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MINUTES - 10011991 - 1.11 (3)
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed b ) BOARD ACTION 9 Y 9 Y the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 1, 991 and Board Action. All Section references are to ) The copy of this document mailed to you is y r notice of California Government Codes. ) the action taken on your claim by the �. d d pervisors (Paragraph IV below), given pursuant to nmerode Amount: $396.20 Section 913 and 915.4. Please not Wan# (s". CLAIMANT: STATE FARM INSURANCE COMPANIES/ BEDFORD, James and Alicia �� Claim No. *05 1837 254 ' ATTORNEY: State Farm Insurance Companies Date received ADDRESS: Northern California Office BY DELIVERY TO CLERK ON September 5, 1991 6400 State Farm Drive Rohnert Park, CA 94926-0001 BY MAIL POSTMARKED: September 4,' 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 9, 1991 gyIL Deputy OR, Clerk_ of I e 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: 9 BY: J�OQ6S• A Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date._ Dated: 0 C T 0 1 1991 PHIL BATCHELOR, Clerk, By d Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR by ), Deputy Clerk CC: County Counsel County Administrator • [STATE FARMState Farm Insuranc.e Companies URANCE September 4, 1991 EECE EDNorthern California Office 6400 State Farm Drive L!SE�P - 5 1991 Rohnert Park,California 94926-0001 County of Contra Costa CLERIC BOARD OF SUPER Room 106, County Adminstration Bldg. CONTRA COSTA CO. 651 Hines Street Martinez, CA 94553 ATTENI'ION: Clerk of Board of Supervisors IMPORTANT -- PLEASE WRITE OUR CLAIM -- NUMBER* ON YOUR REPLY OR PAYMENT. THANK YOU. Re: Our Claim Number: *05 1837 254 Our Insured: James and Alicia Bedford Date of Loss: July 23, 1991 State Farm Mutual Automobile Insurance Company on behalf of Subrogee James and Alicia Bedford hereby makes claim for $396.20 and makes the following statements in support of the claim. 1 . Notices concerning this claim should be sent to State Farm Insurance Companies, 6400 State Farm Drive, Rohnert Park, California 94926, referencing the above claim number. 2. The date and place of the accident giving rise to this claim are; on July 23, 1991 on Pleasant Hill Road in Pleasant Hill, California. 3. The circumstances giving rise to this claim are as follows: Our policyholder, Alicia Bedford, was operating her vehicle on Pleasant Hill Road. A county crew had loose gravel on the road while they were resurfacing. Loose gravel struck and cracked our policyholder's windshield. 4. There were no injuries reported. 5. Our total claim is as follows: Company's Net Payment $296.20 Insured's Deductible Interest $100.00 Total Property Damage $396.20 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 STATE FARM State Farm. Insurance Companies INSURANCE Page 2 Northern California Office 6400 State Farm Drive Rohnert Park,California 94926.0001 NOTICE: This form is to provide notice of our claim for damages in accordance with the six (6) month statute. If this form is not acceptable for compliance with the statute, please rush the necessary forms to my attention for proper filing. STATE FARM INSURANCE COMPANIES -- Dated: 5—7/ By: -- Mickey ito Claim Specialist - ROAC (707) 584-6470 MB/CM:bv 03-012 AC-51 cc: 2614 Enclosure: Supporting Documents HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 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' acerue on or before December 31, 1987., must-be presented not later than the l00th day "after the accrual of the cause of action. Claims relating to 'causes of action for 'death"o'r for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating-to any other cause* of action must be. presented not a . 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 RECENED Against the .County of Contra Costa ) �l P 5 1991 or, d, �LK OF SUPERVJ^4" District) c®F A�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:' ------------------------------------------------------------------------------------- 1. When did the damage or injury- occur? .(Give exact date and hour) -----------rr--it—r----- —r— ----- —r------ ----------.ter---r-------r 2. Where did the damage or injury occur? (Include,city and county) , - //////�����r�d`�` �f/�-'� / /�-e� rte-- - ---------------i ii---�ir--•-----------�L �_rrr--�.r------------------------ 3. How did the damage or injury occur? (Give full details; .use extra paper if required) ca U�� -`' W�./ � �4�= ' .,OA) . i. Z .o --•y` -I - j� �---N--M---N---- ---------------------------------I 4. .What particular act or omission on the part of county or district officers, servants or, employees"caused 'the injury or damage? vd/V (over). 5. What are the names of bounty, or district officers, servants or employees causing the darpage or in jury? .. , . 5. What damage'or injuries do you -claim resulted?,, (Give full extent.of injuries or damages••claimed:=`" :Attaoh two*estimates for auto damage. 7.-` How .was the amount claimed above computed?, (Include the estimated amount- of any prospective injury 'or-damage .) r . --------------------------------------------------------==---=----------------------- 3.:. . Names and- addresses of witnesses, doctors and hospitals•. ----r-r-_ NM-_r--___-_-r_N------_--r-___- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT -- Gov'Code Sec. 910-2 provides: • "The claim must be signed -by the claimant SEND NOTICES TO: (Attorney) or b person on Y *s b -a ." 12 Name and Address of Attorney Claimant s Si 'ture Address Telephone No: Telephone No. 4 r� NOTICE Section 72 of the Penal Code provides: "Every 'person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than ,one.-:year, by•a fine- of not exceeding one thousand` ($1,000'), or by both such imprisonment and fine, or by4imprisonment in the state prison, by a fine of not exceeding ten. thousand .dollars ($10,000, or by both such imprisonment and fine. 1 •1N � �' ` ADDENDUM TO THE CLAIM OF (Print your fu l name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No ( �) ( 2) Were you aware that construction would be commencing n the roadway? Yes ( ). No ( 3 ) Was an alternate route available? Yes { ) No { I ( 4) Did you read about the impending resurfacing in the local newspaper? ` Yes ( ) No ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? J Yes ( No ( ) '( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( ) No (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No (. ( 8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( (�� ( la ) Did you travel the -roadway more - than once during the j resurfacing prior to the' damage sustained to your car? Yes ( ) No ( j ( 11) Did you obtain the identity of the car relating to questions .6 thru 9? Yes ( ) No- ( ) -If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. t lJ �" r fir, 16b Gz�' F"7 z 'y 4/ /V 0 5/7/v/"f ( 13 ) Were you aware that using the road during the chip seal process might result . in damage- to your car? Yes ( ) No (. I declare that the above information is true and correct under the penalty of perjury. _ 2z (Date) a `. 3 9�•': �i��r �g`�'�_ . L�.�t.Y� � 'i'� f i„r '1 e;”" shy .7 Xk`tf a.'�'1'fii".F#�;� `����� -..cJr; �.;' S.'kxr s�;�,-�:: arara - ._.�bT. a •r r ,r �- .rim,+ -cr rr -ri rc ,t i. i ,.,,F .ri'S -.a-a � ap vtx,7 � Xt'r'"si 3r.pt;+x•s-x.-•s...�- �-� � s - cs m fi -r.� - a �a.- a �2 V q 1 3S S• `M! ""�,'�' d �' �3�����T�T ar'��� u ' L`��"':�1K�v�y;��"'f�e.�a ;.a�� �a.: �,... y.. X.q '� .'_�� ,:F ��.. t� a �jk r 7 s C .1 i � 1 y � --�t`'•`f.a r� � k� - S,s�Sa z x .� u. .a. c Jr�' - tI zcc.r> > 5r•F- s �'-���:: � •k�i rw trai.-tT.A -b- �' svcc� @ � �...s��u k fi 'tr f � ;� � - --� .-`'��. ���.,.�:�• __ - �.��:��' �-mss."`--�c� t.� :a.c i. r _-�-d- -3 � � N ���'3_ i�'.. 9.0 ...e A Lr,� ^�.+.�� _- �• _ "� d� r �.1. 2aw.+ J' � s>,� aS9f� �arT� _ _ '[ r3?-�•� �j 7. r �!� 3�g � e: ��'.S ++.a. �i «q 7 �,u 7u'� t .�,.�..• i far c.Y 2y11y t Y � �r'�fuai �2.`kR �!_2�.f- `�' 1- ,r t f 4� n f 1 1 Iti Sw i Sr�.d}� A y ye^' 1zw• acsecr^x. ... .. x. s :mc -<,.. n.r-..' c -=z'� a T'" 'iC .e +,."'s•y t"l+•`'�'S^' -'"Y.a'-.'.Lnt'°�. t t=.9.. � w � �� a�-,s•, .nr• 't•'L p7: �� vEi�K '.�1i�Z•Y f�..,Ky{.?"2La+lY ""� - � .. . .: rjk� �`'{�'! ,.µ t a-sj.�•rr..t�y r� n ��..yt trs}��. {{mm .._.tC� ^'y �x�'t �hq'aY ��v'w�... • dai � .i.�... 2, h L.. v i1.,'-�hGl .a—.!'.}.'af. ..- n - t� ��iL 1 y^F' Y �. �$ ���'."` d`� k „s d .s,,;i�-s1, �`.. ,f '.��"„X' ��4z,•�w7 I r i-. "' *2=.•��r'^. _ ��'�=�++-''��n�:� orf +�., �.:-�.:� x�''tt�YF�•r�•+w"�eu`� { ��,,.,�, ��',x 1�'�•,�, y� � �z�i� .'. � .� _L -.}��(�.i�"r. .'`,•�'d 'a ?.'L Rr's"L°ks.-S"�Y..�-..x1 i'�'A��, �S' ` n-e-.-^=v.,.:. �_-•- f _.?Y-.�s.�"- -.,�: rz•�•t?tLr3iwC.- ^ _ ` f ` ` ) ' MA A-000 wo-NAMEyffil 8EELl i 6L^AISS CO INCLAS ^ / � 1210 W WINTQN M S"CO. INU HAYWARD CA 94545 TAX ID # 94-011833 —�— SAtESMAN 8lU- TO^ W. O R K U R D E R DUE FUlADDRESSADDRESSFINE( CITY ST LICENSE# SPECIAL INST OEM NUMBER DESCRIPTION LIST PRICE SUE PRICE ' Dim EON WIN no or" iL Paymt Reference Approval Date Amount oubtotal Cash DEDUCTIBLE r 100. 00 Total Balance Applied To Customer Account IT / � | —~-------------------------------------------` Aw ' r Ifli 'Null UJ b!Dl � 1� v�ffi�� t,9 SSV19 ISM Q311OS3Nd a1 �a t 4S J � � 2 f E c U- cn `V�} T w R W C O C? co Ct:l CL N w E ��� � C m Z C � o w to w a a C ,� O Fuas CLCc E IU U. d � c cc W •� t: .0 c"nza° d CLAIM . M BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MEMO Claim Against the County, or District governed by) D pp O RTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OC t0�efO 99 1 and Board Action. All Section references are to ) The copy of this document mailed Cb41R�7qu�� r notice of California Government Codes. ) the action taken on your claim bF4ATdN9af-dUFf Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $750,000.00 Section 913 and 915.4. Please rote all "Warnings". CLAIMANT: CAPLOE, Fred ATTORNEY: Eugene N. Rosenberg Date received ADDRESS: 1701 Franklin Street BY DELIVERY TO CLERK ON September 10, 1991 San Francisco, CA 94109 BY MAIL POSTMARKED:. September 91, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk r DATED: September 11, 1991 fib: DeputyOL 0 4 4'4A 9 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: 'QO Dated: (� � By DQ_ /):�� Deputy County Counsel 0— \ZJ III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD 'ORDER: By unanimous vote of the Supervisors present (V) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: VCT 0 1 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above, O Dated: OCT Q 3 l`9 Aa1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Law Offices EUGENE N. ROSENBERG A Professional Corporation 1701 Franklin at California Area Code 415 September 9, 1991 San Francisco, California 94109 Telephone 928-2552 Clerk, Board of Supervisors RECEIVED Contra Costa County 651 Pine Street, First Floor Martinez, California 94553 5EP 1 p 1991 Re: Claim of Fred Caploe; CLERK SCARD 1 :".`. ^ Date of Accident: April 1, 1991 CONTRA COSTA CO To Whom it May Concern: On July 25, 1991 a Claim on behalf of Fred Caploe was filed with the Board of Supervisors with regard to the accident that occurred April 1, 1991. That claim was rejected by action of the Board .taken August 13 , 1991 and Notice of Rejection was mailed August 14, 1991. Since those occurrences, claimant's physical condition has markedly changed, and to that end I am enclosing herewith a Supplemental Claim for Personal Injuries in connection with this matter. When the original claim was filed, claimant's injuries appeared to be only soft tissue in nature. However, claimant was recently diagnosed with a ruptured lumbar disk, and he underwent a lumbar laminectomy within the last week or two. Accordingly, in order to place you on notice with regard to claimant's changed physical condition, I am enclosing herewith a Supplemental Claim for Personal Injuries with respect to this accident. I would ,greatly appreciate it if you would file this Supplemental %-iailn and .:acknowledge receipt thereof by time. or date stamp with respect to the copy and return it to me in the enclosed self- addressed envelope. Thank or your c peration regarding this matter. i.ncere , EU ENE NBERG ENR/ig Enc. SUPPLEMENTAL CLAIM FOR PERSONAL INJURIES RECEIVED TO: Clerk, Board of Supervisors Contra Costa County SEP 1 0 1991 651 Pine Street, First Floor Martinez, California 94553 CLERK BOARD OF-SUPERV14 R CONTRA COSTA CO YOU ARE HEREBY NOTIFIED that Fred Caploe, 2530 Arnold Drive, Suite 360, Martinez, California 94553, files a Supplemental Claim for Damages from the County of Contra Costa and its employee, William Bell. This supplemental claim is based upon personal injuries sustained by claimant Fred Caploe in a motor vehicle accident that occurred on or about April 1, 1991 at about 3 : 30 p.m. when the motor vehicle operated by claimant Caploe was struck from the rear by a County truck operated by its employee, William Bell. This accident occurred on Morello Avenue near Highway 4 in Martinez, California. Claimant sustained a ruptured disk of the lumbar spine, for which he has received medical and surgical treatment, including a lumbar laminectomy, as well as soft tissue injuries of the neck, shoulders and back. Claimant continues to receive medical treatment at this time. Claimant contends that the accident was caused by the negligence of the County' s employee, William Bell, and specifically by his inattentiveness and his failure to keep his vehicle under proper control and his failure to observe claimant's automobile stopped ahead of him. At this time claimant does not know the amount of his medical bills and expenses, nor is he able to estimate the amount of his lost earnings to date. At the time of the presentation of this claim, claimant claims general damages in the sum of $750, 000. 00. All notices or communications concerning this claim should be sent to attorney for claimants, Eugene N. Rosenberg, 1701 Franklin Street, San Francisco, California 94 Dated: September 9, 1991 EUG N. ROS NBERG At orney for Claimant F ED CAPLOE �fj a a cn ,1 I ✓�{\ �tdl a � � wa 0 0 NN ` a aur U U .o 4' a, O N O A R WOv � v ° o w � j d v CLAIM t 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 October 1, 1991 and .Board Action. All Section references are to ) The copy of this document mailed to you i,&-your notice of California Government Codes. ) the action taken on your claim by th Boa of Supervisors (Paragraph IV below), given pursua Npp Gover`rl t Code Amojnt: Unspecified Section 913 and 915.4. Please nAallle(-�rnings". 119,9 CLAIMANT: COWANS, Charlotte M. �99�Ti,, CZ)Gtim 7 ATTORNEY: Date received ADDRESS: 109 Spinel Court BY DELIVERY TO CLERK ON September 4, 1991 Hercules, CA 94547 BY MAIL POSTMARKED: From Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 EVIL BATCHELOR, Clerk e DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act� for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: - Dated: i66 9I BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admi ' tr for (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (VI This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 0 1 1991 PHIL BATCHELOR, Clerk, By a Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over 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. OCT 0 3 1991 Dated: BY: PHIL BATCHELOR b 1 AA 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- property or growing ,crops•and which accrue on or before December 31, 1987', must be presented not later than the 100th day after the accrual' of the cause of action. Claims relating .to� causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after_ January-1,- - .----- . 1988, must be presented not later than six months after the accrual of the cause of action,. _ Claims-relating to any other cause of action must be presented not later ,than one- year after-:the' accrual of-the. cause'of action, (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651. Pine Street, Martinez, CA 94553. C. If claim is'against a •district governed by the Board of Supervisors, rather than the County, the name .of the-District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. ' -Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp - ) FSUPERVISOR4 Against the .County. of Contra Costa 19 + or D1Strlet) STA 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: ------------------7----------------------------- ------------------------------------- 1. When did the damage or'injury occur? (Give exact date and hour) _--------------------------------------------- 2. Where did the, gamage, or injury occur? (Include city and county) � • .c,�c p9 inn ----- ------- ��------------------- — --------'= --------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required). _ Vie, cc x _16 _ 1 01 1 yt, _ -------- 4. What particular act or omission .on the.part of county. or 'distrie officers, servants•or,employees Caused the injury or damage? 9 9an ttnA- t,&�&d 0 .o .. � a an- 619 e die &I yAZ;J/ ��over) 7. What are the names of county or district officers, servants or employees causing the damage or injury?- , 5. What damage or injuries do you clai 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 an addresses of witnesses, doctors .and hospitals. the expenditures YO de on accoun of ' a cident. or in ' 9. List xp y h injury: DATE ITEM --AMOUNT God:`Code�'Sec.' 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by sorpe person on hi beh f." Name and Address of Attorney S ± - Claimant's Si nature Address _ Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: - - - "Every person who, with intent to defraud, presents for allowance or• for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not-more than one year, by a fineof not exceeding one thousand ($1,000), or by both-.such imprisonment and .fine, or by -imprisonment in- the nthe state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. i ADDENDUM TO THE CLAIM OF /�- _ A/lL,� (Print your full ,name) (1) Do you use the roadway as part of a daily commute? zi 4.ua i a (,.W CA Yes ( ) No ( ) ( 2) Were "ou aware that construction would be commencing on the roadway? c Yes ( ) No 1 ( 3) Was an alternate route available? P Yes ( ) No ( �� � � y�CccJacl ,bu.� ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No ( V ) (5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign) _.. i _ -Yes ( ) No ( � Q (6) Did the damage result from another vehicle exceeding the L 25 mile per hour advisory? Yes ( ) No _ T Qd___, ( 7)- Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No (- 4 Sia ( 8 ) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No (✓) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No (� 1f �: , ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? I X e. G,rn of � ,QJt-el Yes ( ) No ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No -If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the . gravel was thrown onto the car, along with the specific damaged parts on your vehicle. w 160-" LHA Ili Zn VLe ��ho u1j4,- -,f&, Zadla &itte 4w, W J In 51' 2id= _,Z2" 7At Sid d u dU 41 a- &A W1 YAt n Cl.!'l 1 Cold f die a� D �Y 6nCLOZ D/"I �. �jt �✓ �. ( 13 ) Vere you aware thai using the roan �uring`the c ip sea4� process might result in damage to your car? Yes ( ) No (� I declare that the above information is true and correct under the penalty of perjury. ( Signature) (Date) VIL L TOP A rISSA A r 3277 Auto Plaza Drive . Richmond, California 94806 (415) 222-4900 August 13, 1991 Charolette Cowans Re: 1991 Nissan 240 SX ID#JN1MS34P6MWO05116 ESTIMATE TO REPAIR WINDSHIELD Repair chip in windshield caused by gravel. $65.00 to repair. $350.00 to replace. Contra Costa County RECEIVED SEP' 31991 Risk Management 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 October 1, 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: $10,000.00 + Section 913 and 915.4. Please note all "W ings". CLAIMANT: CURRY, Barbara Sue SF,a F® 1 ATTORNEY: Peter W. Alfert, Esq. t14 ?V4 Hinton & Alfert Date received cdNsQ ADDRESS: 1646 North California Boulevard BY DELIVERY TO CLERK ON September S. MI Suite 600 Walnut Creek, CA - 94596 BY MAIL POSTMARKED:_ September 4, 1991 Certified P 359 051 273 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk DATED: September _9, 1991 BY: Deputy 44d.<QL 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: _ 9 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: OCT 0 1 1991 PHIL BATCHELOR, Clerk, By Lo , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 3 199 1 BY: PHIL BATCHELOR b P1 AAA Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF r PETER J. HINTON A PROFESSIONAL CORPORATION 1646 NORTH CALIFORNIA BOULEVARD PETER W. ALFERT SUITE 600 MICHAEL P. CLARK WALNUT CREEK, CALIFORNIA 94596-4113 SHERRI J. CONRAD TELEPHONE (510) 932-6006 September 4, 1991 FACSIMILE (510) 932-3412 I, SEP - 5 1991 Clerk, Board of SupervisorsLEK j �L � _s � 651 Pine Street � � 5®ARDOFSUPE�dVIS Martinez, California 94553 CONTRA COSTA CO. Re: Barbara Sue Curry Incident of June 7, 1991 Dear Sir/Madam: Enclosed please find Claim Against the County of Contra Costa in triplicate in the above-referenced matter. Would you please acknowledge receipt of the enclosed claim by date stamping ��,,Q one copy "Received" and return it to us in the self-addressed " "' envelope provided. Thank you in advance for your attention to this matter. Very truly yours, HIN ON & ALFERT Shari K. McMurry, Secretary to PETER W. ALFERT sm Enclosures PETER W. ALFERT, ESQ. j RECE'NED HINTON & ALFERT A Professional Corporation -- 519971 5 (991 1646 North California Boulevard Suite 600 Walnut Creek, Ca. 94596 CLErK80AR®OFSUN�R-�, Telephone: (415) 932-6006 OSTA_C0. CLAIM AGAINST THE COUNTY OF CONTRA COSTA TO: BOARD OF SUPERVISORS, CONTRA COSTA COUNTY This claim is presented by the law offices of HINTON & ALFERT, A Professional Corporation, on behalf of BARBARA SUE CURRY. Claimant resides at 4428 El Cerrito Road, City of Concord, County of Contra Costa, State of California 94518. Notices concerning the claim should be sent to the law offices of HINTON & ALFERT, 1646 North California Boulevard, Suite 600, Walnut Creek, California 94596. This claim arises from an automobile accident which occurred on June 7, 1991 at the intersection of Morello Avenue and Arnold Drive, Martinez, California. On said date, and at said place, claimant, BARBARA SUE CURRY, was traveling southbound on Morello Avenue driving a 1984 Ford Escort when her vehicle was struck by a 1989 Ford Crown Victoria, County of Contra Costa Sheriff's Department, California license number E275017, being operated by OFFICER DAVID DUNNE THYS in a northbound direction on Morello Avenue, causing severe injuries to claimant, BARBARA SUE CURRY. Claimant contends that OFFICER DAVID DUNNE THYS was employed by the COUNTY OF CONTRA COSTA and was acting within the course and scope of his employment at the time of the incident, and r failed to exercise due care in the operation of his vehicle and in the operation of the lights and siren on said vehicle and that he ran a red light at a time when his warning lights and siren were not activated. As a legal result of the negligence of the COUNTY OF CONTRA COSTA employee, claimant BARBARA SUE CURRY suffered multiple injuries. The amount claimed by BARBARA SUE CURRY as of the date of the presentation of this claim exceeds $10, 000, and is sufficient to establish jurisdiction in the Superior Court of the State of California. These damages consist of general and special damages, including, but not limited to, medical expenses, loss of earnings, past and future, and loss of future earning capacity. Dated: September 4, 1991. HItPER dAtFt;d BY Attorneys forlAimant � � O iygtl VVV�,�MMM {y h P G SF C a 0. 00 cn a � � s e N N cd CO .rt tly G O (n U�1 • ,'�p,d•ky C� CL m o o � w � w � Y N o � w � U Yom+l W Q a zjm o Z � 4 3 ta. CLAIM + ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) S 0 R ACSI�N the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCObe r 1, 1991 )UNSEL and Board Action. All Section references are to ) The copy of this document mailed to ITl fFW r1Fnotice of �p TI California Government Codes. ) the action taken on your claim by t oardard of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $150.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: DEL ROSSO, Christine ATTORNEY: Date received ADDRESS: 25 Arreba Street BY DELIVERY TO CLERK ON September 6, 1991 Martinez, CA 94553 BY MAIL POSTMARKED: Hand delivered from Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy _ 444 4 Lz).2 I�. 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: ' In b BY: i JO Deputy County Counsel -0— J 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 (%Ir 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: OCT 0 1 1991 PHIL BATCHELOR, Clerk, B A Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR by O6 ° Deputy Clerk CC: County Counsel County Administrator rot n u *Errt.ti tJ !c r Claim to: HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SEP 6 1991 INSTRUCTIONS TO CLAIMANT p P�PSK y i .w ,�� A. Claims relating to causes of action for death or for injury to person or `.Yc Ci` t sonal property or growing crops and which accrue on or before December 31, 1987, must be presented.not.-later-than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death 'or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later,than. one year-after the-accrual of the cause of action. (Govt. Code §911.2.) B'. Claims must be filed with the Clerk of the Hoard 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. * . a W,'* .. * * +� :* * * * 4-4 RE: Claim By ; Reserved for Clerk's filing stamp ff' ECEI'N/E® .Against the County of ntra Costa j SEP _ 61991 CLERK BOARD OF SUPERVISORS ,District) CONTRA COSTA CO. ~ (Fill in The undersigned claimant hereby makes"claim against the County of Contra Costa or the above-named District in the. sum of $ _ 1,5-0, 06) and in support of this claim represents as follows: rN�N�rOr�rrNrrN�r�rN� -�NNN�rrrNMrrrrNNrNNMMrrr�N�NrM�rN 1. When did the damage or injury occur? (Give exact date and hour) Nrw..mos.�.rrrrrrr.,.r.�r..��rrrrrrreNrrr��rrNrrrrr.�rrrrM.�rrrrrrrrrrrrrrrr rNrrrrrrwr 2. Where:,did the.damage' or injury occur? (Include city and county) Mr�rNrlO..rrrNrr NNr�N�NrNrNrrN��rrM�NMM.MrrrM.i�rY�r r�rN�Nr rNrrrNN 3. How did the damage or injury occur? (Give .full details; use-extra paper if required) /L{ i yh�S. .S` �i��1 51010 a6UJ� ZS` %� � :: ?'' �� Cc�v •a G�1�'v° �e ;moo lauv �NrNr�NNANrrrMrrrrM� wrNrr�r+r�rrrrrrr rrrrrrrr r�rNNrrNrr 4. What particular act or omission omission on the-part.of-county or -district--officers, servants or e'mpl'oyees, caused the injury or damage? � ��� e���0 l� over Ar A. �. + wnat.are the names of county or district officers, servants or employees causing P~ the damage or injury? ------ ----------------------------------------------------- ---------------------- 5. What damage or injuries. do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. /UIG�`S�liLt-fS U!�'►E : /` jri � /0 �----rr----Mr-r----r------------ --r----r------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -�..r-rN-r-r-.�-----r-'�---------------w..rM--r+r-.�--.+-N�---rr---N--..--N�..-r-r---r--- $. Names and addressesof witnesses, doctors and hospitals. VIA, '--------------------- '--'rr------'--'-r�'---N------------------------------------r----- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some erson• on his behalf." Name and Address of Attorney r. - Claimant's Signature S'' Address Telephone No. Telephone Nee�/� 2�24 �_/11_s . 'NOTICE Section 72 of the Penal. Code. provides "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either* by imprisonment in the county jail fora 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. C � � J a. ADDENDUM TO THE CLAIM OF ChriAli1e-- F' DPS/ PQS5 0 (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No (�) ( 3) Was an alternate route available? Yes * No X/t ) 4 Did you read about the impending resur acf ingin the local ( ) Y P g g 7��mnewspaper? � Yes ( ) No (, ) cG ccs 0 ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( �) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory. 4Yes No ( ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes (k) No ( ) (8) Did a vehicle coming from the opposite direction cause , gravel to be thrown onto your car? Yes ( ) No O (9) Was the vehicle located directly in front of you exceeding the speed. advisory? Yes ( ) No ( ) n i l (10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No O ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? . Yes ( ) No If yes, please provide identification below: ( 12) Please., describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown ,onto the car, along with the specific damaged parts on your vehicle. ' 4 "'47 i/ ,7 �. ( 13) Were you aware that using the road during the chip seal process mi_ghtI result in damage to ,your car? r I declare that he above information is true and correct under the penalty of perjury. ( signature) (Date) i�Z�' ��rF ����� ifcl N.. a ; x, ,.; a ,P •6. �� SAN RAM U SS9aaae8N =A, oz:/as�s1 : 0sa,r©NEB 3136604 r OD.S- __. _ �' ;OQ79"fi41� � .-E. �. -_:, 'r: x •a 4+.,,.,yy. 4 i.T.i kS*d 07/30/91 /MOB I=LE 150 ":00 t �' N/W''---FAX#! 1^35' - -ROAb_' DES'R�I :.,. ._ .. - •'G 1. .. _ - .. _ .14 ...1�. Sd ,: 1106"4�- = F4 _ >^� INSURER/BILL TO CUST.,NO., INSURED;/;OWNER , lJSAA INS - SACRAMENTO L7EL° ROSSO. CHR I ST'TNE- _ = CH - PO- BOX 15506 �. :.. .:25- A"RRRABE_,. i rv.a SACRAMENTO. CA _ - MARTINEZ, -CA 95852-1506 945.53: 800-,5.31.-8222 ,,..4i5-2881,715"4277-,231•;8,-- 83 NISSAN STANZA KT11Sib ;i ,2�fSZL 7 ..•.?< ..>,. ._ ^c.?,ni#^'?k« �rs,�res. d., a,.. n�.e�'t„7 its.�fir=, i+ .. ::S an v yf-Cs's 3 �.S_ Y�* '�*^^ t «si { 3, e�✓.•Y" nF` .,+a-r - .h..,r.,....,s :: _,.:. �.,�. ,..n ey*��#. n 'z• _ ....z""N3+i ..����� :e':Xna. ,+ �-.«„2s«vcf:gct+`G a� ic•a-�, r � ,.::fig. .. r� I- %: _` -.. :v .. e.,"' -} t' >x.. •tT�, 'i•'> '. ;sae r .,;r, x .�..;ec .'.�' .',b: ate ._v•r w�=s"'i. s• ..z=r- ,a,,.,�° �u:. '=t:s G•+' ,'; "" ., =",: n,t .:t` ,`fF '#� d,,.: �? .�,.a #.�� P� -pa,. .'�`� Yx.�,:"ro `3"�g.•i :.�+'+4°»�•w, �•^` ., r P,iY' '!'"b. .. '*s"wr..'�.� ,'" ...y�' `F?'=�`,�'"""i�`f"'be(.;:i ..M•c�. ;,• :,.. �.....` a,%` •a5�' "'F .'s ` '�' L - I MIR � r� c •� �.�, fay �. a, ,�'I'`*� s'z� � ,y r �, � .,-;t :� €n� #. � � a e�C ALL ,r `'R 4', L�.r.. ;�:.'"F $� th •.�.� - �:.�•'� -.. 3.I' aZ� a: ti a `: D."q"" Ahaz. lku '4.m4t'. n"itJF .i 5 1.'St# �tJlcir'rST3# E:''1WAiTrAj C Shield Saver_Attempted:.0 yecd'n6 Ti A ,u ;e 4= ,: Ifrnot.attempted>Or.failure,.Reasen:r • i TOTeAL;PART$ NON'-CRITICAL - E L :ACUTE: _ cRmcAL If declined.Customer si nature'': ;+�rfi�r A ...f...,L �}II`q"•.tSutJ•.J Nw 4« ~!✓ ' + h%ALE TAXA STATEMENT-OF AUTHORIZATION AND SATISFACTIONca.J •GROSS'"TOTAL . REPLACEMENT HAS BEEN MADE TO MY'•SA7ISFACTION,AND I HEREBY AUTHORIZE TFIE-ABOYEltJSU �ry4jj. t 1 ❑ ANCE COMPANY TO PAY DIRECT IN.FUM TO WINDSHIELDS AMERICA INC,FOR SAID;INSTALLANN:IAF / {, DEDUCTIB E FOR ANY REASON THE INSURANCE COMPANY DOES NOT PAY FOR THESE REPAIRS OR REPLACEM4 EN7S Xj,.jt14tA. 150. 00. THE BELOW SIGNED AGREES TO PAY FOR SAID REPAIRS OR REPLACEMENT.SUBJECT TO WORK ORDER TERMS SET FORTH ON REVERSE SIDE AND INCORPORATED HEREIN-BY,THIS REFERENCE.;, NET TOTAL DATE SIGNATURE'`' FOR INTERNAL j r USE ONLY 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 0C to FeTF,_T99 1 and Board Action. All Section references are to ) The copy of this document mailed to you is' +Qur notice of California Government Codes. ) the action taken on your claim by then oo d 0 O*ervisors (Paragraph IV below), given pursuanto o GVe//r}}nmenQ Code Amount: $100.00 Section 913 and 915.4. Please note /t)�_"WaFni' " C0( _, . CLAIMANT: FONTANA, Cindy 'r0 ATTORNEY: Date received ADDRESS: 854 Shell Avenue BY DELIVERY TO CLERK ON September 5, 1991 M artinez, CA 94553 BY MAIL POSTMARKED: No envelope I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ��IL gATCHELOR, Clerk DATED: September 9, 1991 : Deputy �I. 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: 9 /�() �q` BY: ` S- Deputy County Counsel U— 64 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 (t/< 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 1 this date. Dated: COT 0 1 1991 PHIL BATCHELOR, Clerk, By A Allv Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 199 1 BY: PHIL BATCHELOR by ° Deputy Clerk CC: County Counsel County Administrator Chaim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or,growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims mist be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 9.4553• 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 717� Against the County of Contra Costa ) SEP 51991 or ) District) c�R con AOCOs A co isoss 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: -------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) 2• Where did titaG ucuuoge or rasJury oL'vua? (Include city a*:dcointy) r 3. How did the damage or injury occur? (Give full details; use extra paper if required) N per�"`\ I�JC�� Lha v 4.Wh --� - � 4 at particular act or cmi Sion on the t of int or distric off servants or employees caused the injury or damage?� LY,C�1 � ���`ny;�C�e.��-mid. (over) Contra Costa Coy.pty RECF S E P i 41991 Risk Mana,gem nt T ` 5•. What are the names of county or district officers, servants or employees causing the damage or injury? \ ^ ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Atta h ,two estimates for auto dqmaL7e. ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------ ,4 `1-- 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 Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by someperson on his behalf." Name and Address of Attorney Cl is Signature S��e-�� 62e. Address nn Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), 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. Contra Costa County RECEIVED P 41991 Risk Management n 11adnosday Aug 6. 1951 #,�-; Na1joncil Glass . DATE v Since 1919 2610 MONUMENT COURT YEAR& MAKE 05 'Riosan CONCORD, CA 94520 (415) 685.1260 Puldar 2DR. Federal I.D.#94-6309346 BODY STYLE B.A.R.AD013564 LICENSE NO. VEHICLE I.D. OR ENGINE NO. Stato Farm Cindy Fontana 854 Shell AVa Martinoz, CA, 94553 DUAN. PART No. DESCRIPTION LIST NET LABOR OR SIZE_ Shbided Windshield 1110p and 13ottom Moldings TERMS AND CONDITIONS OF SALE TERMS:NET CASH,NO DISCOUNT.INTEREST ON PAST DUE ACCOUNTS WILL BE CHARGED AT THE RATE OF 1-112%PER MONTH(ANNUAL RATE 18%)FROM THE DUE DATE UNTIL RECEIVED. SUB-TOTAL LEGAL FEECOSTS AND EXPENSES OF COLLECTION OF PAST DUE ACCOUNTS WILL BE PAID BY PURCH%ER.ALL BILLS DUE AND PAYABLE AT THE OFFICE. CA SALES TAX By VCEIV �IN GOOD ORDER DATE TOTAL MATERIAL AND LABOR INSURANCE PROOF OF LOSS Leo Cantana LESS DEDUCTIBLE/ 100.00 INSURANCE CO. DEPOSIT PAID CLAIM NO. 1662377BO30573 BALANCE DUE POLICY NO. COVERAGE VERIFIED BY Rock CAUSE OF LOSS DATE AND LOCATION OF LOSS CASH SETTLEMENTS CANNOT BE MADE FOR GLASS REPLACEMENT FOR YOUR PROTECTION,CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:"IT IS UNLAWFUL TO(A)PRESENT OR CAUSE TO BE PRESENTED ANY FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS UNDER A CONTRACT OF INSURANCE:(B)PREPARE,MAKE,OR SUBSCRIBE ANY WRITING WITH INTENT TO PRESENT OR USE THE SAME,OR TO ALLOW IT TO BE PRESENTED OR USED IN SUPPORT OF ANY SUCH CLAIM.EVERY PERSON WHO VIOLATES ANY PROVISION OF THIS SECTION IS PUNISHABLE BY IMPRISONMENT IN THE STATE PRISON NOT EXCEEDING THREE YEARS,OR BY FINE NOT EXCEEDING$1,000 OR BOTH. RELEASE AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT THE GLASS HAS BEEN REPLACED TO MY COMPLETE SATISFACTION AND I AUTHORIZE THE STATO FARN TO PAY DIRECT TO NATIONAL GLASS OF Concord -THE FULL AMOUNT DUE ME UNDER THE TERMS OF MY POLICY COVERING THE SAID LOSS,AND I UNDERSTAND IF FOR ANY REASON MY INSURXNCE COMPANY DOES NOT PAY THIS CLAIM I WILL BE RESPONSIBLE FOR PAYMENT OF SAME. INSURE COPYRIGHT 1986—NATIONAL GLASS—ALL RIGHTS RESERVED CREDIT COPY ADDENDUM TO THE CLAIM OF (Pri t your fun name) (1) Do you use the roadway as part of .a daily commute? Yes ( No ( ) ( 2) were you aware that construction would be commencing on the roadway? Yes ( ) No ( 3) was an alternate route available? Yes ( ) No ( ) .( 4) Did you read aboutthe impending resurfacing -in the local newspaper. . Yes ( ) No ( ►'V� ( 5) Did you see warning signs advising .of loose. gravel and a 25 mile -per hour advisory sign? Yes ( No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Oes ( ) No ( ) (7) Did a vehicle traveling in the same direction-.and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No ( -j (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( 9) was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( i (10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( V) No ( ) ( 11) Did you obtain the identity of the car relating to questions •6 thru 92 Yes ( ) No ( � ) If yes, please- provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car,.,.. along. with- .the specific damaged parts on your vehicle. ( 13 ) were you aware that using the road during the chip seal process might result in damage to your car? - Yes ( ) 'No ( {✓) I declare that the above information is true and correct under the penalty of perjury. (Signature,) o l (Date) ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA r • Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 1, 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 Goverment Code Amount: $1,635.00 Section 913 and 915.4. Please note all SZ CLAIMANT: FOUST, Theodore co, ATTORNEY: 7% COGO,��I Date received ADDRESS: 2400 Tara Hills Drive BY DELIVERY TO CLERK ON September 5,' 1991 San Pablo, CA 94006 BY MAIL POSTMARKED: No envelope 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy clam a JaJ4&a 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 or II1. 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 (t/ 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: OCT 0 i 1991 PHIL BATCHELOR, Clerk, B mm 01 A I Deputy Clerk - - — - Q WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT Q ��J1 BY: PHIL BATCHELOR by J A. O Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp T ) 77SEPC EIVED ) " Against the County of Contra Costa ) 991 or ) CLERK BOAUPERVISORS District) CONTCo. Fill in name ) , The undersigned claimant hereby makes claim against t _County of Contra Costa or the above-named District in the sum of $ - and in support of this claim represents as follows: �M----N-ANN-N-�----��MrMMNM-N N-N--�-O----------M--N---N-M --- 1. When did the damage or injury cur? (Give exact date and hour) �M- - J 6. -J M.� N J/ /i'// -NN-M--MO--M--- ----- ---N----------- 2. /ere �did the damage or injury occur? (nInclude city and county) --�1/ ✓�/ //,/V v-=M----.�-MiO�,��YI--M�NMM--M<�--O---M--�N_-N---------- - N 3. How did the damage or injury occur? (Give full details; use extra paper if required) W p_f, -N-------M- (NMj -------MN-NM--N--NN------------------------M-----YMs----- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 241 ..� �Vn,� ter/ -715- 4-ez� ram, ✓=.� -Z- c-v� -p�e,�e�G.� r d� lw�4� � 7- over) a f Claim to: BOARD OF SMERVISORS. 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 319 19879 must be presented not later than the 100th---day after the'accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which'accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year-after the accrual of the cause of-action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the-name of the District should be filled-in: D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp Against the County of Contra Costa ) or ) District) Fill in name , ).. The undersigned claimant hdr6by.miakes '61aitp against the County of Contra Costa or the above-named District in the. sum of $ 1 and in support of this claim represents as follows: 1. When 'did the damage or injury occur? (Give exact date and hour) 6aeq 9- " re .did the damage or injury occur? (Include city and county) V "#VPS 3. How did the damage or injury occur? (Give :full.,details;- use extra paper if required). 7a, -N---N--M-�M--------NM-MN--N----N---N----N1------------------- NN -N-- 4.' What. particular actor omission on the part of county or district officers, servants or•employees, caused the injury or damage? �,,,� Lo V � (over) } w 7. what are the names of county or district officers, servants or employees causing the damage or injury? -- _ �- -- -- , _ 5. What damage or injuries do you-claim resulted? (Give :full. extent- of injuries or damages claimed. Attach two. estimates_.for auto damages 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ------------- •-----------' --------..-�r-r�-. ---' -i' --r--------' --�'---- ------------- 8. Names and addresses of witnesses, doctors and hospitals.. -----------------------rM .r-__----• -_----- ----------------- ---------- ----- 9. . List the expenditures you made on account of this accident or injury: DATE .ITEM - AMOUNT - Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some erson on, his behalf." Name and Address of Attorney Claimant's Signature Address . Telephone No. Telephone No: . „ * NOTICE Section 72 of the. Penal. Code provides: .• ."Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any 'county, city or district board or officer, authorized to allow or pay the same' if genuine, any false or fraudulent claim, ,bill, account, voucher, or writing, is punishable either by imprisonment in the county jail fora 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. J ADDENDUM TO THE CLAIM OF (Print your full name) (1} Do you use the roadway as part of a. daily commute? } Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? _ Yes ( ) No ( ) ( 3) Was an alternate route available?- 'Yes ( ) No ( ) ( 4) ` Did you read about the impending resurfacing in''the local newspaper? Yes ( ) No ( ) ( 5) Did you see warning signs advising of. loose gravel and a 25-mile per hour advisory sign? Yes ( ) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( ) No ( ) (7) Did a vehicle traveling in the same direction. and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No ( ) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( ) (9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( ) 4 w (10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( } No ( ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No ( ) If yes, please provide identification below: (12) Please describe .in your own words how -the gravel caused damage to your vehicle and the angle the gravel was thrown onto` the car, along with the specific damaged parts on your vehicle. ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No ( ) I declare that the above information is true and correct under the penalty of perjury.- (Sig�n`ature) E7 (Date) !J CLAIM �FCIEIVFI? BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA SEP 1 � � Claim Against the County, or District governed by) BOND� CTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT co 1 , 19 91 and Board Action. All Section references are to ) The copy of this document mailed Woy3rF-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: 910,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: FUENTES, Gilbert ATTORNEY: Date received ADDRESS: 46 Polaris Drive BY DELIVERY TO CLERK ON September 11 , 1991 Pittsburg, CA 94565 BY MAIL POSTMARKED: Hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 11 , 1991 EVIL BAATputyLOR, Clerk II. 011A. 0 FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ~� ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: (( 1 BY: , Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated: OCT 0 1 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or depositeu 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:— OCT 0 3 1991 BY: PHIL BATCHELOR by OJ Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT / Q� Q 6611 A. Claims relating to causes of action for death or for injury to person or to ,per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the .end of this form. RE: C aim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) SRI 1991 -or Xpi / vol (oV el, 4vc-�District) CLERK BOARD OF SUPERVISORS Fill in-name ) CONTRA COSTA CO. The undersigned claimant hereby makes `el i against the County of Contra Costa or the above-named District in the sum of a 000.ocia 00 and in support of this claim represents as follows: U� -�� e _e_e___-- ------ _ _ 1 A ----- - ---------------- 1. When did the damage or injury occur? (Give exact date and hour),t b' e'1` f'l!R`Uer � � 4-bC�e C `( Vk Ce. ��pr,. ,�� ��`l`e fC � �ell'he 2. Where did the damage:.-or injury occur. (Include city and county)3. How did the damage or ijury, occur?b (Give full details;use extra paper if j required) C � ,� a -� � ��e� t� �. ^ PC4 k Le L-�4F� .`e�l ai CaC, ----- 4. Wffat particular act or omission on. the part of county or district officers, servants or :employ s caused the .injury or .damage? Q 41t ; 46 J j� pvuo 5C / E 1 ne b e. r Pne /.tet 0 /Wy `( �Aq lf/ a {- 5. What are the names of county or i�ct officers, servants or employees causing-. the damage or injury? rt r 14Q 5. What damage or injuries do you claim resulted? (Give full extent of injuries or � f damagesclaimed. Attach two estimates for damage. ��,$7kle y Q Q ' tib e 7. How was the amount claimed above computed? (Include the estimated amount of anX(x;e prospective injury or damage.) < 1 .� .14e Q ----r-r-rrr-e-�-------rrr-------------------r..-rr-----r-•�---rrF.- 8. Names and ad resses of witnesses, doctors and hospitals. � S'6 +► 50 � ,�rP�-� &vv�� /�,�p lis� �V 47 ---------------------- 9. List the expenditures you made on account of this accidentor injury: DATE ITEM AMOUNT - l'� �3VI I Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by soro Person n his behalf." Name and Address of Attorney C aimant's Signature Address Ak ,; 6 ¢ c ,Y., `' C .. Q o? Telephone No. �S�P Telephone No.e"'�pf� ?� Z/ * * " * * h1 t4{i OC�, I;h: e cQ �� �►�+g.0.��• ��d` ��,-�``o��i �'� .` ....Q N 0 IAC E :4 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, dis,trict 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. w. NOTICE OF INSUFFICIENCY AND OR NON-ACCEPTANCE OF CLAIM TO: Gilbert Fuentes 46 Polaris Drive Pittsburg, California 94565 Re: Claim of FUENTES, Gilbert Please Take Notice As Follows : 1 The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. X 3 . The claim fails to state the date, place or other . circumstances' of the occurrence or transaction which gave rise to the claim asserted. X 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage, or loss, if known. 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000) . If the claim totals less than ten thousand dollars ($10,000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss. so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10, 000 ) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: �. Deputy o y Counsel CERTIFICATE OF SERVICE BY MAIL C.C.P. SS 1012, 1013a, 2015 . 5 ; Evid. C. 99 641 , 664 My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg., P.O. Box 69 , Martinez, California, 94553 , and I am a citizen of the United States,; over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail) , which envelope( s) was then sealed and postage fully prepaid thereon, and thereafter was , on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct . Dated: o? , at Martinez, lifornia. cc: Clerk of the Board of Supervisors (o 'ginal) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4 , 910 . 8 ) fq CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA '`%laim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 1, 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: $160.40 Section 913 and 915.4. Please note all "War4%s". CLAIMANT: KALIOPE, Teri L. c SCCA CF�`�® oG 1 ATTORNEY: CIO 19 Date received ti ADDRESS: 730 Evelyn Circle BY DELIVERY TO CLERK ON September 3, 1 Vallejo, CA 94589-3217 BY MAIL POSTMARKED: August 31, 1991 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 EVIL BATCHELOR, Clerk DATED: eputy _ Lad L 11. FROM: County Counsel TO: Clerk of the Board of Supervisors N ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1, ��� 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 (i/) 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. y Dated: C.I 0.1 .199.1 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown 9 above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR by D Deputy Clerk CC: County Counsel County Administrator Clain 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, 1987v . must be. presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must .be presented `not later than one year after the accrual of the cause 'of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed-by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp ` y RECEIVED Against the County of Contra Costa /) or ) . SEP 31991 District) CLERK-BOARD OF IIPERV Fill in name Y. I CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County o Co ra Costa or the above-named District in the sum of $ to(0,4() and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) E5 .Mr 2. Where did the damage or injury occur? (Include city and county) ioLeASANT 41 LL ` cane- cowm 3. How did the damage or injury occur? (Give full details; use extra paper if reeuiredl - -- 3 . While traveling northbound on Taylor Blvd, another car changed lanes in front of me, causing some of the remaining loose gravel from the center of the road to be thrown up by its tires . Some of this gravel hit my passenger side headlight, causing it to shatter. 4. What particular act or omission on the part of county' or district officers, servants or employees caused the injury or damage? N EW G -A-U GL, o�J 12-��.c e,�q C,+�- �o A-) rJ cL57 71)r-NO En a ot�30 Sv t c.� c��e.�T-c.� 2's MP A L l ren, [T- 5 t GIPS (over) D. what are the names of county or district officers, servants or employees causing the damage or injury? ` ---- -►�- R=7----- -------------------------------------- - ---=---------- 5. What damage or injuries.- do youclaimresulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. C_PeD• ------- VA!�WT- M==--•_~-�---�N--N-NN1-----------------•----- --N---- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -..N.n----------- ------------ V $. Names and addresses. of witnesses, doctors and hospitals. --r-------------------N---------M-------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT ifs : Gov. Code See. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) orb some person on his behalf." Name and Address of Attorney _ - Claimant'sSignature) A Ad ss CSSS -3ai Telephone No. Telephone No. ` s- '` 00 * * * * N, 0 T I C .E Section 72 of: the Penal; Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer;, ,authorized, toallow.'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. INVOICE BILL LANG CADILLAC PONTIAC MAZDA • � I i 70 4301 SONOMA BLVD., VALLEJO, CA. 94589-2288 (707) 552-5555 FAX (707) 554-4992 DISCLAIMER OF WARRANTIES The only warranties applying to this part(s) are those which may be offered by the manufacturer. The selling dealer hereby expressly disclaims all warranties, either express or implied, including any implied warranties of merchantability or fitness for a particular purpose, and neither assumes nor authorizes any other person to assume for it any liability in connection with the sale of this part(s)and/or service. Buyer shall not be entitled to recover from the selling dealer any consequential damages,damages to property, damages for loss of use. loss of time, loss of profits, or income, or any other incidental damages. ***** BILL LANG PARTS DEPT. ***** **** OPEN MONDAY THRU FRIDAY **** ** * 8 AM UNTIL 7 PM *** ** SATURDAY 8. 30AM--4.30PM * * INVOICE NUMBER INVOICE DATE MEMO 32000 7/ 1/91 INVOICE 1 s VISA&MASTER CHARGE S NAME o H ADDRESS _ D P CITY 0 00000 0 PHONE CUSTOMER P.O.NO. COST.ACCT,NO. TYPE OF SALE SALESMAN SHIP VIA 86 CAD CIMMERON 10500 1 1 QTY. PART NUMBER DESCRIPTION BIN LIST NET TOTAL 1 16504848 LENS HOUSSP—OR 90;00 90;00 90;00 I I I I I I I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I 1 I I I 1 I I i I I I I I I I 1 I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I 1 1 I I I I I I I I I I I I I I I I LAST INVOICE # / DATE: 31945 6/29/91 CHARGE 9 U 0 +TAX —4- 540 NO REFUNDS WITHOUT THIS INVOICE. 30%HANDLING CHARGE ON ALL RETURNS. CARBURETOR OR ELECTRICAL PARTS NOT RETURNABLE. SPECIAL ORDER PARTS NOT RETURNABLE. NO REFUNDS AFTER 15 DAYS. NO RETURNS ON PARTS THAT HAVE BEEN INSTALLED, I NO REFUNDS PAY THIS RECD AMOUNT 9 40 WITHOUT I BY THIS INVOICE _ L _ 4301 SONOMA BLVD,.VALLEJO,CA.94589-2288 (707)552-5555 CALIF.B.A.R.REG..gAA003155 MRS. TERI KALIOPE H 32238 730 EVELYN CIR. P1 ( 707 ) 554-8007 T VALLEJO CA T ( 415 ) 8231..-9768 x0000 PRINT TIME 0 — 94589 088 BURG CAD CIM 12: 04 INVOICE d(R.O.4) INVOICE DATE CUSTOMER ACCOUNT NO. P.O.NUMBER SALESMAN ALESMAN/ SHIP VIA 32238 7/10/91 0 81 STOCK # R.O.DATE MILEAGE DELIVERY DATE V/E NO. VEHICLE I.D.NO. LICENSE/TAG NO. CONTROL # 644 /10/91 68179 12/ 3/90 JJ505115 G6JG51WOJJ505115 TLC59 A SERV PROM 7/10 12: 00 CUSTOMER REQUEST PT,CODESVC. OPERATION CODE QUANTITY LIST NET EXTENSION PART,NUMBER DESCRIPTION -�Ac ''k :Ac SERVICE = NEOICIE; STOMER LABOR CHARGES ARE BASED ON A RATE OF $65. 00 PER HR. INSTALL SPECIAL ORDER RIGHT FRONT HEADLAMP ASSY. CHECK & ADVISE REPLACE HEADLAMP ASSY. TECHNICIAN 30 BE LABOR 1 .00 65 .00 65 .00 LINE 1 TOTAL 65 .00 LABOR TOTAL 65 . 00 PARTS TOTAL . 00 SUBTOTAL 65 . 00 PAY THIS AMOUNT 65 . 00 3; )T INVOICE #IDATE TERMS:STRICTLY CASH OR APPROVED CREDIT CARD 390-11367(DDC-RO-5) EXPLANATION OF SHOP SUPPLIES I hereby authorize the repair work to be done along with Ti~essary material,and hereby grant NORICK OKLAHOMA CITY I6G7AP3l —A token charge is Included for your employees pumps a of testingtoperate the vehicle herein described on sveets, highways, o 9 elsewhere for the and/or inspection.Subject to conditions on reverse side of His 5u pplies used on your vehicle.Ap- contract.WE WILL NOT BE HEL�RESP SIBLE OR VALUABLES LEFT IN THE VEHICLE.By �O CLAMS WITHOUT THIS INVOICE law,you mayIfff ernee d repairs or adjustments which thCUSTOMER LABOR CHARGES ARE BASED ON A RATE OF PER HOUR pllcable supply items ora:Nuts. Smog Check s ee at t ehick may be hllr{until all charges )UR POLICY TO ADVISEE YOU OF OUR LABOR CHARGE PER HOUR AND TO PROVIDE A WRITTEN bolts, washers, tape, pins, are peltl lnf ATE OF THE COST OF REPAIRS REQUIRED FOR YOUR VEHICLE.YOU WILL BE NOTIFIED PRIOR aerosp ray,shellac,carburetor Signed X 'r FORMING THE WORK IF THE CHARGES ARE EXPECTED TO EXCEED THE ORIGINAL ESTIMATE. cleaner.solder.battery cleaner, CUSTOMERACNNOWL DGES RECEIPT OFA PY F: CUSTOMER COPY ,�E'N REPLACEMENT PARTS AND RELATED LABOR HAVE A LIMITED WARRANTY ire,window sealer,etc. I ACKNOWLEDGE NOTICE AND ORAL APPROVAL 90 DAYS OR 4.000 MILES,WHICHEVER COMES FIRST. OF AN INCREASE IN THE ORIGINAL ESTIMATED PRICE. INITIALS ADDENDUM To THE CLAIM of G.. KP(-L.-l()Qr= i (Print your full name) ( 1) Do you use the roadway as part off a daily commute? Yes ( v ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? .0 OT- v OrL Yes ( } No ( 3) Was an alternate route available? 60 U-q Yes ( ) NoQjES,NEOT ( 4) Did you read about the .impending resurfacing in the local newspaper? Yes ( ) No (�J)•. ( 5) Did you see warning signs advising of loose' gravel.-and a 25 mile per" hour advisory sign? Ati!ISO Yes ( ) No� ) iq� _ gel A-D N�M ( 6) Did the damage result from another vehiclet_ exceeding e 25 mile per hour advisory? W �ZH Yes ( ) No"N �� (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ) No ( ) ( 8) Did a vehicle coming from the opposite direction cause gravel .to be thrown onto your car? 4 Yes (: ) 'No J,) ( 9) Was. the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No'�, ) t (10) Did you' travel the roadway more than once during the resurfacing prior to the damage sustained to your car? o< Yes ( " ) No ( ) ( 11) Did you obtain the identity of the car relating. to questions 6 thru 9? Yes ( ) No� ) If yes, please provide identification below: „ r (12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. p PWSS P6,G.-- 51 (JE) AtL-Rro'f , ' �AUSIIJG� LT- `p S N'AT1�12 ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes (v ) No ( ) W t-(-tC-J+ CCOT,OD&O M141 WrA-1 i 6LOAT1J)_ S p'e-p U►)Tt L Irv-A% A-pP A-Rz13T- 'T RV-z l'z*& Ob P,.a12-tT Lzu5t I declare that the above information is true and correct under the penalty of perjury. ( Signature (Date) For J.S. ,+n S)30SIAd dflS 40 ' I 1661 E d3S Jd y A r = v t } C i S(� 1 tF it ttt l O x V C' i t 3 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 October 1, 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: $850,000.00 Sect;on .913 and 915.4. Please noteW�1e(Wp;rrings". CLAIMANT: KERSTEN, Henry and KERSTEN, Elizabeth SEP 10 1991 ATTORNEY: Daniel J. Kelly, Esq. COUNTY COUNSEL Walkup, Shelby, Bastian, Ut al Date received MARTINEZ, CALIF ADDRESS: 650 California Street, 30th Floor BY DELIVERY TO CLERK ON September 6, 1991 San Francisco, CA 94108 BY MAIL POSTMARKED: September 5, 1991 Certified P 564-918-117 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 PpHHIL BATCHELOR, Cler DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors . � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: I , ti Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (v-l' 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: OCT 0 1 1991 PHIL BATCHELOR, Clerk, By ° Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. r AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and No a to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR b J A.,J a Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF BRUCE WALKUP WALKUP, SHELBY, BASTIAN, MELODIA, • GEORGE J.SHELBY r RALPH W.BASTIAN.JR. KELLY, ECHEVERRIA & LINK PAUL V.MELODIA A PROFESSIONAL CORPORATION TELEPHONE DANIEL J.KELLY JOHN ECHEVERRIA 6SO CALIFORNIA STREET, 30TH FLOOR (41 S)981-7210 JOHN D.LINK SAN FRANCISCO,CALIFORNIA 94108 FACSIMILE RONALD H..WECHT ) RICHARD THALS,JR. (415 391-6965 EC MICHAEL A.KELLY KEVIN L.00MECUS JEFFREY P. HOLL DANIEL DELCOSSO MARY E.DRISCOLL RICHARD H.SCHOENBERGER September 5 1991 OF COUNSEL e CYNTHIA F. NEWTON p / WESLEY SOKOLOSKY,M.D.,J.D. CERTIFIED MAIL - RETURN RECEIPT REQUESTED RECEIVE® Board of Supervisors SEP - 61991 County of Contra Costa Administration Building 651 Pine Street Room 106 CLERK BOARD OF SUPERVISOR CONTRA COSTA CO. _ Martinez, CA 94553 Re: Claims of Henry and Elizabeth Kersten Dear Clerk: Enclosed herewith are duplicate originals of a Claim for damages made by and on behalf of Henry and Elizabeth Kersten. This claim is presented for filing against the County of Contra Costa pursuant to Government Code §915 (a) . Kindly acknowledge receipt of the claim by signing and returning the copy of this letter. A return envelope is,-1 �,j enclosed for your convenience. Very truly yours, DANIEL J. KELLY DJK: jo Enclosures Receipt of the within claim is acknowledged this day of September, 1991. Clerk, Board of Supervisors County of Contra Costa 117:CI � CLAIM y SEP - 6 1991 i CLERIC 60ARD OF SUPERVISE'"� TO: Board of Supervisors _CONTRA COSTA CG._ County of Contra Costa Administration Building Martinez, CA 94533 HENRY KERSTEN and ELIZABETH KERSTEN herewith present their claims for damages against the County of Contra Costa as hereinafter set forth: A. CLAIMANTS' ADDRESS: Henry Kersten and Elizabeth Kersten P.O. Box 296 Hillsdale, New. York 12529 B. ADDRESS TO WHICH NOTICES ARE TO BE SENT: Daniel J. Kelly, Esq. WALKUP, SHELBY, BASTIAN, MELODIA, KELLY, ECHEVERRIA & LINK 650 California Street, 30th Floor San Francisco, CA 94108 TELEPHONE: (415) 981-7210 C. DATE OF ACCRUAL OF CLAIM: On or after March 8, 1991 D. CIRCUMSTANCES GIVING RISE TO CLAIM AND DESCRIPTION OF INJURIES AND DAMAGES: Claimant, ELIZABETH KERSTEN, underwent surgery at Merrithew Memorial Hospital. During the course of this operation, Contra Costa County employees and/or agents seriously injured Kersten's bile ducts. Subsequent to and as a result of these injuries, Kersten developed severe bile peritonitis, adult respiratory distress syndrome, multiple system organ failure, general debility and myopathy, and severe emotional distress. Claimant, HENRY KERSTEN, is and was at all relevant times married to claimant ELIZABETH KERSTEN. As a result of Elizabeth Kersten' s injuries, claimant Henry Kersten suffered loss of care, comfort, companionship, support and other elements of consortium. E. EMPLOYEES AND/OR AGENTS CAUSING INJURIES AND DAMAGES: The names of Contra Costa County employees and/or agents responsible for the injuries to Claimants are unknown to Claimants at this time. F. AMOUNTS CLAIMED: Claimant ELIZABETH KERSTEN claims general damages in the amount of $250, 000, and special damages in the amount of $250, 000. Claimant HENRY KERSTEN claims general damages in the amount of $250, 000, and special damages in the amount of $100, 000. DATED: September 5, 1991. WALKUP, SHELBY, BASTIAN, MELODIA, K LLY, ECHE E IA & LINK By K Wesley Sokolosky ,Attorneys for Plaintiff � Q N u' O Lo or SY O rAcri O � -rAeA �� V d .`, CD y Q 0 7�_; $� 4 _d dY4a cn O 9inN �' uwoc. 0 ' d Z N 3m U� o `v ti CLAIM ��C�IVE� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1 Claim Against the County, or District governed by) S EP I B;ARS_ T199IOI the Board of Supervisors, Routing Endorsements, ) NOTICE TO,CLAIMANT �pIgTY' �UNSol and Board Action. All Section references are to ) The copy of this document maile&VW1Nfft ftlRour 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: $300. 13 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: MANCEBO, Melanie S. ATTORNEY: Alexis Peri l l at #1 Sansome Street Date received ADDRESS: San Francisco, CA 94104 BY DELIVERY TO CLERK ON September 10, 1991 BY MAIL POSTMARKED: September 9, 1991 I FROM: Clerk of the Board of Supervisors TO: Couoty Counsel Attached is a copy of the above-noted claim. September 11, 1991 PpHHIL BATCHELOR, Clerk a DATED: p BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors �{�} ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim isnot timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 119) i 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 (Vf' 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:— OCT 0 1 1991 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file. a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times 'herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR by I IA.. D 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. 319 1987, must be presented not later. than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one�year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the� Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal, Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp 1 13 mfln, e- &.12Z_2L RECENED Against the County of Contra Costa ) ;E8:::;L )District) CLERK BOARFill in name ) coy: 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:,; - _!__--Nr-M_______________N-rN___-_-Nr____r__rr-Nr_-_--__r-_rNrIIrN_-N__rrr_ 1. When did the damage or injury. occur?. (Give exact date and hour) PM-=--- --------------------- __--_--------------------------- - --- 2. Where did the damage or injury occur? (Include city and county) ���'1 3. How did the damage or injury occur? (Give full details; use extra paper if required), VjI -AhAw ai_ Le- o dle , a- roct- -A itu') INC , 4. What particular act or omission on the' part of °county or district officers, servants or employees caused the injury or damage? �. .y .�.� art: ane names or county or district officers, servants or employees causing' the damage or injury? _ - - ----- ----------------------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. ' Attach two estimates for auto, damage. -----------=----------_---------_ :_ _ .- ----------_=--..--------------------=---- 7. How mas the amount claimed above"computed? (Include the estimated amount of any prospective injury or damage.) " --�w--------------------------- ------------- ------- 8. Names and addresses of.witnesses; doctors'and �hospitals. ------------------------ -N-. ----N-w---------------------•----------------N----- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT -- Gov. Code Sec. 910.2 proe.ide-s: "The claim must be signed .by the claimant SEND NOTICES TO: (Attorney) orb some person on his behalf." Name and Address of ttorney I,C x-i S -..Tcri �afi A Claimant's Signature _�I C�ornc � (` -aj�) FOi-fAsc-D 'CA Address b-- Telephone No. Telephone No. -r Ut NOTICE z Seetion. 72 ofithe'Penal Code..providetl. "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, hill, :account, ,voucher,- or writing;• is punishable either by' imprisonment in the bounty 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. ~~-- -- ADDENDUM TO THE CLAIM OF OCIckn e S+ 0"Ce�`C b (Print your full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No ( ) rUD1 ( `-k ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No (� ) F ( 3) Was an alternate route available? Yes (x ) No ( ) ( 4) Did you'. read about the impending resurfacing in the local newspaper? Yes ( ) No (K) ( 5) Did you see warning signs advising of loose gravel and a 25 mile-per hour advisory sign? Yes ( ) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per- hour advisory? Yes {� ) No ( ) (7) Did a vehicle traveling in the- same direction and exceeding the 25 mile per hour advisory sign- attempt to pass you? 1~ .. Yes ( ) No { ) (8) Did a vehicle coming from the opposite direction cause gravel-to be thrown onto your car? ,, Yes ( ) No (x) (9:) ; Was the vehiclelocated directly in.• f ront,- of you ,exceeding _ the speed advisory? Yes (X ) No ( ) " ( 10) Did you travel the roadway more than once during the • resurfacing prior to the damage sustained to your car? • Yes (K ) No ( ) ( 11) Didyou obtain the identity of the car relating to questions' 6 thru 9? Yes ( ) No (x ) If yes, please provide identification below: (12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. I�1(JJ �A) rdloSQA 1KT4 C LtM Ouc ajm6my r S-'1A,c wYv-,n Mc- vz)ux� u�), .��P�rr�, Imo---- 1l J v - Loa 9S ! A Y - ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No"( X) I declare that the above information is true and correct under the penalty of perjury. (Signatture 2e& - I (Date) 5FP-04-1991 12:24 FROM LOF CEtATRAL tJO. CAL. TO IJALtAUT CREEK P.01 Libby-Owens-Ford Co. EbTIMATE 202161342 Glass Centers WIORK ORDER r♦valcE LESMAN 03 E S T I M A T E TE ADDRESS GASH-8AY MAKEMODEL 57 9 N I S�aAN, A SEDAN SENT RA, DL ADDRESS V.I.N.# CITY,STATE LICENSE# MILEAGE CLAIMANT SPECIAL INST, DATE TIME WORK PHONE# HOME-PH CUSTOMER# INST# CASH COMP?DATE TIME IN&?0 QUANTITY ITEM NUMBER DESCRIPTION LIST PRI SALE PRICE TAX 1 FCW539T FOREIGN WINDSHIELD 202. 90 TX 1 LFW LABOR- UkEIGN WINDSHIE 25. 00 1 Urw U-KIT FOREIGN WINDSHIE 9. 95 TX REQUIRES NEW MOLDI . WHICH `PoILL BE AN ADDITIDNAL COST. WINDSHIELD HOS ANT NA. I A/t• I j I 1 Paymt Reference Approval Date Amount Sub 237. 85 Tax 17- 56 -�----- ----------------- --- .�--__-�_----J-- --�--•- _�--Balance Total 255. 41 � * THIS IS NOT AN INVOICE - 00 NOT PAY INSURANCE COMPANY INFORMATION BELOW THIS LINE INSURANCE COMPANY � AGENT NEI' xxxxxxx NAME P ADDRESS MELANIE MPNCIESO ADDRESS ADDRESS ADDRESS CITY,STATE CITY,STATE PHONE# FLEET# PHONE# POLICY# - CLAIM# INSURANCE DATE OF CAUSE OF VARIFIED BY LOSS LOSS i REi; EIVED FE; 0M 415 538 4907 - - SAFELITE'Glass Corp. ' SAFELITE AUTOGLASS CORP. C;)-U C)-r F—= BAR# AA157967 ` 2098 MARKET ST 08-28-91 CONCORD, CA. 94520 415 687-2150 THIS IS A QUOTE ONLY - DO NOT PAY CASH SALES - 1701 CLAIM # 2098 MARKET STREET POLICY # CONCORD, CA. 94520 0000 415 687-2150 MELANIE MANCEBO ORIGINAL AUTHORIZED IRFVIMSED REASON ADDITIONAL 533 WESTOVER LANE ESTIMATE BY =ST ATE COST PLEASANT HILL CA 94523 PHONE DATE TIME�AGTIORIZED 11 IPN PERSON DATE TIME 415 945 6612 SAFESEAL POSSIBLE [] YE�G [] NO DECLINED CUSTOMER SIGN. PART# REPAIRED______________ Year Make Model Mileage Serial# License# Reference# 1987 NISSAN (DAT SENTRA 2D SPORT COUPE Quantity Part No. Description Extension Total I FCW538-S SHADED WINDSHIELD 438. 10 175. 24 175. 24 LABOR 49. 00 49. 00. 1 MISCMOLD-N MOLDING FOR WINDSHIELD ON 56. 75 56. 75 NISSAN SENTRA QUOTE - DO NOT PAY SUB TOTAL: 280. 99 QUOTE - DO NOT PAY QUOTE - DO NOT PAY SALES TAX: 19. 14 QUOTE - DO NOT PAY TOTAL: 300. 13 ARRANGEMENT: JOB ADDRESS: JOB DATE: JOB CITY: JOB TIME: NOT SCHEDULED JOB PHONE: SUBTOTAL LABOR $ SUBTOTAL PARTS Replacement has been made to my satisfaction and I hereby authorize the above insurance company to pay direct in full to the above listed firm for said installation. If for any reason the insurance company does not pay for these repairs or replacements, the below signed agrees to pay for said repairs or replacement. I ACKNOWLEDGE NOTICE AND ORAL APPROVAL OF AN INCREASE IN THE ORIGINAL ESTIMATED PRICE. DATE SIGNATURE 1787 01701 CASH SALES - 1701 2098 MARKET STREET CONCORD, CA. 94520 0000 Please Reference Invoice U-U C3-F F-= 415 687-2150 ncl K'jch-F I=-1=1`'e 047472-000502-047472 CASH CUSTOMER COPY ALL PARTS ARE NEW UNLESS OTHERWISE SPECIFIED INSURANCE OR CHARGE MAILING COPY ~- -~' 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 October 1, 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: $249.10 Section 913 and 915.4. Please note,all„"W finings". CLAIMANT: MERRELL, Lynn-ALLSTATE INSURANCE COMPANY Claim No. 6750356369FJA ATTORNEY: Allstate Insurance Company .:UUNIY Wu l MI�IRTINE�,,� . Fremont Market Claim Office Date received e Stember 6, ►LI¢1991 ADDRESS: 42840 Christy St. Ste 200 BY DELIVERY TO CLERK ON p Fremont, CA 94538 September 5, 1991 BY MAIL POSTMARKED: Certified P 790 994 797 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 PpHHIL BATCHELOR, Clerk OA40a a4414 a DATED: p BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors � ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 9 Ito 19 , BY: Ixo A Deputy County Counsel I 3,T � III. FROM: Clerk of the Board TO: County Counsel (1) County Adminis ator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 O Dated:—OCT 0 1 1991 PHIL BATCHELOR,. Clerk, By b Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_0 CT 0 3 1991 BY: PHIL BATCHELOR bVW—L y °,.2 Deputy Clerk CC: County Counsel County Administrator A I I bi die ALLSTATE INSURANCE COMPANY FREMONT MARKET CLAIM OFFICE 42840 CHRISTY ST STE 200 FREMONT CA 94538 415-226-6600 September 4, 1991 In reply please refer to RECEIVE® Contra Costa County Risk Management ' 651 Pine Street, 6th Floor ( EP - 6 r Martinez, CA 94553 CLL S0.0t4D Attn: Julie Allmock CEdTRAC SUPERISORS COSTA co. Our investigation shows that your client was involved in an accident with our insured and is responsible. Since we have alreadv made a settlement with our own policyholder, she has assigned her right of claim to us. Copies of the final papers covering her loss from this accident are enclosed. Please accept this letter as notice of our subrogation rights. Your prompt payment will be appreciated. Sincerely, Chinny Law Senior Claim Representative (510) 623-3038 NIS Enclosure Our Claim No. 6750356369FJ Your Client: Contra Costa County Our Insured: Lynn Merrell Client's Address: 2475 Waterbud Way Date of Loss: 7/23/91 Pleasant Hill Location of Loss: Taylor Blvd. , Pleasant. Hill Time of Loss: 12:00 pm Amount of Loss/Total: $249.10 Insured's Deductible: $100.00 Allstate's Interest : $149.10 Description of Loss: County laid gravel on the road, which was kicked up by county truck, and caused damage to insured's windshield. tr � O r-' •L• .Sz -••. :t st f QC3 cn N q p o ME r) F o m G� 3► •• � O Z pFt G ao N cA rn Z O .cmc v� y m •a � } O sc 3 Q r Z y 0 .•t -+ ndo O d o y ^4 Go CO p is ---1 •� ii i • lmsip.Ml ORIGINAL INVOICE • �.., o�20134-1 Notionol Glass ® _ 7/26/91 DATE Since 2610 MONUMENT COURT 85 Volvo . CONCORD, CA 94520 YEAR& MAKE (415) 685.1260 Federal I.D.#94-6309346 - BODY STYLE 740 GLE B.A.R.AD013564 LICENSE NO. VEHICLE I.D. OR ENGINE NO. " Allstate Claims Lynn Merrell 932-6963 757 Arnold Drive Ste 3 3133 Gloria Terrace Martinez, CA 94553 Lafayette, CA DUAN. PART NO. DESCRIPTION OR SIZE LIST NET LABOR FCW457 Shaded Windshield 538. 15 234. 10 Tnstalla�ion 15 00 ;.. TERMS AND CONDITIONS OF SALE TERMS:NET CASH,NO DISCOUNT.INTEREST ON PAST DUE ACCOUNTS WILL BE CHARGED AT THE RATE OF 1-112%PER MONTH(ANNUAL RATE 18%)FROM THE DUE DATE UNTIL RECEIVED. SUB-TOTAL LEGAL FEES,COSTS AND EXPENSES OF COLLECTION OF PAST DUE ACCOUNTS WILL BE PAID BY P RC ASER.ALL BILLS DUE AND PAYABLE AT THE OFFICE. CA SALES TAX REC V D IN GOOD ORDER BY: DATE TOTAL MATERIAL AND LABOR INSURANCE PROOF OF LOSS LESS DEDUCTIBLE/ I 100.00 INSURANCE CO. Parker DEPOSIT PAID CLAIM NO. 675 035 6369 149-.10 034 625 200 BALANCE DUE POLICY NO. COVERAGE VERIFIED BY CAUSE OF LOSS Rock from Highway Truck DATE AND LOCATION OF LOSS 7/23/91 CASH SETTLEMENTS CANNOT BE MADE FOR GLASS REPLACEMENT FOR YOUR PROTECTION,CALIFORNIA LAW REQUIRES THE FOLLOWING TO APPEAR ON THIS FORM:"IT IS UNLAWFUL TO(A)PRESENT OR CAUSE TO BE PRESENTED ANY FALSE OR FRAUDULENT CLAIM FOR THE PAYMENT OF A LOSS UNDER A CONTRACT OF INSURANCE:(B)PREPARE,MAKE,OR SUBSCRIBE ANY WRITING WITH INTENT TO PRESENT OR USE THE SAME,OR TO ALLOW IT TO BE PRESENTED OR USED IN SUPPORT OF ANY SUCH CLAIM.EVERY PERSON WHO VIOLATES ANY PROVISION OF THIS SECTION IS PUNISHABLE BY IMPRISONMENT IN THE STATE PRISON NOT EXCEEDING THREE YEARS,OR BY FINE NOT EXCEEDING$1,000 OR BOTH. RELEASE AND AUTHORIZATION TO PAY OTHER THAN INSURED OR CLAIMANT THE GLASS HAS BEEN REPLACED TO MY COMPLETE SATISFACTION AND I AUTHORIZE THE Allstate Claims TORAY DIRECT TO NATIONAL GLASS OF Concord THE FULL AMOUNT DUE ME UNDER THE TERMS OF MY POLICY COVERING THE SAID LOSS,AND I UNDERSTAND IF FOR ANY REASON MY INSURA CE C. PANY DOES NOT PAY THIS CLAIM I WILL BE RESPONSIBLE FOR PAYMENT OF SAME. INSURE 4 09 4M COPYRIGHT 1986—NATIONAL GLASS—ALL RIGHTS RESERVED ay CD >, w � O M L 4 J. f"t � 4rr✓ �' �, !S1 1,WWW''' � tl� M7 x cl, LO Q. i o � r C� a i I o A;20-- I 0 agco In t co m m �LLau. CLAIM EP 7991 X91 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1 � s: COUNTY, Claim Against the County, or District governed by) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT October 1" MI 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: $552.51 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: NICASTRO, Alana M. ATTORNEY: Date received ADDRESS: 3853 Riviera Drive #B BY DELIVERY TO CLERK ON September 9. 1991 San Diego, CA 92109 BY MAIL POSTMARKED: From Risk Management 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 11, 1991 EVIL BAATTCepuYELOR, Clerk a (L 44 4 I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: rl 191 BY: ANJ A Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (c/�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. 1 Dated: O C T 0 1 1991 PHIL BATCHELOR, Clerk, By, ° Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:— OCT 0 3 1991 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator glai�- 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, 19870 must be presented not later than the 100th day after' the accrual of the cause of action. Claims relating to causes of action for death-*or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one .year-after the accrual of the cause of action., (Govt.. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled' in: D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form: RE: Claim By ) Reserved Clert , f i stamp s � ) Against the County of Contra Costa j SEP _ 9 1991 or: ) _ CLERK BOARD OF SUPERVISORS, District) coIVTRA ces�A ccs. Fill in name ) The undersigned'elaimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �i rin�, / _ and in support of this claim represents as follows: 1. When 'did the damage or inJury occur? (Give exact date and hour)19 C 2. Where did the damage-or. injury occur? (Include city and county) cG W( I cI I A 3. How did the damage or injury P�occ ?p L(Give full details; usl extra per if required). w�~ e,�, 4. ,What particular act or-,omission on thePaz't of county-or district ofcers, Y servannt�sn;or employees caused- the in ury oM. ge? TZ WhI A-L �60 "a OR - 0 4j_ 0�w (�OJL IV P) SAY, t _ (over) M � D. what are the names of county or district officers; servants or employees caVsing the damage orPUR ? Road r r rr rrrwrrrrrrrrrrr--rrrrrrrrrrr-rrrrrwrrrrrrwrr--rrrrrr rrrr-rrrrrrrrrrrrrrr 5. What damage or injuries do,you claim resulted? (Give full extent of injuries or am'es clalM9 d. Attach-two estimates for auto damage. 7. How was the amountlllaimed abovecomput d? (Include the estimated amount of any prospective injury o e.) r onau� hie. Wor D: ...rrrrrrrrrrrrrrrrrrrwrrrrrrrw r..wrrrrrrrrrwrrrrr�rr..rwrrrs.�wr+rrrrr..r..r:.rrr.� -----rrrr 8. Names and addresses of witnesses, doctors and hospitals. rwrrrwrrs—rwrrrrwr— wrrrrrrrrrrrr�rr�rrr..rwrwrrwrra...rrrr..rrr�rrrrrr 9. List the expenditures you made on account of this accident or injury: DATE. ITEM .. AMOUNT JCktH nimol I CyiLLO" Gov. Code Sec. 910:2 provides: "The claim must be signed -by the claimant SEND NOTICES T0:' (Attorney or by somepersojX.onhis beh. lf." Name and Address of Attorney Morse, a/V AS06a" Claimant's Signature ddress Telephone No. Telephone ',N . ELL( I 'l V,V V V I I V 9 F 4 1 i NOTICE Section 72 of the-Penal. Code_ provides: - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable--either by imprisoriment in the county jail for a period,of>not, more than one year, ''by a ,fne of not exceeding one thousand ($1,000), or by both such imprisonment and �f he-, 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. a fADDENDUM TO THE CLAIM OF . a,�aNtea.S�ro (Print..your full name) ( 1) Do ,you use the roadway as -part of a--:-daily commute? Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No ( ) ( 3) Was an alternate route available? Yes ( ) No ( ) ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( ) No ( )' ( 6) Did the damage result from another vehigle _exceeding the 25 mile per 'hour advisory? Yes ( ) No (7) Did a vehicle traveling in the same_ direction and exceeding the 25 mile per hour advisory sign tempt to pass you? Yes ( ) No ( ) (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( ) (9) Was the vehicle located directly in front of you exceeding the speed advisory? ry Yes ) No ( ) (10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ) No ( ) ( 11) Did you obtain the identity of th car relating to questions 6 thru 9? Yes ( ) No ( ) If yes, please provide identification below: How ':hu,q'3- dralf, bu 1 ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts, on your vehicle. e P 0011 a 1,01 Q (1", 4 . T e -Ould hr'I'M, I U Sek- 1-e-RITMr T- 1A)(h -P-L 1,6 HP ayl MU 0--rff 0 ' I' SM64 "L +ft Mi �W . n Ar -h . I (it I )�1 00 11 L. AA( o' vlx-� �; I haVe- ej vy (,ar and. :L- C O-111OU Goh6n , a- JhA ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? r Ipops rbc`d r�v�s � Yes ( ) No , declare that the above information is true and corre t under the penalty of perjury. 9JLv ( S'gnure) l fT (Da 'e) TIPTON MOTORS- . - '�HONDA DATE�1..3�,��.� 889 Arnele Avenue • EL CAJON,CALIFORNIA 92020 • Phone(619)440-1000 (619) 287-1500 CUSTOME / ���—� INS. CO. ADDRESS CIT PHONE MAKE YEAR BODY STYLE LICENSE NO. SERIAL NO. MILEAGE ' RE- RE- Hours Parts 8. Sublet PAIR PLACE Labor Materials f- • I ' Total OPEN ITEMS Labor$.............. .. Parts $.......�...... .. Sublet $.......'............................................ r j Sales Tax $............ .. 1` ADVANCE CHARGES $................... ESTIMATE TOTAL $..... The above is on estimate based on our inspection and does not cover any additional parts or labor which may be required after the work has been started. Oc- casionally after the work has been started damaged or broken ports are discovered which are not evident on the first inspection. Because of this the above prices are not guaranteed. Old parts removed from car will be saved unless otherwise instructed in writing. No vehicles will be released until Insurance Deductables have been paid. j We will not be responsible for loss or damage to your car or its contents by fire, theft, accident or any other cause beyond our control. 1188-04831 NORICK OKLAHOMA CITY THIS ESTIMATE IS ACCEPTABLE FOR 30 DAYS FROM DATE ABOVE 2 0 0 0 MdgriE sEr�vreE (6 19) 549-9121 10897 New Salem Place • San Diego, CA 92126 STAT 'ENT .6,5 T- M T d S S 0 L B D S 0 T E CUST.ORDER NO. DATE ORDERED DUE DATE TERMS SALESMAN F.O.B. OUR ORDER NO. QUANTITY DESCRIPTION UNIT PRICE AMOUNT I I . I I I I I I I I � I I I I I I I I I I I I I � I I I I I � I I 4 I I I I I I I I I 1 I I I I I I I I I I I I I I I I I I I I I I SUB-TOTAL A/3 q TAX TOTAL 4170 I 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 October 1, 1991 and Board Action. All Section references are to ) The copy of this document mailed to yo�iCM your notice of California Government Codes. ) the action taken on your claim by Boa Supervisors (Paragraph IV below), given pu ft nt t4 lover ent Code Amount: $50,000.00 Section 913 and 915.4. Please X11 'S pings". 0 l CLAIMANT: THOMAS, Edmond Benedict ,��? ATTORNEY: Public Defenders Office Date received ADDRESS: 610 Court Street BY DELIVERY TO CLERK ON September 5, 1991 Martinez, CA 94553 BY MAIL POSTMARKED: September 4, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 9, 1991 PpHHIL BATCHELOR, Clerk DATED: BY: Deputy _ rL Of 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: 9 191 BY: I Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admi Nistrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (vr This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 1 1 i 99 1 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT BY: PHIL BATCHELOR by O0eputy Clerk CC: County Counsel County Administrator CLAIM TO: BOARD OF SUPERVISORS OF CONTRA C ORTA0Kapplicatlon to: Instructions to ClaimantClerk of the Board , 45i P,'., Q .ray ,vio Martinez,Callfomla94553 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 baiise ' of action. (Sec. 911. 2 , Govt. Code) B. Claims must be filed with the Clerk .of the Board of Supervisors at its office in Room 106 , .County. Administration Building, ,651 Pane Street, Martinez , California 94553. C. If claim is against a district governed by the Board. of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. . E. : .r.•aud. See penalty forlfraudulent claims , Penal Code Sec. 72 at end of form. RE: Claim by ) Reserved for Clerk' s filing stamps Against the COUNTY, OF CONTRA COSTA) SEP 5 1,0()lI or -- CfDZSTRICT)) II CLERK BOARD OF SUPER CONTRA COSTA Ci� nomname) � (FiThe undersigned claimant hereby makes claim against the Co y o£. Contra .. Costa or.. the above-named District in the sum of $ jO,vao and -in :support of this claim represents as follows : _ 1.--When did the-damage or-injury occur? (Give exact date-and hour] 2.r Where-did til@ ,damage^or;�injury occur? (Include city and-county) _ 1a.ETENT'oc/ >PUt1r /l//> �,rlt=2� G4 . .3. How did the damage or in3ury occur? (Give full:-details , use extra . sheets if required) r/>c. ~7-ie ' vea)OrRI/P° Q /yi�� fL�� Aer 4. What particu - Ct or omission on the part-of county or disUict officers , slaraervants or employees caused the injury or damage? IAI , � i ��/E��cr��/ L•E�t///,lam Z�o�c/� ��G/f�E�crs' ��T tP�tit�Fi� F�'/i� . "LX�jl�tir AX110 M CPuJ (over) G: a." What are the names of county or district officers , servants or . employehs causing the damage or injury? � if`� �LNi4/�/��!�/•c� • _ It STL�,[/S ��aG � �o�r/�/� ' l'C�S�i-Q Cd�in/��� �/iilf�✓U_!if4 6. ^W�iat damage or in0ur�es do you claim resulted? . ZGive—full extent 7 of injuries or damages claimed. • A�tach two estimates fo"r auto damage) SIJI=e�Z/_ A6 �1� �,•. '. .` • ;�'J�j6r�5'r.��G�j`il�ic//�CC� �!l�"H'._.S'yQl/oGt�C �1��- //�f'�� .�/��/lsf�.�" .i r> . '":`• 7 . How was the amount claimed above-computed? (Include the^estimated- a ount of any prosppctIve injury or damage. ) 7of e- 14 1000 __________________________________ ------------------ � 8. Names and addresses of witnesses doctors and hos -,:• • . petals. AR A` �l- �/l c�9cT 9.� �,istrt�ie expenditures-you made on account-of^this aacidentyor^injuzyi DATE ITEM AMOUNT Govt. Code Sec: 91.0.2 provides : "The claim signed by the claimai SEND NOTICES � TOi " (Attorney) or by some person on his behalf. Name and'Address- of Attorney OFFICc:5- Claimant ' s Signature ' ��A�Fii/�Ti ..��. •• f�l,�;'TG°�uNrS/ ,mac--iafri�rsl�9C/ii.��� i Address Telephone No. Telephone No. R NOTICE Section 72 of-the Penal Code provides: "Every person who, with. intent to defraud, presents for all-owance or for payment to any state board or officer, or to any county, town, city district, ward * br village board or officer, •authorized to allow or,pay the same if genuine, any false or fraudulent claim, bill, •account, vouche: or -writing, :is guilty of a fL-hny, " wlc A&,j 9lfl: p��/'��� de Xlln ?G Ac- Eir✓216'e", xx 1r •Y� ..• 'r:��i`r�•�t t,1y�r•1'�';, .i.r.✓;;.' i' .W,�j,�M7�. 'j 1. Gx '{1 } rz✓� k{' �. Kiw• .' r,7ra"tket• si�':;[::. 1 i f ft. 1%44,7: {'••l.�rr. r ♦tM.r: :Y 4 :1 jry�� .�• _a' ;;�.'}A-J{'�,eY{;.rj•%.l r([•ffr�•.`.�T. .d•. ., .. . . •u•.: JN h 1� 4. s� kvo �c� t V t 0 i. Ln �� 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 October r—, = and Board Action. All Section references are to ) The copy of this document maile�ito you is your notice of California Government Codes. ) the action taken on your 'b1� bBoard of Supervisors (Paragraph IV below), g;a�en pu�suant Government Code Amount: Unspecified Sertion 913 and 9�5.4, a ,%ase �o. all "Warnings". CLAIMANT: TOROSIAN, V. Joe ATTORNEY: Date received ADDRESS: 2092 Mohawk Drive BY DELIVERY TO CLERK ON September 6, 1991 Pleasant Hill , CA 94523 BY MAIL POSTMARKED: September 5, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, ppHH gg DATED: September 9, 1991 BYIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. �(V ) 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: Ci ` �I � BYJJ� 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 (tom 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 fo this date. 1 Dated: OCT 0 1 1991 PHIL BATCHELOR, Clerk, B AA A ,�D uty Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Sect 4n 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: OCT 0 3 1991 BY: PHIL BATCHELOR by JAII a Deputy Clerk CC: County Counsel County Administrator t i NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: V. Joe Torosian 2092 Mohawk Drive Pleasant Hill , California 94523 Re: Claim of V. JOE TOROSIAN Please Take Notice As Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code section 910 and 910 . 2, or is otherwise insufficient for the reasons checked below: 1 . The claim fails to state the name and post office address of the claimant. 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. 4 . The claim fails to state the name(s ) of the public employee(s ) causing the injury, damage,. or loss, if known. x_5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ( $10, 000) . If the claim totals less than ten thousand dollars ( $10, 000 ) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10, 000 ) , the claim fails to state whether. jurisdiction over the claim would rest in municipal or superior court . 6 . The claim is not signed by the claimant or by some person on his behalf . 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy Co n y Counse CERTIFICATE OF SERVICE BY MA C.C.P . §§ 1012, 1013a, 2015 . 5: Evid. C. §§ 641 , 664, My business address is the County Counsel's Office of Contra Costa County, Co. Admin. Bldg. , P.O. Box 69, Martinez, California, 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a' true copy of this Notice of Insufficiency and/or Non Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s ) having delivery service by U.S. Mail ) , which envelope(s ) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S . Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct . Dated: g , at Martinez, California. cc: Clerk of the Board of Supervisors ( ginal ) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOV.C.§§ 910, 910 . 2, 920 . 4, 910 . 8 ) V. 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' or to per- sonal property,or growing crops and which accrue on or before December 31, 19879 must be presented'not Eater than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and 'which accrue' on or after January 1, 1988, must_be presented not later than six months after the accrual of the' cause of action. Claims relating to any other cause. of action must be presented not later .than- one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Rom Ro106, 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 01Zo St � , Y. FIRIECENED Against the County of Contra Costa 6 19) - a » or ctiJ ai4f _- District) CLERK C-OPM�-� `�� r.� .. . 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: MOON-�000NN0N0N00�A0 ' NOOOONOOON-OOOMMONOO-OONONO 1. When did the damage or injury occur? (Give exact date and hour) -- , MOONONO.yOONON-N000-O -MO-NMOONO.I.0000-OON001-00-000-----M-N000-O-00 2. Where did the damage or injury occur? (Include city and county) NNM0000N000 0N00NNMM NNNNNNON-N0 0000N 3. How did the damage or injury occur? (Give full details; use extra paper if required). f)q O cCvrl al A ice, , T • .o tT.�d /.,/%0 T'F4 ✓C Trl o e-L/E:f p.-2 .r.r...v c— A T 'Ay C R r A 7�.„♦.0 ,,q J7�/o a� ♦c%.',� o c fc a.i ,G�c.o✓iE G, c.�u.s w..d r- j /47 .1//�p �'G12 T of ud'TA�.J' Adam4+t coax cwlau 42..'v .14oA1 o6 Mood ON000NON0-0000N0000NNOOONOON-N000-N�OOMO-OOM00000000rN-00 NN NO- 4. What particular act or omission on the part of•county or district officers, ' vs vants or employees caused the injury or damage? RECEt L J �L.l£ n G ♦ ✓rc. •A r49 P L0 u♦AR♦✓ •, G �/Z va-�v ,%o �.✓✓k 2 .,/� C m Vs i�2 v 0-f D o v A i?h-/I • A L X o p �i-, ,� T U45 r o u ti AUG 30t dxn, -v ,qv0 - C( 9 /ZrgV .arl-ria W OFFICE #9W (over) o. What are the names of -county or. district officers, servants or employees causing the damage or injury? I I r-A d� r /,t.J H 0 w' n cl 44 c9� c®v G d o rr_. J 0�� w Ld 9 �o 2,�-�A r, o.,✓ yo c/i^-' N--r-rorrraror---rr-ro--orr-o------o---oro-arrrrr---rrr---r-arr--rrrr 5. What damage or injuries do you, claim resulted? (Give full extent of injuries or damages claimed.' Attach, two estimates for auto.damage. p ► 4- G- /t e► �r tom✓ n/aL .r im,r G a( g .✓ d L, r :a d. :✓ �G d D ra �� fj (JMPk2 o -ororoaor---rNo-N--rro-r---oo�or�N0000-ooh. .�oor00000-.rorr.----------------N---- 7. How was the amount claimed'above computed? (Include the estimated amount of any prospective injury or damage.) ham- r Al vL f.�.J Gfcl s - oNoor--000--Mo----000-Nr-r000ro--aoN------o-M-M------N---o----- Names and .addresses of witnesses, doctors and hospitals. oo----------------- ------ ----- 9.. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or Wiome person on his behalf." Name and Address of Attorney Claimant's Signature Address Telephone No. Telephone,-No. G�/ c�= 9 3 3— Z© Z NOTICE Section 72 of the wPenal_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. ' ADDENDUM TO THE CLAIM OF (&I f1 A) (Print your full name) ' ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No (x) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No �) ( 3) Was an alternate route available? Yes ) No ( ) ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No ( 5) - Did.you see warning signs. advising .of loose gravel and a 25 mile per hour advisory sign?' Yes ( ) No (6) Did .the damage result from another vehicle exceeding the. 25 mile per hour advisory? Yes ) No ( ) (7) Did a vehicle traveling• in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes (/X)' No ( ) (8) Did a vehicle coming from the opposite direction cause gravel- to. be thrown onto your car? Yes ( ) No . r (9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ) No ( ) I., f { f ( 10) - Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No (� ) ( 11) Did you obtain the identity of the car relating to questions..--6 thru 9? - Yes ( ) No ( �O If yes, please provide identification, below: ( 12) Please describe in your own wordshow the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. 64 13 4 vz z , r., 41110 z7-N Q A/ P// tqg N� : ©aI 1� ( �z `34 ✓� t,_NA/Z+ti 7�4� �`m.«. rriLvG/ rths �0A_/2 ✓U ' OAJ C2ha :7-0 N d PO yJhz/ o'- ✓rM,C-LA / A) e C yr w ,-r'i �.r l�yr'A...ao L V/; , cLr�5 f:r, AJC HIS / - r4 J 4S' - S_Y� M � L7_'� AiJmO 'd 714r JNoy✓It, Z o F g.o G!i_ ¢ iG9 v A L 71.f q r 77 0 a G R /LA/• ..f fel oaw ra - 7'�,s � c �.-v°r.�",z-�_c�': a,;1 ._..:,s .,s�.-�-P' G-o� r-d �d,a ✓ � �,J s o 14 A LJ 19 L/ &I � A 1v7 14 ✓ ( 13) Were you aware that'using the road during the chip seal process might result in damage to your car? Yes ( ) No- -( *x ul v L d 1� A ✓Go .V rr,,Qt ¢}• / /�L %r 2 rvqTie 2v I declare that the above information is true and correct under the penalty of perjury. (Signature) A / 19 (Date) d � qtr s i Ul M ' / O i 0 �6' en O1 rte„ �V i S1� v CD Saps,��3d�SCJ 4 Sy0 �b1 d c.� � O � N m ll. . C O. e N n'~ CLAIM a• 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 October 1, 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: $412.43 Section 913 and 915.4. Please note all "Warnings". RECEIVED CLAIMANT: WONG, Dennis Y. SEP 10 1991 ATTORNEY: Date received COUNTY COUNSEL em ADDRESS: 400 Timberline Court BY DELIVERY TO CLERK ON Septba�,arWE,z"f191 Pleasant Hill , CA 94523 BY MAIL POSTMARKED: September 5, 1991 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Pp IL BATCHELOR, Clerk DATED: September 9, 1991 B�: Deputy (14 II. FROM: County Counsel TO: Clerk of the Board of Supervisors �`(J ) 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: (a 61 BY: Deputy County Counsel _T 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: CCT 0 1 1991 PHIL BATCHELOR, Clerk, B C A JDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 0 3 1991 BY: PHIL BATCHELOR b AAA 0 At I A, i Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF' SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim-is against more than one public entity, separate claims-must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end ofVthis form. BE: Claim By ) Reserved for Clerk's. filing stamp Ds Y, 61o6r-- ) C C�EPO�� j Against the County of Contra Costa ) ` ��� 7� 665 1991 or J District) Fill in name ) The undersigned claimant hereby makes claim again the County of Contra Costa or the above-named District in the sum of $ 41,J , �� and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) rtHEL tb A--IL41Ks,I ""PELk)E--b ON cJQNE ag , I.aa 1 i 5r-00 PM ---------------------------------------------------------------------- ------------- 2. Where did the damage or injury occur? (Include city and county) bMAKE- OCC-UMRG-D AT -j"P-`(LO(Z ?)0L1LGVA -b QLZ-RSA*JT HILL , C014TAR COAOTA --------------------------------------------------------------------------G°=eoY Y-- 3. How did the damage or injury occur? (Give full details;- use extra paper if required) ,5K- ATtocmir,-b S�fi�Ts . C Two Pa,6i6s, . ------------------------------------------------------------------------------------ 4. What particular act or omission on the part of-county or district officers, servants or employees caused the injury or damage? court Y �PC.oyrt.e5 WagF NeGL t(rlEiv(_E -VaRiA)61 'fhc- FIR67 WEEK OF R,oA-D jay No-r R6-movw6r MANY RSLATjvEI-y L"Z7F_ LOOSE 67Rft-✓FL !N TIYE STREET A-F-rEg C,0NST1euCTroN , (over) D. wnat are the names of county or district officers, servants or employees causing the damage or injury? ------------------------------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage: --- 7'a tv ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? , (Include -.the estimated amount of any prospective injury or damage.) S ATT�tcFP 9= 1 i,�:i`� TF_ O RF PL,�c_;�MeAT. $. Names and addresses of witnesses, .doctors and- hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 810:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney ..�./ Claimant's Si tore 00 T 048FRL OQE CO Address Telephone No. Telephone No. l��s� 01 I `fir Pvae10 # NOTICE J :. 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. ADDENDUM TO THE CLAIM OF (Print your .full name) ( 1) Do you use the roadway as part of a daily commute? Yes ( ) No ( 1 ( 2) Were you aware that construction would be commencing on the roadway? Yes ( x) No ( ) ( 3) Was an alternate route available? Yes ( ) No (X) ( 4) Did you read. about the impending resurfacing in the local newspaper? Yes ( ) No (�) ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( k) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( ) No (x) (7) Did a vehicle traveling in the same direction and exceeding -the 25 mile per hour advisory" sign attempt to pass you? Yes ( ). No (X) , ( 8) Did a vehicle coming from the.' opposite direction cause gravel to be thrown onto your car? Yes ( ) No (x ) (.9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No (�) ( 10) Did you travel the roadway more than once during the resurfacing prior to .the damage sustained to your car? Yes ( x/) No ( ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes ( ) No ( �) If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the specific damaged parts on your vehicle. A'fTA-cHC-a SgVg'TS ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No (x) I declare that the above information is true and correct under the penalty of perjury. ( Signature) - � - 9i (Date) FA(m t of 2 _ 1�OPIs _ Y, LOoNGI_ �'ra.V -�'�� � ,�S ►�P K �'� t c�,u.�.��1- -rte �a�Ur� 0.�. Lo&i-4 crovlozi. - n_; f3 10 _ _ CA,-,:S 6Lt LA tti.ot /1A yam. A; Q jDAQ CL -%AA aAA cam,. Yv-%� 2� ►�1P H �=�,c�s `_ W-en-Q. R.eo�„ oi,� �'� Us-o-�-�e,�,L s 4 + Tv. -(,�a C �r mac .... , iA to-* a v-0444 ' f PS'trlG 10�2 LJOWG v: oki JUL-16-1991 09:24 FROM LOF CENTRHL NU. C;HL.UN 1U GGGGOOo •'-'� 3 Ubbey-OwgwFord Co. ESTIMATE •' q GlassGlass Centers WOFirgm 1NV410E SALMMAN GILL 7 ; C S T I M A TZ DATE 07t 'x'191 SOLD jrmgg -agy - AnnRESSMAKE 9O HONDA„4D�DAN peruW5 DX. UUHES VI.N141 CITU,ST LICEg3E# MILEAt*-, CLAIMAN ILIAL 1NST GAT! WORK PHONE —� HOME PH CUS I FRO Cn _ ins I'e COMP.OATC TIMC tiL1ANT{TY ITEM NUMkrH UERf:RfPTK7N LEST PRICE SALE NttH;E TX 1 FCW641S FOREIGN WINDSHIELD '35a. =3 X I LFW LF18OR-FORSION WINDSHIF 25.00 1 Urw tJ-KIT FOREIGN WINDSHIC 5.95 TX MOULDINGS WILL BE A D1TIONAL Payenti Refwrence Approval Date Amount Sub �e7.08 'rax P-5.33 8aI Anco TobaI 41?.4.3 THLS IS NOT AN INV ITC4 - 00 NOT PAY trn s - - - - - - - - - - - K- -- - - - _- - - - - - - - _- - - - - _ - - TO 1 5 /1N MPANY INFORMATIf1N WOW THTC LINE A[ilNT NAME UENN lir NAME _ ACfDRF!�ti �• ADDKOG _ A00REW ADORERS CITY,fi'I HILCFA '345M L,, C1TY,ST PNdNE A FLEET 1'1 IONR N POLKiY P 13-AIM k I . ANCSATEOf cAU9POr -- YERIFIFIIgY � LC]!�S L433 -.....r-..,...�-_ ..—..ter•-.--• - .�.�. ... -- .w._-...�.-..�--. �.-•----�-.�..�._-..�.__. 77 Bay Area Mobile Glass 436 N. CANAL STREET, #11 SOUTH SAN FRANCISCO CALIFORNIA 94080 (415) 871-1505 PROPOSAL V113lqTZ7FJ) 70-!- Ze�,, PHONF: M &a4ble heAe.ey zuemi t .612eci4cat ion.6 and eztimate.6 )eo2: Glcc PROPOSE heltay .to luAn-i.6h ma.tER-ia.L and & o z - comb fete i n. acco/Zdance w-iM a.,ove.. ,6Tzec,i1ication,6, the .gum o/-.: _ j �4),-," �; N07E: 7hiz /22opoza. may �e w�thrLrawn fy u,6 .il no.t acce/?.ted within day,6. ----------------------------------------------------------------------------------------------------- The agove 121uce.6,. 6peci/-icat i_onz and cord i.Uon 6 a/Le �u t���ac t v2y and acre he"-Ay acceFi.ed. you air_e autho2i.zed .to do .the wozk ass 6peci/- ed. DA7('-: SI yNA71aE: "We Come to You" i i q. n 14, 1 v 4VI a n co o Z d- stn of c� w ? A-- Z � � H 0 LQ �O f / .P F- '2 2 Lu p A �r APPLICATION TO FILE LATE CLAIM '•~ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT October 1, 1991 Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911 .8 and 915.4. Please note the "WARNING" below. R Claimant: COURTOIS, Daniel Lynn S'F/0 j 1 Attorney: Mq°�/Z co 0799 Address: P.O. Box 23 cgcNF�t Carmichael , CA 95609 Amount: Unspecified By delivery to Clerk on September 3, 1991 Date Received: By mail, postmarked on August 30, 1991 Certified P 870 303 73 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Applica n to 'le . La t )aim. DATED: September 9, 1991 PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911 .6). The Board should deny this Application to File Late 'm (Section 9 1.6). DATED: 9 91 VICTOR WESTMAN, County Counsel, By uty- / III. BOARD ORDER By unanimous vote of Supervisors presentj (Check one only) ( ) This Application is granted (Section 911.6). This Application to File Late Claim is denied (Section 911 .6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: OCT 0 1 1991 PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. IP you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator ,r Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Clai in accordance with Section 29703. DATED: OCT 0 3 1991 PHIL BATCHELOR, Clerk, By ° Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM RECEIVED SEP 319% 1 FROM: DANIEL LYNN COURTOIS P.O. Box 23 2 Carmichael, CA 95609 CLERKCBOARDOF SM 3 TO: The Board of Supervisors, Contra Costa County Phil Batchelor, Clerk of the Board of Supervisors and 4 County Administrator 5 REGARDING: Request for leave to present a late claim, as pursuant to Government Code Sections 911.4 to 912.2 6 and 946.6 7 8 I am currently thirty years old, a mentally disabled adult. 9 As a child, I was taken away from my natural parents by your 10 County Juvenile Probation Department and placed into two 11 different foster homes, in which I was sexually molested by 12 these foster parents, repeatedly for the period of four years. 13 At the time of these molestations, I was a student at the Treat 14 Learning Center, a school for the mentally retarded in Concord. 15 I ran away from the abusive foster home at the age of seventeen and went to the streets of San Francisco. Being that I was a 16 mentally slow person trying to survive on the streets of San 17 Francisco, I was taken advantage of and pushed into. street 18 drugs, and consequently I was placed into psychiatric hospitals. 19 I have records from these psychiatric hospitals, dating back to 20 the years 1978-1990, for drug abuse and mental conditions. 21 During the period of 1983-1990 I have been seeing a psychiatrist 22 in between the times that I was not in a psychiatric hospital 23 for my drug abuse and my mental condition relating to my drug 24 abuse. I was given drugs prior to my running away from my 25 foster home in Concord by my foster parent many times, such as 26 marijuana and speed. My claim can be backed " up by my 27 psychiatric hospital records and a Declaration from my 28 1 psychiatrist, Dr. James I. Gabby, and my juvenile records, in 2 which I have, as proof for my claim. I request leave to file a 3 late claim with the Contra Costa County Board of Supervisors, 4 with proof to substantiate my late claim. Thank you. 5 6 Dated: September 3, 1991. By 96,vt�JaA4,t4' DANIEL LYNN CO TOTS 7 P.O. Box 23 Carmichael, CA 95609 8 Telephone: (916) 481-7405 9 Please see attached Declaration of James I. Gabby, M.D. 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RIECEIVED 1 DANIEL LYNN COURTOIS SEP 3 1991 2 P.O. BOX 23 Carmichael, CA 95609 CLERK BOARD OF SUPER 3 Telephone: (916)481-7405 CONTRA TA IN PRO PER 4 SUPERIOR COURT OF CALIFORNIA 5 COUNTY OF CONTRA COSTA 6 7 DANIEL LYNN COURTOIS, ) Case No. C91-02399 Plaintiff ) $ ) REQUEST FOR COURT TO vs. ) TAKE JUDICIAL NOTICE 9 ) 10 JACK EDWARD BIGELOW ) (Evid. Code Sec. 452, 453) PHYLLIS BIGELOW, ) Declaration of 11 Defendants ) James I. Gabby, M.D. 12 To Defendants, Jack Edward Bigelow and Phyllis Bigelow. Please take 13 notice of the Declaration of Plaintiff's Psychiatrist, James I. Gabby, M.D. on 14 attached page, in which hereto as Exhibit "A". 15 16 17 18 19 20 Dated: -September 3, 1991 By: 21 Daniel Lynn Courtrois 22 Plaintiff 23 24 25 Request for Judicial Notice 26 (Evid. Code Sec. 452, 453) 27 Continued 28 1 DANIEL LYNN COURTOIS 2 P.O. BOX 23 Carmichael, CA 95609 3 Telephone: (916)481-7405 IN PRO PER 4 5 SUPERIOR COURT OF CALIFORNIA COUNTY OF CONTRA COSTA 6 7 DANIEL LYNN COURTOIS, ) Plaintiff ) Case No. C91-02399 8 ) 9 vs. ) DECLARATION OF JAMES I. GABBY, M.D. 10 JACK EDWARD BIGELOW ) PHYLLIS BIGELOW, ) Exhibit "A" 11 Defendants ) Evid. Code Sec. 452, 453 12 TO WHOM THIS MAY CONCERN: 13 1 have been seeing Daniel Lynn Courtois for psychological problems, 14 sporadically since 1983. It is my professional opinion, as Daniel's psychiatrist. that 15 the childhood sexual abuse that Daniel suffered, as a child, has strongly. 16 17 -contributed to Daniel's current psychological problems. is I am a practicing psychiatrist in the State of California. I am not a party to 19 this action. 20 I, the undersigned do hereby declare that the above statement is true and 21 correct, under the penalty of perjury, pursuant to (Sec. 340.1. CCP). 22 Dated: August 28, 1991 23 Zby: IJAMES I. GABBY-,-M.D. '--39TLaurel Street 24 San Francisco, CA 94118 Telephone: (415) 567-4777 25 26 Exhibit "A" (Evid. Code Sec. 452, 453) 27 28 O 064 al 04 .. �� m JU ul ti R r� C ru S �` m 0 1 m 0- V r4 3