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HomeMy WebLinkAboutMINUTES - 01071992 - 1.19 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARMTO the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January , 2���� and Board Action. All Section references are to ) The copy of this document mailed to you is,68NW n866RgW f California Government Codes. ) the action taken on your claim by the Boare4►WiflftetW8ors (Paragraph IV below), given pursuant to Government Code Amount: Unspecified Section 913 and 915.4. Please note all "Warnings". CLAIMANT: COGAN, Sheila ATTORNEY: C. L. Gravett, III Gravett & BAlcher Date received ADDRESS: 700 Franklin Street BY DELIVERY TO CLERK ON Tpcpmhpr 12, 1991 Napa CA 94559 BY MAIL POSTMARKED: Hand delivered via Risk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: BY December 13 1991 PpHHIL BATCHELOR, Clerk eputyJZLAO� : D 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 rigr;t to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Q I , AN) J A Deputy County Counsel ? X 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 . (4 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, r- Dated: � �W s ` 11992 PHIL BATCHELOR, Clerk, 8y , Deputy Clerk w __L44 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 pp shown above. 0 Dated: _J BY: PHIL BATCHELOR b a Deputy Clerk CC: County Counsel County Administrator GRAVETT & BALCHER CHARLES L. GRAVETT, III ATTORNEYS AT LAw TELEPHONE: ALAN M. BALCHER 700 FRANKLIN ST. (707) 258-1030 NAPA, CA 94559 FAX: December 10, 1991 (707).257-6134 Certified Mail Return Receipt Requested County Clerk Contra Costa County 822 Main Street Martinez , CA 94553 Re: Claim of Sheila Cogan vs. County of Contra Costa Dear Clerk: Enclosed please find original and two copies of the above- referenced Claim to be filed with your office. Please file same. and return a conformed copy to my office in the enclosed envelope. If you have any questions, or if there is a problem, please do not hesitate to contact my office. Very truly yours, GRAVETT & BALCHER C. L. Gravett, III CLG: jgb Enclosure RECEIVED I / DEC 1 2199 CLAI t�"oc) P"": ' . CLERK BOARD OF SUpEgytSpRg CONTRA COSTA CO. (a) Name and Address of Claimant: Sheila Cogan, 3001 Beecham, P.O. Box 2204, Napa, CA 94558 (b) Notices to be Sent to: C. L. Gravett, Esq. , Gravett & Balcher, 700 Franklin Street, Napa, CA 94559, (707) 258-1030 (c) Date, Place and Circumstances: Ms. Cogan was forced to resign her position on June 21 , 1991 due to a pattern and practice of harassment, refusal to honor her contractual rights, her constitutional rights, and her statutory rights. Since the date of her forced resignation, County employees have interfered with her attempts to find work in her professional field. This interference is continuing. (d) Description: Ms. Cogan has suffered physical injury, and emotional distress. She has lost wages and lost benefits. As a result of these continuing patterns of wrongdoing, she has not been able to find employment in her chosen field, thus continuing her damages. (e) Names of Public Employees Causing Injury, Damage or Loss: Philip Batchelor, Harvey E. Bragdon, Charles A. Zahn, Louise Aeillo, and others as yet not known. (f) Jurisdiction for this claim rests in Superior Court. Respectful]. Submitted, GRAVETT & ALCHER By Ch rles L. Gravett, -III- Attorney IIAttorney at Law CLAIM /, // BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 7, 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: $8,250.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CANNON, Ruth Alice ATTORNEY: John A. Butler III , Esq. DEC 9 in Campeau & Thomas Date received RUNTY COUNSEL ADDRESS: 55 South Market Street, Suite 1040 BY DELIVERY TO CLERK ON DeceRVINE�,CVJ-91 San Jose, CA 95113 BY MAIL POSTMARKED: December 4, 1991 Certified No. P-514 550 264 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 9, 1991 gaIL �ep�tyLOR, Clerk (],/" I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: I Z ,1 �(( BY: Jim rA 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 (v1f This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 7 1992' PHIL BATCHELOR, Clerk, By o • , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN BY: PHIL BATCHELOR by a Deputy Clerk CC: County Counsel County Administrator ATTORNEYS AT LAW " A PARTNERSHIP CONTAINING A PROFESSIONAL CORPORATION 55 SOUTH MARKET STREET - SUITE 1040 SAN JOSE, CALIFORNIA 95113 TELEPHONE: (408) 295-9555 p yy —,..ate KENNETH J. CAMPEAU. P.C. TELECOPIER: (408) 295-6606 "©x ® WAYNE H. THOMAS J C3' _ JOHN A. BUTLER III s '� BURL S. POLON DEC - 5 1991 ,I I LETTER OF TRANSMITTAL CLERIC BOARD 0 0®�SUP'" CONTRA C CERTIFIED/RETURN RECEIPT REQUESTED CERTIFIED NO: P-514 550 264 To: Clerk of the Board of Supervisors Date: December 4, 1991 Room 106 County Administration Building 651 Pine Street Martinez, CA '94553 Re: Cannon v. Contra Costa County From: John A. Butler III, Esq. Enclosed please find the original CLAIM for the above mentioned matter. I am filing it on behalf of my client, Ruth Alice Cannon. If you have any questions, please call. Please send me a conformed copy (envelope provided. Thank you. .Is (are) transmitted herewith: (x) For filing and return conformed ( ) For your information face sheet and/or copies and files ( ) Please submit to Judge ( ) Per our conversation for review, signature and return conformed copies ( ) For your review and comments ( ) See remarks above ( ) For your approval ( ) Per your request Method of Delivery: (x) Mail ( ) Hand-Delivery x.44, C1g342,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 1069 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 RUTH ALICE CANNON ) RECEIVED Against the County of Contra Costa ) DEC - 5 1991 or ) CLERK BOARD OF SUPERVISORS District) CONTRA COSTA Co. Fill in name ) , The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 8 , 250, 00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) October 24, 1991 2. Where did the damage or injury occur? (Include city and county) At Sheriff's-:,sale of a boat. Sheriff ' s sale number 91-12946 3. How did the damage or injury occur? (Give full details; use extra paper if required) Sheriff ' s office did not send proper notice of sale to claimant, who was a 1/2 owner of the boat to be sold at sale. Sheriff ' s office admitted they made the error. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? SEE ABOVE. (over) ,5: What are the names of county or district officers, servants or employees causing the damage or injury? ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Damage to ownership interest (1/2 of boat) _iwas -sol-d_!.at Sheriff ' s sale. ------------------------------------------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 1/2 of fair market value of the boat ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. Deputy Kathy Costa v ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Attorney ' s Fees Continuing Gov. Code Sec. 910.2 provides: llclaim must be signed by the claimant SEND NOTICES TO: (Attorney) orb some p0pon on his behalf." Name and Address of Attorney John A. Butler III , Esq. R t Campeau & Thomas 1 man —s -Signature) 55 South Market Street J hn A. Butler III , Esq. Suite 1040 a e San Jose, CA 95113 Address 55 South Market Street, Suite 1040 San Jose, CA 95113 Telephone No. 4nR/ Vj4555 Telephone No. 408/- 295-9555 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 ($19000), 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. uzaa uuxaa m7 ,.a�.j L•7 �J Wr N . E A? mIU PEI Z o L ", O � n' c: °J oQ W � , O M o Q � 3j � Ln Q L F- a � v � o �O � Z � UN � +� U a f - < oQo .0 (a W m wro O NO' N O ¢ �� +) Pa ri N �4 U) 4-) -i O O Ln r[S V CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 7, 1992 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. � � � ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $5 , 750.00 DEC 111991 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: JENSEN, Robertwlaly and through his Conservator Christine Jensen Winte ATTORNEY: Theodore A. Schlink III Attorney at Law Date received ADDRESS: 1212 Broadway, Ste . 702 BY DELIVERY TO CLERK ON D c•emher 9 , 1991 Oakland, CA 94612 BY MAIL POSTMARKED: Hand delivered 1. FROM: Clerk of the Board 'of Supervisors TO: 'County Counsel Attached is a copy of the above-noted claim. DATED: December 10, 1991 gy!L BATCHELOR, Clerk Uu L-b . 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: 11 q 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 ( %4'This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN o 7 1992 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 Not* a to Claimant, addressed to the claimant as shown above. Dated: EY4 BY: PHIL BATCHELOR bya eputy Clerk CC: County Counsel County Administrator RECEIVE® 1 THEODORE A. SCHLINK IIIc . Attorney at Law 2 1212 Broadway Ste. 702 DEC 91991 Oakland, California 94612 / "i7 ''''` . 3 (51 0) 444-8446 BOARD OF SUPERVISORS CONTRA COSTA 4 Attorney for ROBERT ALLEN JENSEN, by and through his Conservator, 5 CHRISTINE JENSEN WINTE 6 7 8 9 In the Matter of the Claim of CLAIM AGAINST A 10 ROBERT ALLEN JENSEN, by and PUBLIC ENTITY through his Conservator, [Gov.C. §§ 905, 11 CHRISTINE JENSEN WINTE 905, 2, 910, 910 . 21 12 Claimant, 13 VS. 14 15 COUNTY OF CONTRA COSTA 16 17 ROBERT ALLEN JENSEN, by and through his Conservator, 18 CHRISTINE JENSEN WINTE, hereby presents this claim to the 19 County of Contra Costa pursuant to Section 910 of the 20 California Government Code. 21 1 . The name and post-office address of Robert Allen 22 Jensen, by and through his Conservator Christine Jensen Winte 23 is as follows: 24 a. 414 North Main Street, Yreka, California, 25 96097 . 26 b. 3123 Wayside Lane, Walnut Creek, California, 27 94596. 28 1 1 2 . The post-office address to which Robert Allen 2 Jensen, by and through his Conservator Christine Jensen Winte 3 desires notice of this claim to be sent is as follows: 4 a. Theodore A. Schlink III 5 Attorney at Law 6 1212 Broadway Ste. 702 7 Oakland, California 94612 8 3 . On October 16, 1991 , at and on the sidewalk adjacent 9 to the Pleasant Hill Bay Area Rapid Transit station at Las 10 Juntas Way and Wayside Lane, in an unincorporated section of 11 the City of Pleasant Hill, in and about the County of Contra 12 Costa at or near Parcel Numbers 148-221-017 and 148-221-029, 13 claimant Robert Allen Jensen received personal injuries under 14 the following circumstances: 15 a: Claimant was walking on the sidewalk and fell 16 through a plywood board that was covering an excavated hole in 17 the sidewalk. 18 4 . The circumstances giving rise to this claim are as 19 follows: Robert Allen Jensen, a seventy-two (72) year old 20 man, at the above time and place, was walking on the sidewalk 21 which was in a dangerous condition due to repair and 22 construction work believed to be and thereby alleged being 23 performed for the Bay Area Rapid Transit District, and the 24 United States Department of Transportation, under contract 25 number 03NE-110, known as the "Pleasant Hill Parking 26 Structure" . It is believed and thereby alleged that the 27 repair and construction work was actually being performed by 28 2 1 (a) Roebbellen Engineering, Incorporated, 1241 Hawks Flight 2 Court, E1 Dorado Hills, California, 95630; (b) Arc Electric 3 Company; (c) Tri-City Rent-A-Fence and (d) Bay Area Barricade. 4 It is believed and thereby alleged that Contra Costa County 5 Permit Number 7510 was duly issued to correct parking problems 6 along Coggins Drive, as well as for temporary sidewalk 7 construction to allow pedestrian access on a side street. The 8 sidewalk owner is the County of Contra Costa. Due to the 9 dangerous condition that existed on a sidewalk in the County 10 of Contra Costa, the claimant, Robert Allen Jensen, fell 11 through a plywood board concealing and covering an excavation 12 of the sidewalk, causing him serious injury and imprisonment. 13 5 . Claimant Robert Allen Jensen sustained abrasions to 14 his right leg, from his ankle to his groin, numerous cuts, 15 bruises and soreness to his body, and abrasions to his face. 16 6. The names of the public employees and/or their 17 agents that caused claimant' s injuries are unknown at this 18 time, and if a lawsuit is filed in the Municipal Court of the 19 County of Contra Costa, in the Walnut Creek - Danville 20 Judicial District, claimant shall plead them as Does until 21 their identities become known. 22 7 . At the time of the presentation of this claim, 23 Robert Allen Jensen claims damages in the amount of Five 24 Thousand, Seven Hundred, Fifty Dollars ($5, 750.00) . 25 8. The basis of computation of the above amount is as 26 follows: 27 a: Medical Expenses Incurred to date: $ 50 . 00 28 3 .., ,. -,.vim. � • 1 b: Estimated Future Medical Expenses: Unk. 2 1 . Claimant is under medication 3 due to a condition that allows 4 him to bleed blood easily. 5 Claimant is a diabetic. 6 As of December 8, 1991 , the 7 claimant is visibly scarred 8 with scabs on his body. Claimant 9 may suffer infection due to the 10 injuries sustained by him. 11 c: Expenses: 12 1 . Estimated fee for 700 . 00 13 Private Investigator, 14 Investigation, and Service 15 of Process: 16 d: Loss of Wages: 0 . 00 17 e. General Damages: 5000 . 00 18 Total $5, 750 . 00 19 20 Dated: December 8, 1991 "lo�A2 l:. 21 Theodore A. Schlink III Attorney for Claimant 22 ROBERT ALLEN JENSEN, by and through his Conservator, 23 CHRISTINE JENSEN WINTE 24 25 26 27 28 4 p i 1 THEODORE A. SCHLINK III Attorney at Law 2 1212 Broadway Ste. 702 Oakland, California 94612 3 (510) 444-8446 4 Attorney for ROBERT ALLEN JENSEN, by and through his Conservator, 5 CHRISTINE JENSEN WINTE 6 7 8 9 In the Matter of the Claim of CLAIM AGAINST A 10 ROBERT ALLEN JENSEN, by and PUBLIC ENTITY through his Conservator, [Gov.C. §§ 905, 11 CHRISTINE JENSEN WINTE 905, 2, 910, 910 . 21 12 Claimant, 13 VS., 14 15 BAY AREA RAPID TRANSIT DISTRICT 16 17 ROBERT ALLEN JENSEN, by and through his Conservator, 18 CHRISTINE JENSEN WINTE, her � � ee 1�s this claim to the Bay 19 Area Rapid Transit Dis pursuant to Section 910 of the 20 California Government Code. 21 1 . The name and post-office address of Robert Allen 22 Jensen, by and through his Conservator Christine Jensen Winte 23 is as follows: 24 a. 414 North Main Street, Yreka, California, 25 96097 . 26 b. 3123 Wayside Lane, Walnut Creek, California, 27 94596. 28 1 1 2. The post-office address to which Robert Allen 2 Jensen, by and through his Conservator Christine Jensen Winte 3 desires notice of this claim to be sent is as follows: 4 a. Theodore A. Schlink III 5 Attorney at Law 6 1212 Broadway Ste. 702 7 Oakland, California 94612 8 3 . On October 16, 1991 , at and on the sidewalk adjacent 9 to the Pleasant Hill Bay Area Rapid Transit station at Las 101 Juntas Way and Wayside Lane, in an unincorporated section of 11 the City of Pleasant Hill, in and about the County of Contra 12 Costa at or near Parcel Numbers 148-221-017 and 148-221-029, 13 claimant Robert Allen Jensen, received 'personal injuries under 14 the following circumstances: 15 a: Claimant was walking on the sidewalk and fell 16 through a plywood board that was cove ing an excavated hole in 17 the sidewalk. Q 18 4. The circumst ling rise to this claim are as 19 follows: Robert Allen Jensen, a seventy-two (72) year old 20 man, at the above time and place, was walking on the sidewalk 21 which was in a dangerous condition due to repair and 22 construction work believed to be and thereby alleged being 23 performed for the Bay Area Rapid Transit District, _and the 24 United States Department of Transportation, under contract 25 number 03NE-110, known as the "Pleasant Hill Parking 26 Structure" . It is believed and thereby alleged that the 27 repair and construction work was actually being performed by 281 2 Y 1 (a) Roebbellen Engineering, Incorporated, 1241 Hawks Flight 2 Court, E1 Dorado Hills, California, 95630; (b) Arc Electric 3 Company; (c) Tri-City Rent-A-Fence and (d) Bay Area Barricade. 4 It is believed and thereby alleged that Contra Costa County 5 Permit Number 7510 was duly issued to correct parking problems 6 along Coggins Drive, as well as for temporary sidewalk 7 construction to allow pedestrian access on a side street. The 8 sidewalk owner is the County of Contra Costa. Due to the 9 dangerous condition that existed on a sidewalk in the County 10 of Contra Costa, the claimant, Robert Allen Jensen, fell 11 through a plywood board concealing and covering an excavation 12 of the sidewalk, causing him serious in 'u and imprisonment. 13 5 . Claimant Robert A "e3Q s tained abrasions to 14 his right leg, from his an to his groin, numerous cuts, 15 bruises and soreness to his body, and abrasions to his face. 16 6. The names of the public employees and/or their 17 agents that caused claimant' s injuries are unknown at this 18 time, and if a lawsuit is filed in the Municipal Court of the 19 County of Contra Costa, in the Walnut Creek - Danville 20 Judicial District, claimant shall plead them as Does until 21 their identities become known. 22 7 . At the time of the presentation of this claim, 23 Robert Allen Jensen claims damages in the amount of Five 24 Thousand, Seven Hundred, Fifty Dollars ($5, 750. 00) . 25 8. The basis of computation of the above amount is as 26 follows: 27 a: Medical Expenses Incurred to date: $ 50 . 00 28 3 1 b: Estimated Future Medical Expenses: Unk. 2 1 . Claimant is under medication 3 due to a condition that allows 4 him to bleed blood easily. 5 Claimant is a diabetic. 6 As of December 8, 1991 , the 7 claimant is visibly scarred 8 with scabs on his body. Claimant 9 may suffer infection due to the 10 injuries sustained by him. 11 c: Expenses: 12 1 . Estimat or 700 . 00 13 P e estigator, 14 I stigation, and Service 15 of Process: 16 d: Loss of Wages: 0 . 00 17 e. General Damages: , 5000 . 00 18 Total $5 , 750 .00 19 20 Dated: December 8, 1991 21 Theodore A. Schlink III Attorney for Claimant 22 ROBERT ALLEN JENSEN, by and through his Conservator, 23 CHRISTINE JENSEN WINTE 24 25 26 27 28 4 r 1 THEODORE A. SCHLINK III Attorney at Law 2 1212 Broadway Ste. 702 Oakland, California 94612 3 (510) 444-8446 4 Attorney for ROBERT ALLEN JENSEN, by and through his Conservator, 5 CHRISTINE JENSEN WINTE 6 7 8 9 In the Matter of the Claim of CLAIM AGAINST A 10 ROBERT ALLEN JENSEN, by and PUBLIC ENTITY through his Conservator, [Gov.C. §§ 905, 11 CHRISTINE JENSEN WINTE 905, 2, 910, 910 . 21 12 Claimant, DECLARATION OF THEODORE A. SCHLINK 13 VS. 14 15 BAY AREA RAPID TRANSIT DISTRICT 16 1 . I am an attorney licensed to practice law in the 17 courts of the State of Cali fo 18 2. I am the attor y obert Allen Jensen, by and 19 through his Conservator, Christine Jensen Winte. 20 3. I am authorized to represent and sign my signature 21 on behalf of Robert Allen Jensen, by and through and on behalf 22 of his Conservator, Christine Jensen Winte. 23 I declare under penalty of perjury that the above is true 24 and correct. ' 25 Dated: December 8, 1991 26 Theodore A. Schlink III 27 Attorney at Law 28 1 RECEIVED 1 THEODORE A. SCHLINK III Attorney at Law 7DE�C? 91991 2 1212 Broadway Ste. 702 Oakland, California 94612 CLERK BOARD OF SUPERVISORS 3 (510) 444-8446 CONTRA COSTA CO. 4 Attorney for ROBERT ALLEN JENSEN, by and through his Conservator, 5 CHRISTINE JENSEN WINTE 6 7 8 9 10 In the Matter of the Claim of CLAIM AGAINST A 11 ROBERT ALLEN JENSEN, by and PUBLIC ENTITY through his Conservator, [Gov.C. §§ 905, 12 CHRISTINE JENSEN WINTE 905, 2, 910, 910 . 2] 13 Claimant, PROOF OF SERVICE 14 VS. 15 16 COUNTY OF CONTRA COSTA 17 I, Kirk W. Kjeldsen say that I am a citizen of the 18 United States, over 18 years of age, employed in the City of 19 Oakland, County of Alameda, and not a party to the within 20 action. The affiant' s address is 1212 Broadway, Suite 702, 21 Oakland, California, 94612 . The affiant, on December 9, 1991 22 at , personally served a CLAIM AGAINST A PUBLIC 23 ENTITY, AND DECLARATION in the Matter of the Claim of ROBERT 24 ALLEN JENSEN, by and through his Conservator, CHRISTINE JENSEN 25 WINTE vs. COUNTY OF CONTRA COSTA on the Clerk of the Board, by 26 \ / serving /��Z�"1 at 2 7 1� _ � - elilc Martinez, 28 1 California, who accepted service on behalf of the Clerk of the 2 Board, and further informed affiant that they were authorized 3 to do so. 4 Further, I served the above person accepting service a 5 copy of a claim entitled; In the Matter of the Claim of ROBERT 6 ALLEN JENSEN, by and through his Conservator, CHRISTINE JENSEN 7 WINTE vs. BAY AREA TRANSIT DISTRICT. 8 I declare under penalty of perjury that the foregoing is 9 true and correct. 10 Executed on December 9, 1991 at Martinez, California: 11 12 WY icj en 13 I a employed as a Private Investigator by a licensed California Private Investigator, License #AA007990, and I am 14 exempt from registration under California Business and Professions Code 6 22350 (b) . 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 RECEIVED 1 THEODORE A. SCHLINK III L1,C 91991 Attorney at Law 2 1212 Broadway Ste. 702 17 /-�fr� Oakland, California 94612 CLERK BOARD OF SUPERVISORS 3 (510) 444-8446 CONTRA COSTA CO. 4 Attorney for ROBERT ALLEN JENSEN, by and through his Conservator, 5 CHRISTINE JENSEN WINTE 6 7 8 9 In the Matter of the Claim of CLAIM AGAINST A 10 ROBERT ALLEN JENSEN, by and PUBLIC ENTITY through his Conservator, [Gov.C. §§ 905, 11 CHRISTINE JENSEN WINTE 905, 2, 910, 910 . 21 12 Claimant, DECLARATION OF THEODORE A. SCHLINK 13 vs. 14 15 COUNTY OF CONTRA COSTA 16 1 . I am an attorney licensed to practice law in the 17 courts of the State of California. 18 2 . I am the attorney for Robert Allen Jensen, by and 19 through his Conservator, Christine Jensen Winte. 20 3 . I am authorized to represent and sign my signature 21 on behalf of Robert Allen Jensen, by and through and on behalf 22 of his Conservator, Christine Jensen Winte. 23 I declare under penalty of perjury that a ove i rue /f 24 and correct. 25 Dated: December 8, 1991 26 T eodore A. Schlink III 27 Attorney at Law 28 1 A/ 7 DEC 111991 CLAIM COUNTY COUNSEL BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA MARTINEZ, CALIF. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT January 7, 1992 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: $4052.06 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: WILSON, Mark and Mercedes ATTORNEY: Date received ADDRESS: 595 Andrew Way BY DELIVERY TO CLERK ON December 10 . 1991 E1 Sobrante , CA 94803 December 9, 1991 BY MAIL POTertiOf 1. FROM: Clerk of the Board of Supervisors TO: County-Counsel Attached is a copy of the-.above-noted claim. JV!L BATCHELOR, Clerk d DATED: DprembPr 10, 1991 BY: Deputy aw" 0,0"14-1 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: -12�UA Dated: An BY: Deputy County Counsel 1I1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (1I 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:. 1992 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: IAN 8 1.982 BY: PHIL BATCHELOR b ° Deputy Clerk CC: County Counsel County Administrator Clair t6: HOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAI14ANT 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 1060 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 riled against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. C * * * * * RE: Claim By ) Reserved for Clerk's filing stamp + RECEIVED ) Against the County of Contra Costa ) 4theCountyy or ) District) Fill in name ) . The undersigned claimant hereby makes claim againsof;a 'Costa or the above-named District in the sum of $ q b 502 and in support of this claim represents as Fo1� eL&x.�JNa-aaw- 1. When did the damage or injury occur? (Give exact date and hour) Oc_To8EZSS.00p _oei60sL11jj - =ooa�. &m� 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or' injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? SC-F- A-t7,gC i4 L rz. 4,ten I i r (over) d i a 5. 'What are the names of county or district officers, servants or employees causing • the damage or injury? ---- ---------------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. _Std__=�--�� ---t�s�---QF_�RoP�_2� ��Y�►'�U� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) g Co .Re a Y o, ¢Ss i.� 8. -Names and addresses of witnesses, doctors and hospi ls. P� ----1522-A C L aag 9. List the expenditures you made on account of this accident or injury: DATE jl R�a~fig `frITEM yc DEVELOPAMOUNT AMOUNT� 5(� TAT1dN •-bAA,i)JALFbe0 o 00 LETAZ 2 9Pca Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature 1r?1Z V0 (Address) T e Telephone No. I Telephone No.Lbl N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or, by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. V K Mark C. Wilson and Mercedes A. Wilson 595 Andrew Way E1 Sobrante, California 94803 Phone: 510-222-9307 Work: 510-944-8449 November 11, 1991 Mr, Michael Walford Head of Public Works Department 255 Glacier Martinez, California 94553 RE: MINOR SUBDIVISION NO. 2289 Dear Mr. Walford: The purpose of this letter is to make you aware of my loss and the potential for future loss resulting from approved development at 580 Andrew Way, El Sobrante, California. About four years ago, the owner of 580 Andrew Way, E1 Sobrante, began doing major construction work upon existing structures on this property. Upon neighborhood complaints to Contra Costa County, it was discovered this was being done without a building permit:. Soon, new structures were erected and the beginning of a number of variances were issued. Included in this construction work., was the movement of much land. Neighborhood complaints to the 'Contra Costa County Grading Permit Department, prompted an investigation. On numerous occasions, this Department was contacted. Responding to neighborhood concerns were Gordon Whistler, Greg Sto.ffelbach, and Ron Kilo. On March 13, ,;, 1990, I called the Contra Costa County Grading Department regarding massive grading being done on the elevated property bordering my residence. Ron Kilo, of the Grading Department, investigated on March 14, 1990, and told Mr. Fahmie to move dirt and mix with mulch. He said the grading permit issued was for a temporary stockpile for a retaining wall . At this time grading and dirt dumping on the Fahmie property had been on-going for two years . I had explained that my property at 595 Andrew Way had a history of mud and water problems from this adjacent property ,_(580 Andrew Way) when it was owned by the Chase family prior to the Fahmie' s purchasing it. Neighbors had informed me that the garage, living r000m, and underneath my home had been flooded with water and mud. The Chases put in an asphalt culvert on their property, to run the water into the street in order to rectify the problem. T Letter to Michael Wolford re Minor Subdivision No. 2289 November 1, 1991 Page 2 When Ron Kilo initially investigated, Mr. Fahmie had built the plateau of land next to my property, approximately two feet above my roof level, 30 feet away from my residence, sloping down at approximately 75 degrees toward 595 Andrew Way. I called Ron Kilo again on May 8, 1990, and informed him more dumping and grading had started. No one responded to me regarding action taken. Again on August 23, 1990, I informed the Grading Department that major dumping had been on-going for days . This incident was investigated by Greg Stoffelbach, who said the dirt (which had grown in height and by this time, a number of feet) was again a temporary stockpile and told my wife, Mercedes Wilson, "There is no perceived danger to your property. " I have also ; been in contact with Construction Inspector, Francis Rolfson. Mr. Rolfson informed me that upon the sale of the first home on the adjacent property, at the end of, Andrew Way, Mr. Fahmie got a variance to swing the road (his continuance of Andrew Way) , directly in front of my property, 595 Andrew Way. This meant the road did not have to be as wide as would usually be the case for a road feeding a multiple home development. The original asphalt culvert was removed to accommodate this road. Mr. Rolfson also indicated that Mr. Fahmie/Lamb and Associates had hired surveyors who made errors of more than 12 inches in height in the proposed scope of Mr. Fahmie' s extension of Andrew Way, as well as, the county owned a portion of Andrew Way in front of 595 Andrew Way. I wonder if the blueprints presented to the county and from county records reflect the changed contour/height of the property at 580 Andrew Way? � I would assume the plans were approved sight- unseen or some engineering department would have caught the errors associated with the variances . It was I , out of concern for my family and property, who brought this to the attention of Contra Costa County. Mr. Rolfson also indicated that no storm drain plan had been approved which since Mr. Fahmie/Lamb and Associates had changed the original drainage plans . I have been in contact with Mr. Rolfson every couple of weeks for the last three months . Mr. Rolfson indicated that Mr. Fahmie/Lamb and Associates proposed draining this property via 800 feet of a new sewage pipe down Andrew Way to connect to an existing city storm drain on Argyle. J Letter to Michael Wolford re Minor Subdivision No. 2289 November 1, 1991 Page 3 I indicated repeated concern to Mr. Rolfson that rains were coming. I was told that approval for the new storm drain plans were pending. Another future concern mentioned by Mr. Rolfson was that Contra Costa County would ensure the sewer on 580 Andrew Way was installed properly, but would not necessarily maintain it once installed. Since it is on private property, I wonder what kind of storm drain the county will approve that can handle 4 - 5 newly dug/graded acres of unpaved dirt which will be mud when it rains? On the evening of October 25, 1991, it rained. Water and mud from the Fahmie/Lamb and Associates property ran downhill onto my property at 595 Andrew Way. This was due to the height/contour of the land being changed, lack of a drainage system, and the original culvert being removed. . I do not possess a Degree in Civil Engineering; however, I do have enough common sense to realize that when water and dirt mix, there is mud, and given the chance, mud runs downhill freely. My home is obviously downhill from this recipe. The mud and water damage to my property from what the weather people called "a light rain" was severe. The water eroded a ditch along the low side of the plateau portion of 580 Andrew Way, which bled water and mud onto my redwood fence, which is now leaning severely under pressure from built-up mud. Water and mud ran down my front walk to my front porch and down along the east- wall of my residence. The volume and velocity of water from all the acreage at 580 Andrew Way, actually eroded a trench, down the east wall of my home, well below the ground level, and came up under my house below the inverted "T" foundation. Many of my personal belongings were ruined. From the "mud line" caused by this water, it appears my hot water heater almost lost its pilot light. This heater is on a raised slab! This runoff has possibly compromised the structural integrity of my home. On advise of an attorney, I have contacted a structural engineer. All this was from a "light rain. " Evidence of this runoff is an eroded trench starting approximately 100 feet .into Fahmie/Lamb and Associates property at 580 Andrew Way, which is approximately 20 inches wide and 15 inches deep at places running down to my fence which borders the two properties . Our attorney is currently collecting documentation, and we may file suit naming Contra Costa County, East Bay Mud, and the developer as co- defendants . Letter to Michael Wolford re Minor Subdivision No. 2289 November 1, 1991 Page 4 Mr. Walford, we would also like you to know that on October 31, 1991, we made Stan Matsumoto, Contra Costa County Engineering Services/Planning Approval, aware that nothing has been done to remedy this situation since he came out to inspect the minor subdivision on October 28, 1991 . We again made Mr. Matsumoto aware of this on November 8, 1991, when rain threatened. As of today, November 11, 1991, still nothing has been done. My fence is still leaning under the pressure of yards of mud and there is no storm drainage system. On November 8, 1991, my wife spoke to you, Mr. Walford, at 10: 30 a.m. You indicated to her that "someone would look into this" on that day. We have seen no action taken and know of no action done. On November 8, 1991, this problem was escalated to Supervisor Tom Power' s office. I would like Contra Costa County to take immediate steps to rectify this problem and ensure the safety of my home and those on my side of Andrew Way. This may include reconsideration of variances and plans which have already been approved. My neighbors and I would like to meet with you as soon as possible regarding these issues . I sincerely hope this becomes an immediate priority. It will rain again. I would also appreciate being kept updated with your most current proposed plan of action. Failure to do so, will prompt me to involve the Board of Supervisors and further the financial liability of Contra Costa County. Sincerely, Mark C. Wilson Mercedes A. Wilson cc : Clerk of the Board of Supervisors State Farm Insurance Richard Bartke, Attorney at Law Grand Jury, Contra Costa County Tom Powers, Supervisor - District 1 West County Times 913059g.kge ' . ' , . - ^ List of damages from storm 10-25-91 to 10-26-91 20 Fillmore/Avalon posters valued at $30.00 each $600.00 Hitachi vhs vcr $350.00 Gibson Hawk 1963 vintage tube guitar amplifier $750.00 8.5 feet x 8.5 feet of wool carpet , incl pad and installation estimate from Floor Dimensions, El Sobrante; 510 223 3300 $591 .00 1500 watt electric heater $35.00 Western electric 300 modet antique phone and 18 ft. cloth cord $75.00 four shelf bookshelf cabinent $35.00 wooden wine rack $20.00 3 days wages lost from work (24hrs. ) $561 . 16 repair to redwood fence $200. 00 refinish to solid teak desk 60"x3O" , pick up and delivery: estimate from Sundance Antiques, El Sobrante: 510 223 6436 $400.00 repair to bronze and brass antique floor lamp which will need a new base as aresult of storm damage $300.00 amateur radio antenna cabling for 5 antennas $275.00 refinish antique wooden office chair on 4 casters, pick up and delivery, estimate from Sundance Antiques, El sobrante; 510 223 6436 $100.00 green naugahyde chair mildewed as a result of storm damage; estimate from Montgomery Wards $350.00 miscellaneous technical and antique books $150.00 Ray-O-Vac battery garbage can $7. 50 Kenwood amateur radio technical manuals and shipping equipment $20.00 Kenwood amateur radio battery charging manuals and shipping equipment $10.00 Kenwood amateur radio icO2at leather belt holder $25. 00 guitar cord $20.00 vcr cords $6.00 re-paint 8.5 ft. x *.5 ft.room and ceiling; estimate from Pacific Northwest Paint 510 232 9200 $325.00 ------------------------------------------------------------------------------ Tot . l $5213.66 Less EBMUD payment for partial damage responsibility $1161 .60 remainder of property total : $4052.06 ` � :.� �= •tea � C i i s4 J to �c LLs ® m C3 ru <) CA Lu vj Eff .. 2. Qj � k5b w �� � CLAIM ClaimBOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ict governed by) BOARD ACTION Against - ' '0--, the Board of Supervi, ow [ .sements, A MANT January 7, I942 ' tj �@#w��fereoxes are to > The ,copy of this document mailed to you is your notice of and Board Action. A19 .""� .= California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: in excess of $25 ,000, 00 Section 913 and 915,4^ Please note all "Warnings". CLAIMANT: Y0SBZYAMA, James V. ATTORNEY: M. Sue J�ccono, �eg. Date received 2531 Polk Street December 4 lQ4I CA DELIVERY TO CLERK ON ADDRESS: Sao Francisco, � 44104 BY MAIL POSTMARKED: Certified P 869 894 497 1. FROM: Clerk of the Board of Supervisors TO: County Counseln, Attached is a copy of the above-noted claim. DATED: DecemberlO l99l 8y�^ BATCHELOR, 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' . ulm /91 BY: Deputy County Counsel Ill. 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-I' This Claim is rejected in full. [ ) Other' l certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:- JAN - 7 1992 PHIL BATCHELOR, Clerk, 8 (IM 0/ Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptipns, you have only mix (G) months from the date this notice was personally nerved or deposited in the mail to filo m court action on this claim. Sew Government Code Section 945.6, You may see 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 I declare under penalty of perjury that l am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today l deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy f this Board Order d N ie to Claimant, add d t c„ i 1 � 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 JAMES V. YOSHIYAMA RECEIVE® Against the County of Contra Costa ) DEC - 91991 or ) AGAINST -THE CONTRA COSTA COUNTY CLERK PSOARD OF SUPER`'- SHERIFF'S DEPARTMENT-- - __-IfttffiXW CONTRA COSTA C Fill in name ) The undersigned"claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ in excess of $25,000 and in support of this claim represents as follows: __ _ ---- - *Mr.. Yash m2 is still underJo n evaluation-and-treatment1. When did the damage or injury occur? (Give exact date and hour) August 13, 1991, at 0940 A.M. -------------- -- ------ ----------------------------------- 2. Where did the damage or injury occur? (Include city and county) PARKER AVENUE, RODEO, CALIFORNIA, COUNTY OF CONTRA COSTA 3.MHow did the damage or injury occur? (Give .full _details; use extra paper if .. required) James Yoshiyama was standing on the corner of Second Street and Parker waiting for the green light. , He pushed the button indicated-on the stop sign And subsequently the green walk sign came. on. He started forward to cross.-Parker in the pedestriaz`; walk way; midway in the .pedestrian .walk way a Contra Costa 4. What. particular act or omission on the part of..county or district officers, servants 'or employees. caused the injury or damage?. Officer 'Ernest. Rodrigues failed to yield to a pedestrian within a marked cross walk and engaged in other negligent acts which are currently under investigation. (over) • j 5. Wnat are the names of county or district officers, servants or employees causing . the damage or injury? Officer Ernest Rodrigues CDL H0629815 --------------------------------- ---------------------- ------------------------------------------------------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Mr. Yoshiyama's arm was lacerated and he is currently undergoing medical treatment and evaluationconcerning injuries sustained. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury ,or damage.) Mr. Yoshiyama is 84 years. old, the residual' and prospective effects':are currently being evaluated.: Until. Mr. Yoshiyama's evaluation and treatment are complete, the amount claimed in excess of $25,000 was estimated'- on the basis of ongoing treatment, lab tests, 'orthopedic evaluation, etc. ------ -- - --- ..-- 8. Names and addresses of witnesses, doctors*and hospitals. Doctors Hospital Dr. Martin Serota *(Mr. Yoshiyama will 2151 Appian. Way 2160 Appian Way, Suite 200 seek further evaluation . Pinole, CA . 9.4564' , Pinole, CA 94564 and/or treatment from an ------ ----- --------- ------------ ---------------- 9• List the expenditures you made' on account of this accident or injury: *Dr. James Morris DATE ITEM AMOUNT UCSF San Francisco, 8/13/91 Ambulance to Hospital $342.00 California - 8/13/91 Doctors Hospital 102.20 :F �F * �F .�F ., �F W # V* Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney M. SUE JACKSON, KESQ. ., 2531 POLK. STREET Clai t s tore (415) 921=21Rod 09 ' e 15 SAN FRANCISCO, CA 941 .•. e Address Rodeo, CA 94572 Telephone No. "(415) 92T-2144 Telephone No. (415) 799-7096 * �t NOTICE Section 72 of the'Penai 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, orwriting, 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. *County Sheriff's patrol car made .a left turn across the pedestrian walk way striking James Yoshiyama. yy,y r�.tvtv.rvti,r:� d v ¢ N � � LO �r 6N maimU N Cc- 44 • O 4 .1�3 P4 . p— ) (15 a5 • c� V 0 U Ln tr —0 Ct to Ca Q Lu U co cp LL CY U oa cr� W ccIWO A. 9� o N r4 ire U �r H � tr+ �4 W � O a �'