rd`c7,.iSy,'yrvit ra..mn r d:Ar a '� k FEEi�. s } r { .,J "s �' m'�ra9 a��t S'kr�?' '�a�.''` �7 t,g! �j+r ��'�+�'�$+� c ��'��`"�j' �, ��:� � �*,��i m ,. �'6A ,w# x ,Ay`t a s+�` ' "T n�$ .� ,.yr „�, �,tr vr,r hY"'''�',5.-k+�'Y.`s 9^ �£?+Y a `' 4r w Rf ffi DATE �d�/ ��d �I� ��„ � x�sr ��� . sr a �a - � T�IMEFACILIIY`��,������ �� � ,gyp ��t�ry�,, k s #r1 df4tcp� �i4x 3Naomo " �'t{. .v, F $ k AC- of 4 } € yxav J x * NAME (l; F, M) ;'�f/t��J '� F e np3 a" f as {i 1 ,c 4. Rk y 1OOKI�IG;NBR Its r!351'3x� ..�E� . ; `r` 1a �" ��^, 4�?:;rfY9=1101;a ., a {;^, r�s }f 'A?f�t•raa^a,xt'ry z 7 �r a �Y r a� "" W rt u -s rs . �A'`k`� f � + SHIRT/�BLOUSE � , � 5 rANTS/SIE+RT�� ME ,COAT tA'C'KEI � , SHOES) 5 �£t A'��3i rtr / uy"{"a+ "� r r t M _tzr wLt x , SHORT :xa a SPIR� x �, a ? a :; SOCKS`: y � aG ,� ,At fi I ,tr n y 4 , j 3 y rF t��g rt n q ,2,r Y s,fi F SV1/EATER/SWT°'SWIRiT � x � 4 PRESS a � � � a ,� '�` rtA�aas.�'.ty.a pr�;;;},,!`Y�p' ""rS''y'} 3 [s ai;r � `L� �"` ar xn � A �a Y.'gt,`�i,_ �,P {s a`,rty�",}i R Mf °' Salrs�a' {"3t�[Fr"�"u''t$ i�`�k s`' { _ '' }h '' "�'" Yr i.'d 3 FI "r c w .a w7 w *y�a� tdr rc c rs xa P c fkrF, ' 1iu�� k S too it�yv n adr a� tr � Y Pr� jft .� 'r4' Y a€ R"y-M Sjkd'y"AT.� iGyR.^' 4,t"f.�mGrx ,whR`f i�"�; ..,�`,r5 ??M1,id;s> w F N } ) <1Px 't- 2£ k'f7.�.�!A v,YfF� i� 1Nf".\ N�4M� .}'S l� ''w 341.�.i Ky .F �`iY[ 5t ,s9 mss " & ,�at"A,� �c "�� �r�ip; 3{�st Attu m ✓ ��t Va rt a.• n n ,i 4'S 7.Y Y'• tUA r P Et G7O - v.,Zg K FC ' tr �� s a w ��x w � �3 S �y{ zYX} � s 1 ria �y�: Y e ,t wt 'at v ],r Nat, S. 'gip a�' �.Cs ;::Y a� r t�r �21" M 2,'p�. t x S f kgu L r �/ � xev�y x 'te }t ++FA3' ,+ �/`Ytt.$vx ay ui x a i� tycba& ��r SA r?a TESIGNATURE f snr €s it 3 y , '09. � ;•1 ry �Y1.`G r4 P P€S a' „ rp��:q.. d se "Y w x? iay¢ 3rsv 'e.r"PG V mt F '"ti "' . � DATE t , pA�{' s R'F � I HAVE RECEIVED ALL�O,"WMILL L� sS,' �%F r } rp43 r aTd y SN 4.: 2 e t r l r a fpr 4j y ln� €} t. s ?a s r u rr -Hj sat 4� � � CLOING Lx r +,F' °ayt, t ` Tm A ,2 Fe V 'xs +axr g'f",a,u t�R rsf a *c"v a'r £`'"M�'f ,� 4 a�"'.5� ' P'a ' t u o A gg M, ,x} �•'}+"* �ra', '«`t k rn a t rvrs y 1 anINMATEi51GNATURE �+` r{` n [fir- rr'2^ x x�a#t-.. `act ?' � u a'd 'C 76 rWIsa' s,§e >tir's` t mr,lt n �" � "�` x.,a:r.' 3 uz• ffi�t,%�"�}z��'ut's.`-.{S3".rk-E�` w>���tN.v-4� � :3S S� A � �, a y�:t"'^�^—tu.i y r. .,A .. r 7 t t r ; �f-C o ro n m r Richard K. Raiff u"i �. Contra SHERIFF-COROt` P.O. Box 391 + Dwayne J. Dillon (Martinez. California 94553. Costa Assistant Sheriff (315) 372- 4495 County(��� warren E . Rupf Assistant Sheriff r Enclosed, is- a County Claim Form.. Please. list the missing articles and their value, along %-.ith any documents you may have, i .e. , receipts etc. Be sure you have included Dertinent dates that tie in with your loss. These dates should shout when you were brought here and when you left. Then you must return this form to Contra Costa County, Clerk of the Board, 651 Pine.St. , Room 106; Martinez., CA 94553. EE® 1990 UPERVISORS STA CO. AN EQUAL OPPORTUNITY EMPLOYER tee. o c v F V- fryer, 0 ' 1 b� t �4 V � I ,r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8, 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 Co Amount: $195.00 Section 913 and 915.4. Please note all "Warts W CLAIMANT: GILL, Randy DEC 041990 3919 Meadowbrook Circle ATTORNEY: , Pittsburg, CA 94565 COUNTY COUNSEL N1ARTfNR, CALIF. Date received ADDRESS: BY DELIVERY TO CLERK ON December 3, 1990 (via Risk Mgmt) BY MAIL POSTMARKED:. I. FROM: Clerk of the Board of Supervisors. TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 4, 1990 gyIL BATCHELOR, 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). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: _ �. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (kl 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. c� Dated: JAN 8 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se 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: `SAN S 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: _ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY : INSTRUCTIONS TO CLAIMANT A. Claims .relating .to causes .of .action for' death or for injury to person'or" to per* - or,or' growing crops and which accrue on or before. D.ecemb'er.: 3 1. 19$7., ' must, 66 presented not later than .the 100th day, after, the .accrual of- .the. cause of action: Claims` i^elat,ing 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 relatingto any other cause--of- action must..be. presented._not.. -- later than.one .year after.the accrual of.the cause of action. (Govt. Code-1911..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 A K C1 - -- ) RECEKSU Against the County of Contra -Costa -, , )_. 1 DEC __. ... " ' -District) Fill in name ) CLERK CONTRA The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ • � � and in-support of this claim represents -as follows.:. ------------------------------------------------- ------------------------------------- 1. When did- the damage or injury occur.? (Give exact date and hour) AIN - ------------ -------- -2 Where did the damage or injury occur? (Include city and county) • t ------ - iEL�-E, - -��- ----2-L ----------------------------- 3. How did the damage or- injury occur? (Give full details; use extra paper if required). .UAC:N E� V F K�e:K G 9 p,S S �ICiNI• hR1�JE'� CO�+h�i`� aE��acNC� fi�'L 'c. F ' G4li� p�iNC� �'1�PU�I, ii'Ss�.ow.i,f�Ni: H� TX. CANks.c C_KitsC 1.. Lo k_11N S;"'41 CE L-AN -------- ---- --- -------- --- ------------------- ------------------------------ 4. 'What partidular act or omission onthe part of county or district officers,, servants. or employees caused the injury or damage? .: 1J� C �C-\2S vol 1A 5 }.,\ - (over) CJE� \Sv- 5. What are the names of county or district officers, servants or employees causing the damage or in jui ry? r 5: What damage or Injuries_ do you,.elai resulted9` (Give full_exterit of injuries or damages claimed:' Attach two .estimates for auto damage. ,'~ >7. "-HowVwas the amount claimed above computed.. (Include the estimated amount`of any prospective injury or damage.) - 8. Names and addresses of witnesses, doctors and hospitals. --------=----------------= I N_ ---------=-=------------------------------- , ----- 9... List the, expenditures you made, on ac_eount _of this accident or.-injury.: :•:.: . DATE ITEM AMOUNT , Gov. C de'Se'c 91012 provides: The c aim must be signed by the claimant SEND NOTICES TOO (Attorney) or by some, ers n his-behalf. Name and Address Pef Abterney -=�0 , . Tr '(Caiffiahtl s Sign4tureT Address jj- Z12 IIA, Telephone No. Telephone No N O T I C E Section 72 of the Penal"Code. provide`s: _ "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- i_f• 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 thdri. one year, by a` fine of. not ;exceeding one thousand '($1,000)"; or by both such'.ii p'risonment and -fine, or, by.impi isonment in the: state prison, (by= r f ��e of, Uqt tt xceeding ten thousand-dollars ($10;000, or by both such imprisonment Fp. ndrfin(P1��g,. LOLL' II- LIES ��n, ESTIMATE HARMON GLASS IAB°_ A29538 Da QUOTATION TO DATE ADDRESS RESIDENCE PHONE CITY BUSINESS PHONE QUANTITY MATERIALS i b3 -IC) okc -p� of) UNIT PRICE AMOUNT I �3 Jar 6-f THIS ESTIMATE IS SUBJECT TO CHANGE AFTER 30 DAYS CONCORD ANTIOCH 1140 ERICKSON ROAD 1013 W. 10TH CONCORD,CA 94520ANTIOCH,CA 94509 Ago" 827-4173 754-0799 'Co o?�U ���1 Q►c� �� �n�11e a \CQ, &cx� "30 c�QvJS �cfm 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 `jam_ 9 9/ and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,264.10 Section 913 and 915.4. Please note all "Warn ingslp.%EIVE® CLAIMANT: KAHL, Robert L. or Marietta P. (Claim No. 02-V66869-3) DEC 041990 ATTORNEY• California State Automobile Assoc. COUNTY COUNSEL Inter-Insurance Bureau Date received MARTINET,, CALIF. ADDRESS: Attn: Donald S. Hyatt BY DELIVERY TO CLERK ON December 1 ; 1990 P.O. Box 1699 Lafayette, CA 94549 BY MAIL POSTMARKED: November 30, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JpH IL BATCHELOR, Clerk DATED: December 4, 1990 BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors �(�S ) 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 _ 6ho BY: a, �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 ( his 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.. p Dated: JAN 8PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code s 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, 'postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 IM BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ^ ' California State Automobile Association * * U nnt ey-vU nsu rance Bureau RECEIVED Dal 3 1990 LAFAYETTE BOARD 0 SU R 15) 283-9450 P.O. BOX 1.699 LAFAYETTE CA 945 NOVEMBER 30, 1.990 CONTRA COSTA COUNTY INSD : �AHL,ROBERT,L;OR MARIETTA P 651 PINE ROOM' 1O6 CLM-NO: O2-V66869-3 MARTINEZ CA 94553 DOL : O6-13-9O CONTRA COSTA COUNTY: ' ATTACHED ARE BILLS TO SUBSTANTIATE OUR SUBROGATION CLAIM. THESE EXPENSES ARE ITEMIZED BELOW. AS WE HAVE SETTLED WITH OUR INSURED, PLEASE MKE YOUR CHECK OR MONEY ORDER IN SETTLEMENT OF THIS CLAIM PAYABLE TO THE CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU (CSAA-IIB) . REPAIR BILL $ 1264. 1O TOTAL: $ 1264. 1O ATTACHED DOCUMENTS TO SHOW LIABILITY SINCERELY, ' ' ` DONALD SHYATT °~ CLAIM REPRESENTATIVE ` ` ` ' ' ` ' ' •� �• assignment of claim and . subrogation agreement In consideration of the payment to the undersigned of the sum of $1,264.10 ❑. a sum estimated to be ONE THOUSAND TWO HUNDRED SIXTY FOUR AND 10 CENTS Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number V66869-3 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER-INSURANCE BUREAU, said loss and damage having occurred on or about the 13TH _day of NOVEMBER 19 90 , the said undersigned hereby assigns and transfers to said Bureau HIS/HER" said claim in the above amount plus HIS/HER additional claim for damage resulting from said accident, not I a total covered under said policy of insurance, in the amount of$ 0 , constituting O a total estimated claim in the amount of$ 1,264. 10 Said Bureau is hereby subrogated in HIS/HER place and stead to the extent of the above amount of the said total claim and is hereby authorized and empowered to sue, compromise or settle in HIS/HER name or other- wise to the extent of said total claim for loss and damage, and to endorse in my name any check made payable to me therefor, and collect and receive any money payable thereby. The undersigned covenants thatIjE�Fjig ha S not released or discharged any such claim or demand against such party or parties and that HE/SHE will furnish to said Bureau any and all papers and information in NTg/RF.R possession, necessary for the proper prosecution of such claim. Dated at a?^l7'1.cLG�. this day of ��y�'i/J9,lb�.� 19 . WITNESS RECEIVED be $# 1990 CLERK BOARD OF SUPERVI CONTRA COSTA CO. F1433 (RE V.7-77) 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: NOVEMBER 20 19 90 LAFAYETTE California Claim is hereby made and filed against the CONTRA COSTA COUNTY as follows: Insured/Claimant's: KAHL, ROBERT L. OR MARIETTA California State Automobile Association Inter-Insurance Bureau Address of Claimant: (send notices to this address) P.O. BOX 1699, LAFAYETTE, CA 94549 Reference File 02—V668693 Date of Occurrence: 6/13/90 Place of Occurrence: MORAGA WAY AT STEIN, ORINDA, CA 94563 Nature and Amount of Damages VEHICLE REPAIR $1,264. 10 Items Making up said Amount: REPAIR DOCUMENTS Name of Public Employee(s) causing said Damage(if known): JAMES WILLIAM JENKINS Facts & Details: POLICE OFFICER JENKINS TURNED UNSAFELY AT INTERSECTION AND WAS CITED FOR 22109VC AND 22107VC WHILE ATTEMPTING TO MAKE A U TURN., California State Automobile Association Inter-Insurance Bureau By. t J� F1688(Rev.11-87) ._.a.a.•.rr.__. �_.._. .yr .�.�.. .�....:..+ -� �.:� - .i.�:s tea. �...a_.J..;:.v ,,, '._:- rs {;n s-+ _ S"e.�"��'g+; c��.�'� `... F .'Y-:�.M'p�, �'�:- ����rh v :..i TM•�g,-•...� ��...>,•,. x_'- /•��<3 ��,�'�y f,;Z ""Califora tatehAu#omeb�le Associafi�on_inier-nsurance.BUreau nj �D23 4v i7+ir } -,i.t a •�` -L,d�d `���--' _ N ax��C'v� i3�:. 0 '��., .-- - .Kn��..,.:':"''„�..-�* ._:f.'it,"�Y...��J t �r'- -''�- A TW��N�-_,�g�. �'4t•�F.*., x� t.+T�-'�,�'���....�'+�. _ ,�'!ta._..n .:._.sr'f�:y-wIf`, - ',T DATE ?t�.. ROBERT- 7 I3R ARIETTA .� r. r _tet – UCV—TYPE KIND OF IHSS SUFFIX ;rt J.,;* CLAI6IATRSiiAME::;....e �y `,. . . .i... PAY-', AUTO cOL �O1P 's�?°c 'Xy`�l}3L;_R0BERTa''L,Df-V MARI E T r 51r Oft c �:3.. ;� `P h+r ? �i`L:_. �.. ��+`'�-� !.?'....�..�as�-."1^a4'?rw"'.��.' S s;; `i`?v:t�r .�,- ^rt�.�.. :-.++. ,n •�!1. ..:�,Yv�^R.� nik•'-V 3 - u DA. .ADJUSTER NO; `IN OF: ly�n• 4�vT* a C PAYMENT . ,c, NftlowK! ;.LAF 14046 �` i. REP.AYRS; r,. ' 2Tp �j s , k son F,. °M.I„DKb.l(X`12 77 a 2 i>:r ��..� ._ .r-�- ..M> ��u'n .7270 - .. wpsnbw_, . CA 111 -SONE THOUSAND -7W0 HUNDRED ,FSF7Y.- DNE ..05%1 " PAY .'PARKER=ROBB :CHEVROLET .:AND ROBER T-'''.KAHL_` r = THE 17.07 :NO "MAIN`'ST ? r wuT R .-WILL.I'AM °:M .ORDER :WALNUT .CREEK' - CA.•�94.59.b `` .` . OF .: ....- .._... ri.:.:..:: _:vv'....y .s. : r, �..a.«.._......N'siz ✓WnY•�.,.'.: :•r.Nt.+.•.u.�wd.:.4. -r.... Yr,..._s i.w. _.R«_...-_.-:.r.,.a�,.. .. .. ......_....�. 111023027262,1' 1: 1210000L,I,1: 9281,1926269ul :.•w ��:< `- "r,-4� e,� }, ^' 'a'»;"a .�.;r•.r �-i- ��+ •4 ,� s,.(a+ 'x,�= r � �'` -�w�:zPt'S-•-..sA xya �v('a:- < �:•� y....,.t::. ;� .....�`_�-. _ :... :-.,:.._�.' ., �-�"..* ..rilK, `+�•''1 ,L._,•.,cr'��� .«;,•>�`�,. �«�?.',�-` .•e.-"..,rcl..,es.,�r��,•.x�,�x-r--.tyi-mss+,.�">?��..f�.`.�Y,�IS.rJ•'_ .a3+t'C,':fS.e*a,..- 1 .' �4i �,.� N'Si,'}�,S- i+ZKn,3�� *k�-� -y�"`a1�'�_",��..� �G..L,Y-d�±y� `�" i �,�.-• j � .sYG•"'7�Y w.�� � E�i'1+ 7•n H.►t�'8 "az-ir��'�-3-.Sasl."+. .C:4��`�i♦1,4�. .`•`W�--.A$ :`�.i,�[ -�T.�.�a�8'fi6'4°^',x 2�i��'?�Sa����E'.'�! � ... 9-'+', rwi�"c''�5.�'-Y �_r.-rr-� _ .++-iv. G _ � ,<;+� - - s-.: �,� _ - _� - �'_ ice' �_ - _ " '•X_'-r • _ '"':!n 3. �'w. � �:."�•-� r�'k,P..- _.ay..r�'4�..ar.rw„,.v.:••: e%as:a r er.;. _ _ scL .v - .cas. .��S.oi°�'�".�',ac. -RO.BB 'CHEVROLET `ESTtM,ATE' / ;O PARKER REPAIRS: . . ... -_. / ..': WIV 1707 No:Main SL Phone-934-4481 _ �..r T i WALNUT-CREEK, CALIFORNIA 94596 .' DATE o ��7 /z NAME ADDRESS CITY LP DAYTIME PHONE R�/f� rm/ MODEL ! LICENSE NO. SPEEDOMETER SERIAL NO.(VIN NO.) / ! SERIAL; r. i / "�� �y INSURANCE CARRIER ADJUSTER CLAIM M REFIN- PAINT REPAIR RE' DESCRIPTION PARTS LABOR ISHING MATERIALS PLACE - ®UST HRS. . HRS. 8 SUBLET 3 — ! E � 8 4 }( / /i i 8 qx 10 13 i 14 / 15 16 -T 18 I �C/ //� P� SEE i /�� G✓�� >� 19 20 21 22 - 23 J L j r' 1Dcc t6) .L The in C. } i �A Ak C ; inspection, and does not cover TOTAL i�: S addi �==� v„ equired after the work has been opel S0 Itarted, worn, broken or �. Pl LZ LL BOR HRS. part: Cnt on first inspection.gQ t is V ' �L REF.H S. On p .t to chan e. TOTAL / PER 9 D BOR HRS! X S HR. 3 ARTS LIST 7� ` SS °io D1ISC. $ EST. MADE BY D `/ �� Li I'2'-7 P I T& ATEIjIALS S SUBLET$ THANK YOU FOR BRINGING YOUR CAR TO SALES TAX S PARKER-ROBB CHEVROLET. TOTAL OF' STIMATE. ,��,� ® California State Automobile Association inter Insurance Bureau 023=3 52Y20 � T '• J. 'T 7' f?,,Y i.• Y•Ls i T DATE OF LOS .',:•ir-•V . _ �. 23, L352210;F'3`R` .. y INSUREDS NAME.r f % .", +'06—.1.3-90 02=-Vb6Bb9 3 ' 14AHLiROBERT�i1�OR 'MARZ'ETTA' �+` ', r DATE POLICY TYPE KIND OF LOSS SUFFIX CWMANT51111ME_ ^`t .- -AUTO COL 01F t R — PAY ! KARL;ROBERT,L; OR MAR:IETT :$50-36 :D.O.. ADJUSTER N0. .- .-y IN PAYMENT OF;:,,�,., d ►- :. . LAF :14046 s SUr-PP � _ tIE_N �. rsarsY.'h�'s..�._+-•r.`-- �_ n tln OMia�06t 2 i - 11-4 .,1210 _ Orr EmwreaGaro Gnbr�1.. -PAY •� F_IFTY ,�6/<100# r r;SanFranceoD CA 94111 r PARKER '.ROBB ,:CHEVROLET ` ti TO _1707 -NO -MAIN ST `< ' THE WALNUT CREEK CA 94596 „` .� A17THO ONATURE r ORDER _ '-W I LL IAM -OF .. ..: .�-e-mss:..•_ .:a.�;; '. '. 0 2 3 3 5 2 2 10it' 1 2 LD000441:9 28-9 26 269ii' 7. ._ - .y '' r to�t....+CL•3 � •f'�,,.'§cb�.-� :.�a:tir1•Zrs„ •� "'yC t 1 �-.v+rw•��� ` sS �`��rr,S'^tip?. �•4 s .�•. -•c W. ..is > ..a •ti .�!x Ste.-7...• Yr s�.r,,.. *.+_f... 2C. - Kev .. _'_:..- ,..::.� �c'. ::.... ......�_.. -.'. _,;.....--�.. - _,v ;.y�•"����',G^1•r,4A•s, i.-�=z'-r't r--^'`'%. .-y, v _ '' -«. :� ��v,. „ �'- r ate' '�• -'- -,a• �+N�-. fc�r.: y. �x - o.c� -lw:: o,-y - y - u. .. ... ...•'%"�'I•ia.%:'�' =�r:...,r'r.� ::�!_..-{s. ��. .ti+a�•:7�'rti:� -.,.�.++y:y�-•l. �yrs� rk'1.:`1,"'+ < ac:�•y-� x<3 c%-*;;ge(•«•r�••..r.L�. v .. ,. _ .p�..?Y_ •c..:i. ;ci;f J`ti=.«� ., .d•� _ih..:"!r�`.?w;" --=��'Iea'i.,tin-•l.a: � J.!7.�1"l�• -.aa,�•m,�e•,• .•. � ,.a,.� ,a•::s' vet �+-ae �.*„ ... �� .. '�r .$'-c.'�'-''�+•.�m•���'•''saAt' - ::�F�-`� ',.'�"d" � ®rr,���c�msil>�.� e.,-e,"-�.aai�i3"'�--� �.-'�. -s�,� _� ,.r.`�'.•.w�s:^i3t�ar�r....�.: PARKER ROBB'CHEVROLET - ESTIMATEF,. 3EiRS 1707 No Main'St. -Phone 934-4481 WALNUT-CREEK -CALIFORNIA.94596 _ DATE NAME CITY DP DAYTIME PHONE YEAR MAIC MODEL LICENSE NO. SPEEDOMETER i SERIAL NO.(viN NO.) qC� G�A-Q�J 8v � 3R1K�3 I�, y ( �fJE� 1(Q�3�F11�� INSURANCE CARRIER ADJUSTER .. - CLAIM N RE- PARTS LABOR REFIN- PAINT REPAIR PLACE DESCRIPTION LIST HRS. ISHING MATERIALS HRS. 8 SUBLET L_ 4 5 6 7 8 9 10 11 12 g 13 14 15 16 17 I 16 19 20 l 21 22 23 The above is an estimate, based on our inspection, and does not cover ' TOTAL S ) S additional parts or labor which may be required after the work has been opened up. Occasionally, after work has started,worn, broken or damaged LABOR HRS. parts are discovered which are not evident on first inspection. Quotations REF.HRS.. on parts and4abor are current and subject to change. TOTAL PER LABOR HRS. X $ HR. _ $ PARTS L4 /Q @ LIST S LESS %DISC. _ EST. MADE BY PAINT 8 MATERIALS$ SUBLET$ THANK YOU FOR BRINGING YOUR CAR TO SALES TAX$ PARKER'ROBB CHEVROLET. TOTAL 7 ESTIMATE ITAnoraALrbHBRw ` TRAFFIC COLLISION- EPORT PADS OF SPECIAA;CONOITIONS- NMSRR MTI RUN C"- JWXMALDHTMCT LOCOA REPORTMU"ER �)���O�LT. Ewr♦Eo s�p CUN VT.1._ NWEM HIT&RUN COUN" RaPOIRMO 00.MCI. _ EUT`" q E'T�At &ENCY VF,?f W COLLISION OCCURRED ON am_ DAY YEAR.: TOM/BL=) n10C S OFYNCm L 0. C -/--10 Ad �!!��_ �C/f/ ,T i y G _ � 'u. / `J./Lo /a 'r MILEPOST EYORYA770N "volt WEEK- TOW AWAY PHOTOGRAPHS SY: S M TOf FS ❑m ®"D g OAT RNnEN48C710N WrtH BTATE.nBIY REL ® ET X / - PARTY DRIVWM tueIlE NUMBER STATE MASS SAFETY VOL YEAR MAKE I YDDELI COLOR, 4-x ucimammum STATE 0 .? �� C� ,? f0uE1. q 0 C/46-✓ uA'��?�AJr. / 2/1/rX 3s. c� ORIVERNAME(POW,MODUS.LAST) .. •- OEDEs .ADOR6iE.. _ NRrE. sAY[AS DINER TRIAN.,- _ < �. PARKED ISTATEInSP• OWNS"ADDRESS SAYE AD DRIVER VEHICLE .. ®.. p . oA/,�. BICV... BEX HMAIM, EYES .IIEIOIR WEIONTYEAR BIRTHDAYS RACE DISPOSITION OF VEHICLE ON ORDERS OF- aOFRCIA MOWER ❑OTHER Ct1ET' NR DAY DISPOSITION - . ❑ Q.(.✓ �- Z /J 3— i Z S— ; .�.� o n ✓F TH✓ F2o'n .f e E�E OTHER NOME PHONE, - BUIBBESD PHONE PRIOR tlECHMOCAL DEFECTS: NOME APPARENT 19 REFER TO NARRATIVE ❑_ . (5'rS j Z f'y-,f O>� ( ) J'0 . - CHIP USEE ITK L of"XE VEHICLE SAVAGE SHIN DAMAGED AREA INSURMKECARRIIER POLICY NUMBER VtISCL []LINK..[]HONE 2"" e - 6 Y G 1-- o/ OM 0. D....AL 'DW.OF ON STREET OR HIGHWAY I SKIED PCF ICC❑LOST .-.- TRAVEL KC(3 PARTY DRIVE"LICENSE NUMBER STATE CLASS SAFETY VEK VSAA YAKEIMODELICOLOR ID"MUMS[R STATE lQUIP C It•�..J.; I••I•ire 2' Fe2o/✓PcTtit:i-4�Q�9 CA DRIVER NAME(RAST.YDOLE.LAST) �� Q U r-1 EM c-e-�La _. .. :. PEDES STREET ADDRESS. OWNEA7 WA []SAYE AS DWYER - TAIAN- ❑ -26 U/Z/.✓/, w Cc.✓rX A co -' cpAi.v g 29/p PARKED CITY/STATE/ZV' OWNS"ADDRESS pSAME AS DRIVER p `O�ti.✓/JA c.q 9 BK:Y. :SEE': HIAUI EYES• MEOW WEIGHT SIRTHOAT= RACE OlSPOIRHONOF VEHICLE ON ORDERS OF:-. O•MER. CU6T' �., DAY- YEAR DRIVER U ®. ❑. --- ❑ . : .: ,�c,� Iffeve--.? 2zo i f D.c/✓f-�✓ JiCON c t OTHER- HOME P"O EL' DN8WESe FNOfll• PISOi1 YECMMSCAL DEFECTS::. NOW APPARENT� TO IIAlIRA17VE❑ CHIP USE ONL ocom"VEHICLE DAYAOE SHADEW DAMAQW VIENICIAWSURAMCZ CAATSEAPOLICY NUMSM- ,- put«.., []NOUS' ®L.N°R . iNJc./Lr40 SCJ ❑L'°° pru°" pTorAl oft OF- ON STREET OR HSOMWAV -1 SPEED PCP m=[3 - - `TRwIl6'. A.1 u G w S' 7 v- CHIP E3 PARTY DRIVE"LICENSE NUMBER. STATE CLASS SAFETY VSK VERA YAKS I YODEL/.COLOR• ENDS NUMBER.. _ ..'STATE 3:.: : ... . . .. ._.: DRIVER, NAYE-(RRST;YDOLS.LAST-> - PEDES'. STREETADDRESS-• _ OWNE"NMS- SAYE AS DRIVER .. PARKED- CflT/STATE/IIP` OWNER'S ADDRESS r' []SAYE AS OMER, .. VEHICLE: - - tpctr BR HAI R'r. ETES C.. .HEHGMT' WE>a1TT:4 ' BIRTMOATE'. RACE:.. DISFWfl10N OF VEHICLE ON ORDERS OF:r DRIVER:. OTHER, CLm °' - ._ E0..•. . DAY YEANL` ❑ OTHRR MOVE MIOHE BuslNEss wHDNi , I QPRIOR MECHANICAL DE -:..:- NOME APPARENT❑ RERIn TO NAIUMTIVE p. CHP USEONLY SHADE IN DAMAGED AREA. �.. wBLwANec C11RWER ...... PGL,CY NUMBER.`.. . YEIICLETYFE p{liK..y NOMtD� IOL011 ♦OE ❑ ❑ f ❑rAJat.[]TOTAL DER OFA STR[ETOR HIONYAT SFEEDIL PCP ICCQ .. - e. •} TRAVEL C '. ;.N y LMSi ►LKQ _ � .. ;CID ! vaEPPATCH NOT' r 'EVIE �.. $-0.N0:'�W 1�663PACEi i .,T ),.On Pa [/(/,f_}.. (/ /7�`• 48887 gg ��'2i 4 ,. - z .. ..,_.r}n t�'_.._ _,k .,_,�1!._...:�x t:`. ... li......: r u 4.....,. _..- s 7F�r_.«. _.- _ . s:.e_... �.,.�..•_ ;�a'i� -- -::i.` .e..,», -.., ....., ....,.E.1.,_....,.r.;`: iTA7E OF CALiPOMA TRAFFIC COLLISION CODING DAYS Of COLU6ION 7116(1w NC1C "ICU L 1. Nw6611 ra DAY IJ TIMI 0 s0 /1 2-O u � • Ovown NAN61 AD011611 PROPERTY ` N t� NDYwED N am ❑-. DAMAGE pascmrrION OF DAYAO6 SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE L•AIR BAG DEPLOYED MLC BICYCLE-HE J&r ® ECTED A-NONE M VEHI E Y-AIR BAG NOT DEPLOYED QF6YER t-FULLNoT Y EJECTED B-UIp(NOI� N_OTHER V-NO 2-PARTIALLY EJECTED ELT C•LAP BUSED P-NOT REQUIRED AW-YES i-UNKNOWN 1-DRIVER 0-LAP BwnOT USED 1 2 3 2 TO 6-PASSENGERS F-SH0I HARSHOUILOR NESS SS USEDPASSENGERCHILD RESTRAINT PASSENGER 4 5 6 7-STATION WAGON REAR G-LAP/>iBOtQDER HARNESS USED . O-IN VEHICLE USED X-140 ,1: -REAR OCC TRK OR VAN H-LAP/>�I DER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES 6-POSITION UNKNOWN J.PASSIIIEYESTRAMT USED: :. B-IN VEHICLE USE UNKIlOWN 7 0-OTHER K•PAS8f WAUTRAiNT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS M AKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR s�Ri1 iG CONTROL DEVICES 1 2 3 TYPE of VEHICLE 1. 2: 3 MOVEMENT PRECEDING UST NUMBER(a) OF PARTY AT FAULT COLLISION c AVC SECTION VIOLATED: csvu ACmIROLs FUNCn APASSENGER CAR/STATION WA ASTOPPED L O No B Comms NOT FUNCTIONING• BPASSENGER CAR W/TRAJLEVOr B PROCEEDING STRAIGHT r B OTHER IMPROPER DRIVING C COUROLS OBSCURED C MOTORCYCLE/SCOOTFWr C RAN OFF ROAD D wocoNTROLS PRESENT/FACTOR• D PICKUP OR PANEL TRKK D MAKING RIGHT TURN COTHER THAN DRIVER• TYPE OF COLLISION E PICKUP/PANEL T96CK W/TRAILER JE MAKING LEFT TURN DUNKNOWN• HEM-ON . F TRUCK OR TRok TRACTOR F MAKING U TURN M E - B SSPE GTRUCK/ K TRACTOR W/TRLcL BACKING_ REAR END SC US SLOWING/STOPPING WEATHER( MARK I TO 21TEMS) Ba I OTH BUS I PASSING OTHER VEHICLE ACLEAR E HITGBJECT J El/ VEHICLE J CHANGING LAMS B CLOUOY OVERTURNED K HWAY CONST.EQUIPMENT K PARKING MANEUVER C RAINING VEWLEI PEDESTRIAN CYCLE L ENTERING TRAFFIC SNOWNNG H OTiwR•: AMOTHFR VEHICLE OTHER UNSAFE TURNING B FOG/VISIBILITY FT. MOBOR VEHICLE INVOLVED WITH N PEDESTRIAN RING INTO OPPOSING LANE IF OTHER•: ANOR-COLLISION MOPED PARKED G WIND 8 PEDESTRIAN P MERGING LIGHTING C OUER MOTOR VEHICLE TRAVELING WRONG WAY ADAYUGHT D uovm VEHICLE ON OTHER ROADWAY 1 2 3 OTHER ASSOCIATED FACTOR(S)- OTHER**. B DUSK.DAWN E PANEED MOTOR VEHICLE (MARK 7 TO 2ITEMS) C DARK-STREET LIGHTS F TRm AVC 8Sc"ON v10u710N: CITED ❑vs D DARK-NO STREET LIGHTSG acx:LE ., ®M DARK•STREET LIGHTS NOT ANM6L: B vc"'0"wounal: p FUNCTIONING• Ovis SOBRIETY-DRUG ve ADRY ROADWAY SURFACE I RXEDOBJECT: �'�IV 9 ND• PHYSICAL a6vau Qp1 2 3 m (PARK i TO 2 ITEMS)- i B WET OTiBi OBJECT: G 110 HAD NOT BEEN DRINKING sNowr-rcr J D D SLIPPERY(MUDDY,OILY,ETC.) E VISION OBSCUREMENT: B HBO-UNDER INFLUENCE E1Cfe HBO•NOT UNDER INFLUENCE' F INATTENTION': HBO•IMPAIRMEItT UNKNOWN ROADWAY CONDITIONS) G STOP i GO TRAFFIC E UNDER-I DRUG INFLUENCE (MARK I TO 2ITEMS) PEDESTRIANSINVOLVED INVOLVED A N0Fwf-:s RUIN INVOLYEO H ENTERING!LEAPING RAMP PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL A HOLES,DEEP RUT• CpD6$iNG IN CROSSWALK GlmPAIRMENTNOTKNOWN j UNFAMILIAR WITH ROAD B LOOSE MATERIAL ON ROADWAY• ATUTUMECTIO44 NOT APPLICABLE C OBSTRUCTION ON ROADWAY• CFAWNG IN CROSSWALK-NOT' I(DEFECTIVE YEH EQUIP.: L 13pR I SLEEPY/FATIGUED DCONSTRUCTION-'REPAIR ZONE ATNITERSECTION UNO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH CR=NG-NOT IN CROSSWALK I L UNINVOLVED VEHICLE: I I JAN.AzARDOus MATT31IAL i FLOODED• INROAD-INCLUDES SHOULDER OTHER': t OTHER': NOiYI ROAD NONE APPARENT NO UNUSUAL CONDITIONS APPROACHING/LEAVING SCHOOL BUS 1 10 RUNAWAY VEHICLE KETCH MISCELLANEOUS 812•sLAi✓E` .. /,/_.'f. ..- MbICAT1N01RN" WKS. V CHP.35S PAGE 2(,rkv 1-")OPI 042 h-> .. -....- -s -.•a^ srn,,,xa:v-.... ..r.-: ,,,.r*'_".`c`, c;•s.�•.."_'s�.�„r.'.:,J,�.i"xrtr+�7.��. "';�".�' .^''tel.,. '......,.._.:?..;�• T^•,....'q.'"`r'2'�'Tf.':�Y1^..F S'j.�....•c..�_, .�.:x �-T•S�.Fes`....F,.. Y." ':_n:,T -:.. _ STATEOF AWFORNA Nju 1 / WITNESSES / PASSENGERS DATE OF COLLISION: TIME OrSSI _ NC NtN BER OFRCIA Ilk NLMBO i > EXTENT OF INJURY("X:.':ONE INJURED WAS(-."X" ow) YITTNEss-- PASSENOEW PARTY . FEAT &AFf'TY ONLY ONLY_ ADE SEx 'NumalM --POf:.. EOLAP. FATAL. SEVERE OTHER.VISIBLE COMPLA NTL- DRIVER -PASS;— FED: &IC-CUST+ OTYIfR INJURY- INJURY, IWURY> Of PAN- ❑ ❑ .3l /-1 ❑ 1 ❑ ❑ ❑ 1 Ell Cl 10 -�- NAME I D.O.s./ADORES&.. TELEPHONE 11,40-10 — i9:1 (INJURED ONLY)TRANSPORTED BY: TAKEN TOC DESCRIBE NJURIES.- ❑VICTIM OF VIOLENT cmm Normo NAME 10.01.1 ADDRESS TELEPHONE �'/9!t YIP4 O A c� /�/ it i s S' ? - oo 5r.? v/tL cd-y O'c . a NQ c S ONJURED ONLY)TRANSPORTED BY: Z,TAKEN TR S' -A / ' ?i/ DESCRIBE INJURIES - ❑VICTIM OF VIOLENT CINE NOTIFIED ❑# 77111111 ❑ ❑ 1 1:110101 ❑ 101 NAME I D.O.B.I ADDRESS TELEPHONE ' (INJURED ONLY)TRANSPORTED BY: TAKEN TOC _ DESCRIBE INJURIES ❑,VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ ❑- ❑ ❑ ❑ ❑ ❑ NAME I D.OA I ADDRESS. TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TOC DESCRIBE WURIEs- - VICTIM OF VIOLENT.CRIW-NOTIFIED ❑� ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/D.O.S.I ADDRESS. TELEPHONE - (INJURED DOILY)TRANSPORTED BY: TAKEN TM DESCRIBE INJURIES- .. - ❑"VICTIM OF VIOLENT CFLSM NOTIFIED,-- ❑ D ❑ ❑ I El I ❑ 10 10 ❑. ❑ NAME I MO.&I ADDRESS - TELEPNONf .. ONJURED ONLY)TRANSPORTED BY:- - TAKEN TON: x-.. DESCRIBB BIJURIEi I .. '•-. - x ? tiry` �� k t a v-:.. �", ❑LL VICTIM OF VIOLENT CME NOTIAEDLu L0.NUMBER:: - MQ DAV':,...-. _ YEAR REYIEWERY NAEIEcu _ M0. DAY.t.. _ YEAA n C 555-Page 3(Rev 7 87)OPI 042 N B7 43637' • �fTAT[OOT GACt►OwN1A ' FACTUAL DIAGRAM ►ADE y DAT[ OR'tolt.IfloN TIME (2000) NCtCs NUME[w Or►ICEw 1.0, NU ER ALL.MEASUREMENTS ARE APPROXIMATE AND NOT.TO SCALE UNLESS STATED r 1 ATE TN glerur dicY[L�- L AA^�f NIB S/B I To No/LT}/.ROwY. .rAlit- P2VAO.V0' /9TjA.d of.JTr/N whl Y. S 6!o O C.4r�0 /fi9/L/Y JTi9/LT/cb . J'puTN OF wNE�'tE— �t— SS 9 F/'CAuB /7,119 12,1r .rT/17/tTJ. 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U L..ri fi— ,.✓ = U L v 20. !-"7 - G 21. 22. 23. 25. ni ,_ J 42 27: 28. ro 29. fv ..�/ %: Lc. ' C:U.C-/L� O,/ Ort MpttjNlOAYtYEAR. PREPAitEA'S NAME r CHR458 pwkAn�6lipr uMl . 88 48841'•' i 1�4 z t t 3 iw m�'hr• .� ""_'5 } 53 � 1E s� T '' ,e€at.� HL TS.rr`.M ,. EMT c..: UTATEAUMFOWrIM1 - E/SUP PLEMENTAL. PAGE DATE OF IN/GOE IOCCURENNCE:. TIME(760q- NCICNUMBER OFFIOERLD. NUMBER v . 'X ONE ')CONE.. - TYPE SUPPtBEIRAI CX APPLICABLE) . �. NAAAATTVE'• ® C.OLLSIC*4 REPORT ❑ BA UPDATE ❑ FATAL ❑ NR ARUN UPDATE' SUPPLEWNTAL. ❑ OTHER' ❑ MAZAF00418 MATERIALS. ❑ SCHOOL BUB OTHER CRY/COUNT Y/JUDCAL OISTRICT REPORTING OISTAICT/BEAT GTATION NUMBER LOCATION/SUM= STATE HIGHWAY RELATED rl YES NO 1. 7-1 1y - !- L- L 0- Z O = v-2 /0 4. lr 5. "D G-` V 'J U 2 - 6. vv 7. 15,- a ( -/ — 22LA 8. o — i2 !/ • i _ 9. — w OL/ E � 12. =UL" GL 13. - / 4 - / 14. C If—Z- 15. 16. - 67 L 17. L 0 O 18. L -- 19. 20. V n/ Q 21. 22. = 23. ,O -/ - XI 24. 25. L E — - 27: _ _ �- 28 c _ _ !� _ ;V 29.'- yc Citi/ 30 s` h 32: E ct. (icv G/i2c� UATI MOMH/ tCNP'S58(Ra�.7-87)„OPI 042 �r h u..p..w».alm»I.wa.Pl.asa 8814WAI r. IATEAW VE/SUPPLEMENTAL PAGE DATE OF IWtDEMTIOOCUREMCE TIMEIZAW MCC NUMBER OFFICER LO. NUMBER . - gu / 9 ,JZ /o / 7 • 'X ONE. "X ONE v TYPE BUppLom#TALCX APPUCA8l.E1 - ❑ BA UPDATE ❑; FATAL i_ HTt RUNUPDATE NAARATTI/E . REPORT Luu� . ❑ SUP'PLOW-WAL OTHER: ❑_ NAZN10OW MATERIALS ❑ SCHOOL&A �.. OTHER: REPORTINGOSTPJCT/SEAT CITATION NUMBER CITY/COUNTY IAMXCdlO1STRCT STATE HIGHWAY RELATED LOCATIONISUMUWT YES' NO 1. / t= 2. 3. / 4. c - w � /7/ � � Y 5 Oma/ 6-/ - 0 6. 2 7. 8. U u 9. ,-- oe� 11. - 12. 13. 16. 17. - o – 18. ��` �7.�'2i✓ '7J 26 //i Z X 1,77Y77 19. � 20. l 2 7 21. 22; 23 /2 — —�' 24. —� L / 25. `/� 7.. /- 26. /✓ 20 Z�z 27 ZA 28. (�'. G JZ" 30,10, 1 � 0- 4 MONTNtOAYtYEAR ' p v V f YIYEAA ER�►� t r i ee U..pn.lo...abxrurwe�.on•. , �a . A X qxAw Tl,v6sUPPLEMENTAL PAGE DATE Of INCIDENT/'OCCURENCE T1ME(2Wq NGC NUMBER OPFK:ERLD. NULLBEA. . '7�pNE W ONE TYPE SUPPt SWXTALr7C APPUCANLA - ® NARRAnYE ® COLLISION REPORT ❑ SA UPDATE ❑ ANIAL ❑ Wr A RUN UPDATE . t © SUPPLEMENTAL a OTHER: a HAZARDOUS MATERIALS ❑ •CNOOL BUS El CT140t REPORTING OMTRp=IBEAT GTATDN NUMBER CITY fCOUNTYIJUDICALDISTAICT STATEMGNWAY RELATED LOCATIONISUBJECT - YES' NO Ale- 4227 All 4, p E 72 E 3 C IV 6. 7. 8. n/ - - v / S Lr/Zl L 9. / ,-9 - Qu4R7 10. v e E_ --- 11. .... 14. 15. 16. b Jrlf VA= 17. ` - / - r 18. �- 19. f 40;'- f7=0/2l� 20. A--- 21. ,O E Z41/Al 22. 23. _ 25. AKII-f 26. 27.' L G vE 28. 7j Zvo ,7- ? - 4 - 30. ' 00, ._ qtr. _ 31 EYHIDAYIY3ZEAR NAPE 1. .NU q 88.48847 k'.C 558{Rev 7-87}OPI 042 s L` -__ '.. ^�,r",Ts-�F*Fa s - _ � ;�.'.=�x.` a. _�:..._oi-.r:, ..�r�::_._ - _ _-. .�a,t"R�y....•�1`, ...�-.v:.>..,.. ._...._ r .. .... ...x- ,,�y..: NAIVE/SUPPLEMENTAL PAGE DATE OF INCIDENT I OCCURENCE TME(2.00) M=NUMBER OFFIOERLD. NUMBER 'X ONE '7C OME. TVPE SUFVLEMENTAL M APPLICABLE) NARRAnvE ® � COt3N REPORT 6A UPDATE ❑ FATAL Q_ WT A RUN UPDATE . �C aSUPPLEMENTAL ❑ OTHER: D HAZARDOUS MATERIA,S Q SCMOOLSUS. ❑ OTHER L� REPORTING p6TFICT/BEAT CITATION NUMBER CITY I COUNTY I JUOICAL DISTRICT STATE HIGHWAY RELATED LOCATIONISUQUECT YES NO 2. 5. v �' 6. 7. 8. g �'E TZ�/L♦n/ Lam✓) 7 7Z 1�C�7'— 10. 2 —� 12. 06) 17. ocJG a C.� 2.L 18. /i✓U °C� �/L4 L G 19. _- Cl U ' 20. z 23. 2 .l - 19Z J 24. L�1 C) 25. J/ 26. 27. G 29r U G Y U 'Z ♦ i .NU MON Ht YtYEAR- REVIEWERS NAME.. MONTH/DAYlY NAME :.. ... :. ... .-. .. ..: .. .. - crtp sss(Rev 7-87)oP!oa2 UNp�Mw».Qitlwlslr,MMp«W+ as 48641 -a. .{'.. .•i -a-'�E '-ii�t h - kXAR TIVE/SUPPLEMENTAL PAGE DATE OF INCIDENTf OCCUFENCE TIMETZA0o NCC NUMBER OFFCEAIa- IRJMBER" fu 0 'X ONE '%'ONE TYPE SUPPLFJEIRAIryf:APPLICABLE) ® NARRATIVE ® COLUSCN REPORT ❑ SA UPDATE- ❑ FATAL ❑ NR f PION UPDATE - aSUPPLEMENTAL OTHER: NAZMbOUB MATERIALS SCHOOLSM ❑ OTHER:' CITY/COUNTY/JUDCAL DISTRICT HEPORTINO DBTII BEAT CITATION NUMBER LOCATION/SUBJECT STATE NNGHWAY RELATED L YE9 NO 1- ,019n 3. e 10— e -0 L1 E— 4• 5. Zi-,A,7 %!L /J W / L — G— 6. Z9 f- 7. - -/ 8. - 9. - 2- 10. - 11. 12. �/ - Z— - 17'4,0 13. _ - 4 i15. -. ZD — 16. 1 7. .f - - E'- _ - - 18.• C - .✓p '-D 19. _ _ - - 20. 2VJQ / L - - 21. lool--k/�—Zj 722ZZ / —C v �/ C ;I 22. „ �/ 23. )� — 24. ZIJ d Z G 0Z-- 25. ZY,14 26: D C U 27. C ISLE — ,S;ol 28- , 30: L. .� T_ 32 _ _J (/ � .i PREpLAgEiTS NAME::,- _ ID.NUMBER,. - 7 Y/ - - MON HJOAY IYEAl N r y 2L. -. CW,.456(Rev 7-81 Y.rF 042 U-PIVA” "a«� ea IM41 �... .. ,u ,.....Y.. ii.;' .... .,.Trt-.. r.•w-.- .aH/PS.. , -..,. •. -.4 .�.. !.._:.,..L. Y.....-i..... fid.::.. STAT$OF UFORNATIA^ NARIVE/SUPPLEMENTAL. PAGE DATEOFINCI ENT/oCCURENCE TIME124000 k=NUMBER OFfICERLD.- NUMBER 2 0 / 0 792?Z 2 'X ONE •X'ONE TYPE SUPPLEMENTAL PX•APPLJCA" NARRATWE ® COLLISION REPORT ❑ SA UPDATE' 13 FATAL ❑ HIR f RUN UPDATE - ❑ SUPPLEMENTAL ❑ OTNER: ❑ HAZARDOUS MATERIALS. SCHOOLBUS ❑ 0T11ER: CITY/COUNTY/JUDICALDISTRICT REPORTING DISTRICT/BEAT GTATION NUMBER LOCATION/SUBJECT STATE HIGHWAY RELATED El VES NO 1. — 2. 3• _ C -7f / o _ 4. - 5. — � _ v s. 7. o — = c e) 8. -�✓ — 10. / t - - 11. Iti/ w 1. — 12. O 13. 14. 15. / /.f c- L / 16. — '1 — f 0 = 22 r 18. _ C �0 �✓ G 19. Z— 21. 22. 23. E- -/ L - 24. 25. .J OF 2 '-D — E T -x 26. - o - 27. — "7 J v till E 28. o 29. — Af 2294-7-,-)Aw 30. �C - [ G 31. O 32. ULG 0 PREPARERS NAME I.D.NUMBER houNrH/DAY/YEAR REVIEW NAME- M H/DAY/Yl:&R CHP 556(Rev.;7-87)QPI 042. u«PI•Wa•.d4on.unNe.p.r4 88 48641 STATE FA U NAA E/SUPPLEMENTAL PAGE OAT 'JF INCIDENT/OCCCUREWA TIME - AGC NUMBER OFFICER lO. MUAltE7i ,Fo •X,OUF 'Tc'ONe TYPE SUPPL,961TALCr APPMA" . NARRATIVE ® COIUBION REPORT �:..SA UPDATE ❑ FATAL ❑. MT i RUN UPDATE ❑ SUPPLEMENTAL. .❑ OTNER:: ❑ IMZAFDOIIS MATERIALS.. SCNOOLBUS ❑ OTHER CITY/COUNTY/JUOCALOISTWCT REPORTING DISTRICT SEAT GTATION NUMBER LOCATIONISUBJECT STATE HGNWAY RELATED r_jVES NO 2. 0z 4 V ,f GZ et 3. E_ / 4. 5. 6. - 7. • 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22, 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. PREPARERS NAME I.D.NUMBER YOKTN/ Y/YEAR REVIEWERS - YONTNlDAY/YEA CHP 556(Rev.7-87)OPI 042'-. U-P-4w» wU"aswwd Be 4WI ti -.L,-;;,P. ..J e..�P..:L..'i.?>•'.,.. �.A..."..,...}h uJ.s Y....^!�-•;er'v�. .... ':�._� :..x. ...i ..- v' .. 6 ... . x '14 f i� t ECE9 E a pyo 199a ARD OF SUP VI cy c NTRA COSTA CO. i! s e� N 0-0 a, :n r H r f H Q�-- % — C N t77 ,0 stn z O44 • x �ITt a C a - z � a v �rD 1 � � Ops ; �g O5 It ! € i> cy.. O �. f�F � ca !,:j cn CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8 , 1990 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $80 . 00 Section 913 and 915.4. Please note all "Warning,,,.rn/E CLAIMANT: PHILLIPS, knthony 9 ATTORNEY: YVAo dvLPL Date received ADDRESS: - none- BY DELIVERY TO CLERK ON December 10 , 1990 (inter- office) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 11 1990 PpHHIL ATCHELOR, Cle BY: Deputy _ II. FROM: County Counsel TO: Clerk of the Board ofrvisors `,�S ) 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: ii � - Dated: �o BY: t ' �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 (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. �Aq**'' i Dated:_JAN 8 NI PHIL BATCHELOR, Clerk, Deputy Clerk WARNING (Gov. code ecti 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, .California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator i t ?r LOST PROPERTY CLAIM Return original application to: Clerk of the Board PO Box 911 Martinez, CA 94553 A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than - the 100th day after the accrual of the cause of action. Claims relating to any other cause of. action must be presented not later than one year after the accrual of ' the cause of action. - (Sec. 911.2, Govt. Code) Claims must be filed with the Clerk of the Board of Supervisors at it's office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA.94553. C. If claio 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 - 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 of fradulent claim, bill, account, voucher, or writing, -is guilty of a felony. " �'.c�•�;'c:cdcic'•c:c::;c•� :c:c:::c:;:c'c'c'.•d::Y:c�•;:;;;c�c:c��•:;:'c:;:c �•;c�••�:c•O.-�;'c•�;ckr -'••��:c;::c 4cx�Y'c';*�*:c�•:'c��:t�Y��*�:�:'c�:F*'•c _ RE: Claim By Reserved for Clerk's.-.filing stamps RECEIVED 1990 Against the COUNTY OF CONTRA COSTA '' -= E� ( � or tj&cf,�ieZ C auAa ISTRICT"' CLERK BOARD OF SUPERVISORS (Fill in name) CONTRA COSTA CO. The undersigned claimant hereby makes clai �ainst the County._of Contra. Costa or the.above-named District in the sum of $ and in support of this claim re- presents as follows: 1, When did the damage or .injury occur? .. (Give. exact. date and hour) 2. Where did the damage or injury occur: (IncILIde city and county.) 3. How did the. dama;e or injury ccur? (Give full details ; use extra sheets if required.) 4^ What particular act or omission on the part of/county or district officers, servants, or qmployees caused the injury or damage? over - s 5.. What are the names or c my or district officers , servants, or~ employees causing the damage or injury?. b. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed 'above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals: 9. List the expenditures you made on account of this .accident or injury: DATE ITEM AMOUNT "P _ -� Govt. Code Sec. 910.2 provides: J GC P' /V S' 0 e !M e �/7 "The claim signed by the claimant or by some person on his behalf." SEND NOTICES TO (Attorney) . Name and Address of Attorney _ CVaimants Signature o Alc Address Telephone Number: Telephone Number: /V O ) f 0 1 •1 +yKV.w�+'fx.1vM"J•�.wt T.i!tS'S»•���� "WLwf 4 � K h- f-Coroner Contra r Richard K. Rai >'J On tl l a - SHERIFF-COROt P.O. Box 391 + Duayne J. Dillon Martinez. California 94553 Cosa Assistant Sheriff (415) 372- 4495 County Warren E. Rupf Assistant Sheriff _t • Enclosed, is- a County Claim Form.. Please list the missing articles and their value, along with any documents you may have, i .e. , receipts etc. Be sure you have included oertinent dates that tie in with your loss: These dates should show when you were brought here and 'When you left. Then you must return this form to Contra Costa County, Clerk of the Board, 651 Pine .St. , Room 106; Martinez CA 94553. •Z3 -Z AN EQUAL OPPORTUNITY EMPLOYER It t z i y = 1 a c .za L a a r tf• I x " c �; .l ..s � V 1 IN cs s o x. (3 to rA SDI d,•�, o ,r•-�, Hca � n N N O w CD � `� co O Q Oib .O. • 1 � '; a E U �+ O ✓ � O � , O U �� m r CLAIM i BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8 1990 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice or California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $80 .00 Section 913 and 915.4. Please note all "Warn ing°s�'. CLAIMANT: PHILLIPS, Anthony ATTORNEY: M z . L ago IO C (Nkra dvL Date received ADDRESS: - none- BY DELIVERY TO CLERK ON December 10 , 1990 (inter- oDi.ce) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: faMMMIM Attached is a. copy of the above-noted claim. GATED: December 11 , 1.990 IVIL BAATTCepuVELOR, Cle II. FROM: County Counsel TO: Clerk of the Board of visors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: '{J Dated: BY: I S_ Deputy Count) Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( 1 Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 8 PHIL BATCHELOR, Clerk, Deputy Clerk WARNING (Gov. code ect 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited• in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM �• 3 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA r Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8 , 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: Unknown Section 913 and 915.4. { Please note all "Warning ' CEIVE® CLAIMANT: THOMPSON ELECTRIC DEC 111990 ATTORNEY: Michael T. Lucey, Esq . COUNTY COUNSEL Gordon & Rees Date received MARTINEZ, CMIF. ADDRESS: 275 Battery St . , 20th Floor BY DELIVERY TO CLERK_ ON December 7 , 1990 San Francisco , CA 94111 BY MAIL POSTMARKED: December 5 , 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Clerk DATED: December 11 , 1990 ��: peputy II. FROM: County Counsel TO: Clerk of the Board of Supe sors r ) 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: 112 f 190 BY: _ �. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 8 '1.991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code s ctio 13) Subject to certain'exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of th, United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator r LAW OFFICES STUART M.GORDON DONALD W.REES GORDON & REES P.GERHARDT ZACHER JAMES MOUSHEGIAN TWENTIETH FLOOR DOUGLAS B.HARVEY JAMES M.HANAVAN FAX(415)986-8054 JACK B.McCOWAN,JR. JAMES PATRICK CASTLES EMBARCADERO CENTER WEST P KURT PETERSON WILLIAM A.ROBLES FAX(415)2969287 WILLIAM C.WILKA ARTHUR L.LANTZ,JR. 275 BATTERY STREET DIANE R.CROWLEY MICHAEL T.LUCEY SAN FRANCISCO,CALIFORNIA 94111 OF COUNSEL THOMAS C.CROSBY EDWARD A.WEINER H.SCOTT SIRLIN S.MITCHELL KAPLAN (415)986-5900 MICHAEL E.MYERS DANIEL J.HERLING THOMAS A.PACKER DAVID R.DO7SON WILLIAM J.PETERS CAROL E.REESE CASEY S.CLOW PETER W.CRAIGIE G.CHRISTOPHER RITTER ROBERT G.TUNNELL December 5, 1990 ALEXANDER M.WEYAND GORDON I.ENDOW JOHN F HUGHES RYAN L.WERNER DEBORAH A.LEE DAVID C.CAPELL SOUTHERN CALIFORNIA OFFICE M.J.PIETRYKOWSKI GEORGE J.DECKER TWENTY-SECOND FLOOR RICHARD D.FIKE JEWEL KOLLING BASSE DONNA J.GENESIS SARA A.SMITH 225 BROADWAY GRETA W.SUMMERVILLE JEFFREY S.MARTIN SARA M.THORPE CHARLES S.CUSTER SAN DIEGO,CALIFORNIA 92101 SCOTT A.BONZELL ROBERT V.DUGONI ANTHONY R.FLORES LINDA A.LOURIMORE (619)696-6700 STEVEN M.SELNA JAMES P.BLAKE DION N.COMINGS KEITH S.OMSBERG FAX(619)696-7124 MICHAEL K UFMANSCULLY SHERYL ANNE-MARIE BOURGEOIS RECEIVE KAREN L.KAUFMAN ANNE-MARIE BOURGEOIS MICHAEL L.CARPENTER MARK J,DIVELBISS ROY A.PERRIN III SHARON SHAW CRULL JOSEPH T BURKE DEC 7 1990 Clerk CLERK BOARD OF SU County of Contra Costa CONTRACOSTACO. Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 RE: Claim Against the County of Contra Costa Dear Clerk of the Board of Supervisors: Enclosed please find Thompson Electric' s Claim Against the County of Contra Costa. Please present this claim to the Board of Supervisors, and advise this office by notice of the outcome. In the interim, please mark the enclosed copy indicating that the claim has been received, and return it in t envelope provided. ((JJ If you have any questions, please do not hesitate to call. Very truly yours, GOR4ael R ES Mic . Luce lee Enclosures RECEIVE® DEC 71990 Irk CLM 6pARD COSTA CO. CLAIM AGAINST THE COUNTY OF 'CONTRA COSTA THOMPSON ELECTRIC hereby presents and makes its claim against the COUNTY OF CONTRA COSTA for full and partial indemnity and/or contribution for any sums which may be paid by THOMPSON ELECTRIC or on its behalf by way of settlement, judgment or legal fees and expenses in an action entitled, Kristina Kelly v. Kevin Michael Tierney, MPM Electric, Inc. , International Brotherhood of Electric Workers Local 302, Crockett Electric Company, John Adams, Toyota Motor Sales U.S.A. Inc. , County of Contra Costa, State of California, City of Clayton, and Does 1 through 100, inclusive, now pending against THOMPSON ELECTRIC in the Superior Court in and for the County of Contra Costa, action No. C' 90-03057 (a copy of the complaint initiating this action is attached hereto as Exhibit "A" and a copy of the amendment substituting THOMPSON ELECTRIC for Doe 20 is attached as Exhibit "B" . ) . A copy of the summons and complaint in this action was served on THOMPSON ELECTRIC on or about November 9, 1990, which is less than six ( 6) months from the date of this claim for indemnity and contribution. Claimant THOMPSON ELECTRIC makes the following statements in support of this claim. 1. Claimant Name: THOMPSON ELECTRIC 2. Claimant Address: P. O. Box 7 San Ramon, CA 94583 3 . Address to Which Notices are to be' Sent: Michael T. Lucey GORDON & REES 275 Battery Street, 20th Floor San Francisco, CA 94111 4. Incident Giving Rise to This Claim: Claimant is informed that on or about July 22, 1989, a 1989 Toyota 4x4 pickup truck driven by KEVIN MICHAEL TIERNEY was traveling on Marsh Creek Road, a public road located in or near the County of Contra Costa, State of California. KRISTINA KELLY was a passenger in the Toyota truck. On that date, at a place approximately . 8 of a mile east of the intersection of Marsh Creek Road and Morgan Territory Road, the Toyota pickup truck was involved in a single- vehicle accident which resulted in an injury to the passenger, KRISTINA KELLY. On or about July 18, 1990, plaintiff filed the above- described action in Contra Costa Superior Court. THOMPSON ELECTRIC is informed and believes that, prior to filing this action, plaintiff filed a claim with the County of Contra Costa alleging that the public roadway was in a dangerous condition that created a substantial risk of the type of injury she sustained. In particular, plaintiff claimed that the road was defective because no rails or other controls existed to prevent an automobile from leaving the highway or colliding with embankments and other obstacles found along the shoulder. THOMPSON ELECTRIC is informed 2 and believes that plaintiff ' s claim was rejected by the County of Contra Costa on or about February 27 , 1990. THOMPSON ELECTRIC contends that the matter set forth in Exhibit "A" and the resulting damages were not caused by any act, error or omission by THOMPSON ELECTRIC, but were caused by the fault of the. County of Contra Costa, and others; and that THOMPSON ELECTRIC is entitled to indemnity and/or contribution from such public entity, and others, as to all or part of any damages which may be paid by or ordered against THOMPSON ELECTRIC in the above-- referenced action. 5. Amount of Claim: THOMPSON ELECTRI`C'.s claim, as of the date of this notice, is for an unknown amount, in that the damages which may be awarded against or paid by THOMPSON ELECTRIC, together with its costs of suit, legal .expenses and other expenses, and a proportionate share of the claim to which THOMPSON ELECTRIC would be entitled to indemnity from the County of Contra Costa, are unknown at this time. By reason of the foregoing, the basis for computation of TMS' s claim is unascertained at this time. THOMPSON ELECTRIC is. informed and believes that the amount of damages sought is within the jurisdiction of the Superior Court. 3 6. Name of Public Employees Responsible: The names of the public employees alleged to have been responsible for or to have caused the damages to plaintiff is unknown by THOMPSON ELECTRIC. THOMPSON ELECTRIC is informed and believes that an employee or employees of the County of Contra Costa are responsible in some: manner for the injuries and damages to plaintiff in the lawsuit: mentioned herein, as well as for any damages THOMPSON ELECTRIC may suffer thereby. DATED: December 3, 1990 CORDON & ES By011A — Mich el Lu ey 4 BREKHUS, WILLIAMS, WESTER & HALL 2 1000 Drakes Landing Road Greenbrae, CA 94904 D 3 (415) 461-1000 JUL 181990 Attorneys for Plaintiff S. L. WEIR.COUNTY CLERK 4 KRISTINA KELLY CONTRA COSTA COUNTY By 5 C. Sonavere. Deputy I 6 THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 8 IN AND FOR THE COUNTY OF CONTRA COSTA 9 KRI STINA KELLY, No. C 90 - 03057 - 10 0 - 0305710 Plaintiff, COMPLAINT FOR DAMAGES 11 VS. 12 KEVIN MICHAEL TIERNEY, "::;':SCF: 13 MPM ELECTRIC, INC. , 0 .� . INTERNATIONAL BROTHERHOOD :. ;34o;,IL5 L7c► Eli GGVEWiMENT CODE 686M 14 OF ELECTRICAL WORKERS LOCAL ;L'3�;AL PULE 5) 302, CROCKETT ELECTRIC 15 CO. , JOHN ADAMS, TOYOTA MOTOR SALES U.S.A. INC. , 16 COUNTY OF CONTRA COSTA, STATE OF CALIFORNIA, CITY OF CLAYTON, 17 and DOES 1 through 100, inclusive, 18 Defendants i 19 / 20 FIRST CAUSE OF ACTION: NEGLIGENCE 21 1. Defendant KEVIN MICHAEL TIERNEY is, and at all times 22 mentioned herein was, a resident of Contra Costa County, 23 California. 24 2 . Defendant MPM ELECTRIC, INC. , is, and at all times .herein 25I mentioned was, a corporation orgainzed and existing under the laws 961 of the State of California. 27 3 . Defendant CROCKETT ELECTRIC CO. is, and at all times 28 herein mentioned was, a corporation organized and existing under i EXHIBIT ,� i I 1 the laws of the State of California. 2I 4 . Plaintiff KRISTINA KELLY is ignorant of the true names I 3 and capacities of defendants sued herein as DOES 1 through 100 , 4 inclusive, and therefore sues these. defendants by such fictitious 5 names. Plaintiff will amend this complaint to allege their true 6names and capacities when ascertained. Plaintiff is informed and 7 believes and thereon alleges that each of the fictitiously named 8 defendants is responsible in some manner for the occurrences herein 9 alleged, and plaintiff's injuries as herein alleged were 10 proximately caused by said defendants. 11 5. At all times herein mentioned, defendants John Adams 12 (hereinafter Adams) and Does 11 through 15 were the owners and 13 operators of a certain pick up truck, make and model unknown at -the 14 time of filing this complaint (hereinafter referred to as the Adams 15 truck) which was being driven immediately behind the Tierney truck 16 at the above mentioned time and place. 17 , 6. At all times herein mentioned, defendants John Adams and I 18 Does 16 through 20 were the agents, servants, and employees of 19 defendants Crockett Electric Co. (hereinafter Crockett) , Local No. 20 302 and DOES 20 through 25. 21 7 . On or about July 22, 1989, at or about 6:45 p.m. , 22 plaintiff was, a passenger riding in the Tierney truck, which was 231 being driven and operated by defendant Kevin Michael Tierney in a I 241 general easterly direction on Marsh Creek Road approximately . 8 of 25 a mile east of the intersection of Marsh Creek Road and Morgan 261 Territory Road in or near the City of Clayton in Contra Costa 27i County California. 281 ' I i 18 . At all times mentioned herein defendant Kevin Michael 2I Tierney (hereinafter Tierney) and Does 1 through 5 were the owners 3 of a certain 1989 Toyota 4X4 Pick-up truck, California License No. 4 3U78638 (hereinafter referred to as the Tierney truck) . 5 9 . At all times herein mentioned defendant Tierney and DOES 6 1 through 5 were the agents, servants, and employees of defendants 7 MPM ELECTRIC, INC. , (hereinafter MPM) The International Brotherhood 8 of Electrical Workers .Local 302 (hereinafter Local 302) and DOES 6 9 through 10, and were operating the Tierney truck in the course and 10 scope of that agency and employment and with the knowledge, consent 11 and permission of defendants MPM, Local 302 and DOES 6 through 10. 12 10. At the above-mentioned time and place defendants, and 13 each of them, so negligently and carelessly drove, operated, 14 entrusted, controlled, maintained and supervised .the Tierney truck 15 and the Adams truck, so as to cause the Tierney truck, in which 16 plaintiff was a passenger, to leave the roadway, overturn and 17 crash, proximately causing the injuries to plaintiff hereinafter 18 alleged. 19 11. At all times herein mentioned, defendants Tierny and 20 Adams drove the Tierney truck and the Adams truck while -under the 21 influence of alcohol, and at a high rate of speed for road 22 conditions, with knowledge that operating said vehicle in such a 23 manner was likely to result in loss of control of the Tierney truck 24 and cause serious injuries to plaintiff. Notwithstanding this 25 � knowledge, defendants Tierny and Adams, in willfull and conscious 261 disregard of the safety of plaintiff herein, drove the truck in the 27i manner alleged above, proximately causing plaintiff ' s injuries as i 28 i I i �i I hereinafter alleged. 2 WHEREFORE plaintiff prays judgment against defendants, and 3 each of them as set forth below. 4 SECOND CAUSE OF ACTION 5 Dangerous Condition of Public Property 6 12 . Plaintiff realleges Paragraph 1 through 7 and 7 incorporates the same by reference. 8 13. Defendant County of Contra Costa is and at all times 9 mentioned herein was a County, duly organized and existing under 10 the laws of the State of California. 11 14 . Defendant City of Clayton is, and at all times mentioned 12 herein, was a municiple corporation, duly organized and existing _ 13 under the laws of the State of California. 14 15. Defendant State of California is, and at all times 15 mentioned herein was, a sovereign State of the United States of 16 America. 17 16. Plaintiff is ignorant of the true names and capacities of 18 defendants sued herein as Does 26 through 30, inclusive, and 19 therefore sues these defendants by such fictitious names. 20 plaintiff will amend this complaint to allege their true names and 21 capacities when ascertained. Plaintiff is informed and believes 22 that at all times mentioned herein, defendants Does 25 through 30 231 inclusive, were the agents, servants and employees of their co- 24 defendants, and in doing the things hereinafter alleged, were 25 , acting in the course and scope of their authority as such agents, 26I servants, and employees and with the permission and consent of 27i their co-defendants. 28 I I i 1 17 . On or about July 22., 19'89 plaintiff was a passenger in 9 the Tierney truck, while it was, being driven by Tierney on Marsh 3 Creek Road, approximately . 8 of a mile east of the intersection of PP I 4 Marsh Creek Road and Morgan Territory Road. i I 5 18 . At such time and place, defendants County of Contra 6 Costa, City of Clayton, State of California and DOES 26 through 30 7 negligently and carelessly designed, engineered, constructed, 8 repaired, maintained, controlled, owned, used, inspected and 9 supervised Marsh :Creek Road, and in particular the area where the 10 subject accident occurred, including but not limited to the 11 spreading of loose gravel on sections of the road where it was 12 likely to cause vehicles to skid and lose control. This created a 13 dangerous condition resulting in a substantial risk of the type of 14 injuries hereinafter alleged when the road was used in a reasonable 15 manner. 16 19. Said defendants had actual knowledge of the existence of 171 the conditions of said road and knew or should have known of its 18I dangerous character in sufficient time prior to July 22 , 1989 to 19 have taken measures to protect against the dangerous condition. 20 Defendants had the autority and it was their responsibility to take 21 adequate measures to protect against said dangerous condition at 22 the expense of the public entity and the funds or other means were 23 . immediately available to them to take such measures. 24I 20. On July 22 , 1989 and prior thereto, the Marsh Creek Road 251 was in a dangerous condition, creating a substantial risk of the 26 � type of injury hereinafter alleged, when the road was used in a 27 � reasonable manner, in that the road was unsafe as designed, i 28 1 I ;I I l engineered, constructed, repaired, maintained, controlled, owned, 1 2I used, inspected and supervised. Further, there was no warning 31 posted of such dangerous conditions. 4 21. As a proximate result of the negligence and carelessness . 51 in designing, engineering, constructing, repairing, maintaining, 6 controlling, owning, using, inspecting and supervising Marsh Creek 7 Road, defendants County of Contra Costa, City of Clayton, the State 8 of California and Does 25 through 30, caused the Tierney truck in 9 which plaintiff was a passenger to leave the road, roll over and 101 crash, causing plaintiff the injuries hereinafter described. 11 22, On or about January 18 , 1990, plaintiff presented claims 12 to the County of Contra Costa, The City of Clayton, and the State 13 of California by delivering claims to the clerks for the City of 14I Clayton and the County of Contra Costa and the State Board of 15 Control for the State of California for. the injuries, disability, 16 and other losses, and damages incurred b g y plaintiff as a result of 17I the above-described occurrence, all in compliance with the 18 � requirements of section 90 of the Government Code. A copy of the 19 claims are attached hereto as Exhibits "A" "B" and "C" and made 20 a part hereof. 21I 23 . on or about February 27, 1990 the County of Contra Costa 22 i rejected the claim in this entirety and on or about May 2 , 1990 the 23i State of California rejected this claim in its entirety. The City 241 of Clayton failed to act on the claim within the period of 45 days 25after its presentation, and the claim was thus deemed rejected, 26 under the provisions of section 912 . 4 of the government code at the 27 ; expiration of the 45 days period to wit on or about March 5 , 1990. 28 1 ii I i li WHEREFORE, plaintiff prays judgment against defendants, and i 2i each of them as set forth below. I 3 THIRD CAUSE OF ACTION i 4 Product Liability Against Toyota Motor Company i 5 24 . Plaintiff realleges paragraphs 1 through 7 and 6 incorporates the same herein by reference. 7 25. Defendants Toyota Motor Sales U.S.A. , Inc. (hereinafter 8 Toyota) are and at all times herein mentioned were corporations 9 qualified to do business in California. 10 26. Plaintiff is ignorant of the true names and capacities of 11 defendants sued herein as Does 30 through 35 inclusive, and 12 therefore sues these defendants by such fictitious names. 13 plaintiff will amend this complaint to allege their true names and 14 capacities when ascertained. 15 27. Plaintiff. is informed and believes and based thereon 16 alleges that at all times mentioned herein each of the defendants 17 sued herein were the agents and or employees of each of the 18 remaining defendants and were acting within the purpose and scope 19 of such agency and/or employment. 20I 28. Defendants Toyota and Does 30 through 35 inclusive are 21 and were at all times herein mentioned engaged in the business of 221 designing, assembling and manufacturing automobiles including the 231 Tierney truck, for sale and use by members of the general public, 241 directly and through retailers. 251 29. Defendant Toyota and Does 30 through 35 are, and at all 261 times herein mentioned were engaged in the business of wholesaling i 271 and distributing automobiles, including the above described Tierney I 281 i I i 1 , truck, for sale to and use by members of the general public both i 2 directly and through retailers. 3 30. Defendants Toyota and Does 30 through 35 are, and at all i 4 times herein mentioned were engaged in the business of selling j 5 automobiles, including the Tierney truck, to members of the general 6 public. 7 31. Defendants Toyota and Does 30 through 35 intended that 8 the automobiles designed, manufactured, assembled and distributed 9 by them be used for travel on highways and byways and for 10 transporting passengers in same. 11 32. At all times herein mentioned defendants Toyota and Does 12 30 through 35 knew said automobiles would be purchased by members 13 of the public and used by the purchasers without inspection for 14 defects. 15 33 . In or about 1989 defendants Tierney and Does 1 through 5 16 purchased the Tierney truck from Defendants Toyota and Does 30 17 through 35 at their place of business. 18 34 . The Tierney truck was, at the time plaintiff purchased it 19 as herein alleged, defective, and unsafe for its intended purpose 20 in that, among other defects, the roof and door of the passenger 21 area collapsed when the truck rolled over and the rear wheels 22 became detached from the vehicle, causing a loss of control and 23 resulting in the vehicle rolling over. As a proximate result of 24 said defects plaintiff suffered the injuries as hereinafter 25 alleged. 26 � 35. As a proximate result of the conduct of defendants, and 27i each of them, plaintiff was injured in her health, strength, and 28 I 'I 11 activity, sustaining injury to her nervous system and person, ' I 21 including but not limited to, the following injuries, fracture of 31 pelvis and vertebra, laceration and abrasions and brain injury, all 4 � to her general damage in the sum of $5, 000, 000. 00. 36. As a further proximate result of the negligence of 6 defendants, and each of them, as aforesaid, and because of the ii injuries, it was necessary for plaintiff to receive medical and 8 related care and treatment, and plaintiff did incur hospital and 9I incidental expenses, and will in the future be compelled to incur 10 additional obligations therefore, in an amount unknwon to plaintiff I 11 at the time of filing this complaint. 12 37. On or about July 23 , 1989 plaintiff was to be employed as 13 an administrative assistant. As a proximate result of the 14 negligence of defendants, and each of them, and because of 15 , plaintiff's injuries, plaintiff has been and will continue to be 16 prevented from attending to her occupation, thereby sustaining a 171 loss of earnings and future loss- of earning capacity in an amount 181 unknown to plaintiff at the time of filing this complaint. 191 Wherefore plaintiff prays judgment against all Defendants and I 201 each of them as follows: 2111.1. For general damages in the sum of $5, 000, 000. 00; 22 ! 2 . For all medical and incidental expenses according to t 23 I proof; i 241 3 . For all loss of earnings and earning capacity according , 25 i to proof; 26 V 4 . For costs of suit herein incurred; l . `'7 ,I ! iI j � 1 ' 5. For such other and further relief as the court may deem I 21 proper; and i 31 6. as against defendants Tierney and Adams, for exemplary 41 and punitive damages in the sum of $5, 000, 000. 00. 5 DATED: BREKHUS, WILLIAMS, WESTER & HALL 8 BARRY F. WESTER Attorney for Plaintiff KRISTINA KELLY 9 I 10 �11 12 13 14 15 16 I 171 i 181 I 19 i 20 1 21 1 I 22 ! 23 24 1 25 1 � 261'1 2 7 11 28 11 t i 1 Exhibit A " REC EIVED JAN 19 199C1 CI.MX AGAINST THE COUNTY OF CONTRA STA $�EpK BOA OF S�f�NFIOf S W COSTA . To: Contra Costa County 255 Glacier Drive Martinez, CA 94553-4897 The undersigned hereby presents the following claim against the County of Contra Costa, in accord with the provisions of Government Code Section 910. 1. Name and address of claimant: Kristine Kelly 240 Paso Nogal Pleasant Hill, CA 94523 2. Mailing address to which notices from County are to be directed: BREIMS, WILLIAMS & WESTER 1000 Drakes Landing Road Greenbrae, CA 94904 3 . Date of incident: July 22, 1989. Location of incident: Marsh Creek Road eight-tenths of a mile east of the intersection of Marsh Creek Road and Morgan. Territory Road. 4 . Description of incident or accident including your reason for believing that the County is liable for your damages: On July 22, 1989, claimant.was a passenger in the automobile of Kevin Tierney traveling westbound on Marsh Creek Road. The subject vehicle left the highway, hit an embankment, and flipped overcausing claimant's injuries. On or about July 22, 1989, and prior thereto, the above described public property was in a dangerous condition that created a substantial risk of the type of injuries sustained by claimant in that among other defects, no rails or other controls existed to prevent an automobile from leaving said highway and colliding with embankments and other obstacles found along the shoulder. 5. Description of all damages which you believe that you have incurred as a result of the incident: Personal injuries, emotional distress, special damages, including but not limited to, medical and related bills, loss of income, loss of impairment of income capacity, and other economic losses and general damages. 6. The name or names of any county employees causing the damages that you are claiming: Unknown at this time. 7. The dollar amount of all damages that you are claiming (please attach all estimates that are available) : $5,000, 0.00.. 8. If this is a claim for indemnity, on what date were you . served with the underlying lawsuit: N/A. I declare under penalty of perjury that the foregoing is true and correct. Executed on January 19 , 1990, in Greenbrae, California. BARRY F. WESTER Attorney for Claimant ATTACM= CAUSES OF ACTION AND LEGAL THEORIES 1. Negligence 2. Strict Liability 3. Maintenance of a dangerous condition 4. Violation of ordinance 5. Nuisance 6. Inverse condemnation 7. Vicarious liability for acts of public employees r S. Iii addition, claimants are seeking recovery under any and all other causes of action recognized by the California Supreme Court and the California Appellate Courts, as reflec,zed in the official reports of the State of California, incur-,orated herein by reference. Further, claimants incorporate herein by reference and assert any and all theories of recovery discussed, referred to or otherwise mentioned in Witkin, Summary of California Law (8th Edition) and California Jurispr.:dance (3rd Edition) . -V1 ' �� .._A__ PACE OF ,:\%1 Exhibit B CLAIM AGAINST THE CITY OF CLAYTON To: City of Clayton 1007 Oak Street Clayton, CA 94517 The undersigned hereby presents the following claim against the County of Contra Costa, in accord with the provisions of Government Code Section 910. 1. Name and address of claimant: John Kent-Guardian for Kristine Kelly 240 Paso Nogal r Pleasant Hill, CA 94523 2. Mailing address to which notices from County are to be directed: BREKHUS, WILLIAMS & WESTER 1000 Drakes Landing Road Greenbrae, CA 94904 3. Date of incident: July 22, 1989. Location of incident: Marsh Creek Road eight-tenths of a mile east of the intersection of Marsh Creek Road and Morgan Territory Road. 4. Description of incident. or accident including your reason for believing that the County is liable for your damages: On July 22, '1989, claimant was a passenger in the automobile of Kevin Tierney, traveling westbound on Marsh Creek Road. The subject vehicle left the highway, hit an embankment, and flipped over causing claimant's injuries. On or about July 22, 1989, and prior thereto, the above described public property was in a dangerous condition that created a substantial risk of the type of injuries sustained by claimant in that among other defects, no rails or other controls existed to prevent an automobile from leaving said highway and colliding with embankments and other obstacles found along the shoulder. 5. Description of all damages which you believe that you have incurred as a result of the incident: Personal injuries, emotional distress, -special damages , including but not limited to, medical and related. bills , loss of income, loss of impairment of income capacity, and other economic losses and general damages. 6. The name or names of any County employees causing the damages that you are claiming: Unknown at this time. 7. The dollar amount of all damages that you ate claiming (please attach all estimates that are available) : $5,000,000. 8. If this is a claim for indemnity, on what date were you served with .the underlying lawsuit: N/A. I declare under penalty of perjury that the foregoing is true and correct. Executed on January 19, 1990, in Greenbrae, California. BARRY F. WESTER Attorney for Claimant ATTACHMENT CAUSES OF ACTION AND LEGAL THEORIES I. Negligence 2. Strict Liability 3. Maintenance of a dangerous condition 4. Violation of ordinance 5. Nuisance 6. Inverse condemnation 7. Vicarious liability for acts of public employees � 8. In addition, claimants are seeking recovery under any and all other causes of action recognized by the California Supreme Court and the California Appellate Courts, as reflected in the official reports of the State of California, incorporated herein by reference. Further, claimants incorporate herein by reference and assert any and all theories of recovery discussed, referred to or otherwise mentioned in Witkin, Suamary of California Law (8th Edition) and California Jurisprudence (3rd Edition) . ` Exhibit C ATTACMIM CAUSES OF ACTION AND GAL TIMORIES I. Negligence 2. Strict Liability 3. Maintenance of a dangerous condition 4. Violation of ordinance 5. Nuisance 6. Inverse condemnation 7. Vicarious liability for acts of public emplcyess f� g, in addition, claimants are .seeking reccverl under any and all other causes of action recognized by the Califc-'Mia Supreme Court and the California Appellate Courts, as ref_ec ad in the ofFicial reports of the State of California, inccrp:.ra ted herein by reference. Further, claimants incorporate herai.n. by reference and assert any and all theories of reccverl disc-:ss e=, referred to or otherwise mentioned in Witkin, Sur!-=-: of Califor:aa Law (8th Edition) and California Juriszr'adanc_ (3rd Edition) '. r': 2- fir 1 1I BREKHUS, WILLIAMS, WESTER & HALL 1000 Drakes Landing Road 2i Greenbrae, CA 94.904 Facsimile: (415) 461- 7356 3 Telephone: (415) 461-1000 n 4 Attorneys for Plaintiff (� D KRISTINA KELLY NOV 9 1990 6 S.L. WEIR Count Clerk By CONTRA COSTA COUNTY 7 M.M.WADDELL,Deputy g 9 SUPERIOR COURT OF CALIFORNIA 10 COUNTY OF CONTRA COSTA 11 12 KRISTINA KELLY, No. , C 90-03057 13 Plaintiff, 14 v. AMENDMENT' TO COMPLAINT SUBSTITUTING DEFENDANT'S 15 KEVIN MICHAEL TIERNEY, TRUE NAME FOR FICTITIOUS NAME et al, 16 Defendants. 17 181 Plaintiff KRISTINA KELLY was ignorant of a Defendant's name, 191 stated that fact in the Complaint, and designated the Defendant by 20 a fictitious name. That Defendant's true name has now been 21I discovered and Plaintiff hereby amends" the Complaint as follows: 221 True Name Fictitious Name 23ji Thompson Electric, Inc. to substitute for DOE 20 24DATED: October 30, 1990 BREKHUS, WILLIAMS, WESTER & HALL 95 i 26j KIRK WALLACE Attorney for Plaintiff 27 KRISTINA KELLY e:\ke11y\amendcom.p 28 EA j f •!' ( �}' 00 wo go. go to " ~ f00 00 'C. go tS1"' 1 go .(DN` H) go goO 10 ct soa > 0, 10 io w.O.;:n 0 O<Z m> N, m rndo . 00,. so 90 ,AS oy fvR go $� rj i �• 1 - p ms's S. , �l tt'�I�f 1 �ht) 90 to r.T CLAIM BOARD OF SUPERVISORS OF CONTRA .COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANTJANUARY 8 1 9 9 4 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: $396 . 00 Section 913 and 915.4. Please note all 11Warnings11.0c*,t ED CLAIMANT: WYATT, IDonnie DEC 111990 2029 Lincoln Avenue ATTORNEY: Richmond, CA 94801 COUNTY COUNSEL Date received MARTINEZ, CALK ADDRESS: BY DELIVERY TO CLERK ON December 4 , 1990 (hand JeTI-77red) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 11 1990 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). C ) Other: Gated: BY J I7 �2 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. An Dated: JAN 8 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se 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: ,)A N R TggI BY: PHIL BATCHELOR by Deputy .Clerk CC: County Counsel County Administrator LOST PROPERTY CLAIM = Return original application to: Clerk of the Board PO Box 911 Martinez, CA 94553 A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops must be presented not later than ' the 100th day after the accrual of the cause of action. Claims relating to any other cause of. action must be presented not later than one year after the accrual of the cause of action. (Sec. 911.2, Govt. Code) i B. Claims gust he filed with .the Clerk of the Board of Supervisors at it's 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 - 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 of officer, authorized to allow or pay the same if genuine, any false of fradulent claim, bill, account, voucher, or writing, is g6ilty of. a felony. " ' nn'n•J"JC iC n•iC•iC i�i�X-i�i��iC i�iC i�i�n�i.•i�.\iC J..V J.J J. .J.!.!.J.J.4 J.J.J.J.J.IJ.J J.J.- J.J..I JJ.J .J .4 J. J.1J..L 1 L n.L� � nn•.•t�C•.�....•. .C•.n•.•.•.•.•.n.<•.•.•C-n•.•.nJ•C•C•.•t'n�.•G�C..Jt..�f J•C..•.n•.it�Cn�*T�. 5� J•C� - _ RIE: - Claim By Reserved for C1erk's.Jiling stamps RECEIVED F - 41990 Against the COUNTY fp,.ONTRA COSTA or �ppNj r. - '`.. DISTRICT- Y CLERK SWDOFSUPERVISORS (Fil in name) G'n5'_ . CONTRA COSTA CO. The undersigned claimant hereby .makes claim against the "County of,. Contra. Costa or the above-named District in. the sum of Y and in support of this claim re -presents as follows: .1. When did the damage or injuryi occur? (Give exact. date and hour)- 1,7 our)- Z�_ © ✓ z�v, 7, Where did- the .farm-age or injury c•_cur. (Inch. e'cir and county.) / a �, or injury occu_r? _(Give full details : use extra sheets3. to`w'vdid nhed� s ._ if required.) n_� 4. What p ticular act or o ission on the rt of county or district officers, servants, or employees caused the injury or damage? over - S.. Miat are the names or county or district officers , servants, or employees causing the damage or injury?. 6. What damage or injuries do you claim 'esulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �iiiJlo,9M7 S 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Idaines and addresses o. wis,) doctors, and hospitals: r " .V 9. List the expenditures you made on 'account of this accident or injury: DATE IT a- AMOUNT Govt. Code Sec. 910.2 provides: "The claim signed by the claimant or by some person on his behalf." SEND NOTICES TO (Attorney) . Name and Address df Attorney Claim Signature a: l �Y Address Telephone Number: Telephone Number:_ 3 %33 l 41T 00 AG3Ti1�Cm.a - 044 - -Ad JL- -- - - - ---- -- ----- --- - - --=- - -- RECEIVED- - - -- - �.. JAN- -41991- D Q 199--- --- __- - -.--- -__ - - - - - -- F --- CONTRACOSTA SUPERVISORS CO - -- 04 � D • AMENDED CLAIM / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 'Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 8, J-991 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 purgsuuan�tB to Government Code Amount: Undetermined Section,913 and 915.4. Please no B7 Warnings '. D E C 1999 CLAIMANT: PASOMSOUK, Sengthong COUNTY COUN5% ATTORNEY: H.iguchi & Higuchi MARTINM CALI& Law Offices Date received ADDRESS: 3325 Wilshire Blvd, Ste. 509 BY DELIVERY TO CLERK ON November 28, 1990 Los Angeles, CA 90010 Cert. P 314 241 712 BY MAIL POSTMARKED: November 25, 1990 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 17, 1990 IVIL BAATTCHELOR. Clerk ty II. FROM: County'Counsel TO: Clerk of the Board of Supervisors This' ,"x4 claim complies substantially with Sections 910 and 910.2. . ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send Warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 12,411 I gn BY: /JAL 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: JAN 8 .1991 PHIL. BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sect' n 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ;!A N Q 1Qt39 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ' Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , INSTRUCTIONS TO. CLAIMANT A. Claims_relating, to causes ,of action for death, or .for ,irijury' to person or to per- ,sonal..property .or..growing crops and which .accr.ue, 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 .o,-, action for .death or ,-for �irijury,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 �SENGTHONG PASOMSOUK > RECEIVED Against the County-of Contra Costa 7 ) N9V'2 8 1990 ` or. ) CLERK BOARD OF SUPERvi 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 $ * and in support of this claim represents- as follows:. * - Jurisdiction of the Municipal Court. Gov C.. ---------------------------------------�R:L41f L------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) T/15/90 ;.. .Approximately 8 : 30 A.M. ------------- 2. Where did the damage or injury occur? (Include city and county) 23rd St. & Burbeck Ave. ; Ricmond, Contra Costa County, California --------=--------------------------------------------------------------------------- 3. How did the. damage or injury occur? (Give full details; use extra paper if required) - Con:t'ra . Costa County. vehicle•, backed up into claimant.--------------------- -- 4. What particular. act oromission on the ,.part of county or district officers, servants,.or. 'employees--caused-„the injury or damage? . The driver of the County vehicle, Bradley Dean Kershaw, failed to: exercise due care in -the operation of said vehicle, ' and was in,,.-violation of Vehicle Code §22106 , for backing on a highway when such movement could not be made with reasonable safety. (over) 5. What are the names of county or district officers, servants or employees` causing ' the damage or injury? Bradley. Dean '.Kershaw, Animal Ser vices •Dept`: ' 6.� What damage or injuries do you claim resulted? (Give full extent of�) injuries or :damages claimed. . Attach two 'estimates for 'auto damage: " Loss of 'use of vehicle Medical- expenses wage Loss; property 'damage`, 1.pain and suff'erinq. 7. How 'was the amount claimed -abi& e computed?,'' (Include the- estimated amount of any prospective injury. or damage.) Claim -is within the_ uris-1:E of the .Municipal .Court. . Gov, C. §910 (f ) • -- ----- 8. Names and-addresses of.witnesses doctors' and- hosp-ftals. Dr. Nguyen K. Phan, ,M.D. .' a, _ 345 9th St'. Suite 301 Oakland, CA 94607 i • ------------------------ ------------------------------------------------------- 9• List the expenditures you made on account of this accident or ,injury: DATE ITEM AMOUNT V1:11 4 . J( Y Y yy p Y U1X�+.�.Y�LCQs�`y-•wYySM>zs.S.yu y. Y •y-• x• Y Y Y Jx y Y y Y iC 1i ]C A 4 * ii if ii ii 1f _R ii iC iC ii ]i if ikikbbbb ri.�-• ---Sec. , . Gov. Code es provides. a "The claim must be signed by the claimant SEND NOTICES TO' :. (A:ttorneyA): ., i u or by some person on his behalf." Name and Address of eAttor-ndy"`"°.::. UCHI _ E. JAMES HIGUCHI BIGE. JAMESIHIGUCHI HIGUCHI & HIGUCHI Claimant's Signat e 3325 'Wilslii"re- Blvd. , Suit:e'.-'509 Sengthong Pasomsouk Los Angeles; California.-_ 90010 457 ',6th St•.., 'Richmond, ­Calif o.rnia .94804 Address Telephone No. ( 213 ) 933-5765 Telephone No. ( 415 ) 237-9391 N 0 T I C E Section�72 of the Penal Code"providesi "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,OW); or'by bothsuch imprisonment and -fine; or'by imprisonment in the state prison, by a fine of not--exceed ing'ten thousand- dollars-($10,000, `or -by both such imprisonment and fine. LAW OFFICES OF HIGUCHI & HIGUCHI WILEY "HIGLICHI • E. JAMES HIGLICHI 3325 WILSHIRE BLVD., SUITE 509 • LOS ANGELES, CALIFORNIA 90010 • (213) 933-5765 Clerk of the Board of_.___Supervisorns I DATE TO County Administration Bldg. , Rm. 106 651 Pine Stre_e__t Martinez , CA 94553 DATE November 26 ,-1,9- Re: 6,_l9Re: -5engthong P_a.soms_ouk DOA - 7-15-90 pur _Ei.le—No._9 0=.1.3.1 RECEIVED ___.___ Ge.ntlemen_: Enc1_o_5ed_pl.e.a.se_f.ind,your claim_f_o.rm_ f or the above_r_e.f_er_enc.e.d_indivi.d.ual_. ARK eOA UP RV CONTRA COSTA CO BY E JAMES IGUCHI SIGNED Item NN73 The Drawing Board,Dallas,Texas 75266-0429 , ©Wheeler Group,Inc.,1982 INSTRUCTIONS TO SENDER: INSTRUCTIONS TO RECEIVER: 1.KEEP YELLOW COPY. 2.SEND WHITE AND PINK COPIES INTACT. 1.WRITE REPLY. 2.DETACH STUB,KEEP PINK COPY,RETURN WHITE COPY TO SENDER. W W 1 0 N _ y f � \� 0 0 1- 00 0 0 "Q U� N � N O cp �ny.� �O 1�