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HomeMy WebLinkAboutMINUTES - 10061992 - 1.36 r CLAIM BOARDIhOF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing End liorsements, ) NOTICE TO CLAIMANT OCTOBER 6; 1992 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. 'n ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT• CANTANDO, Phyllis F. Suite 6L-158 ATTORNEY: 1550 California Street San Francisco, CA 94109 Date received ADDRESS: BY DELIVERY TO CLERK ON August 25, 1992 Cert P425 669 366 BY MAIL POSTMARKED: August 22, 1992 0 I. FROM: Clerk of the Board of Supervisors TO: County Counsel III Attached is a copy of the above-noted claim. September 8 1992 Clerkg�&. pHDeDATED: puty y _ II. FROM: County Counsel T0: Clerk of the Board ofqpXpAsors ( (This claim complies substantially with Sections 910 and 910.2. Iii ( ) 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: �(�.-. '��- /rS /Y2- BY - t_ ; Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Adm istrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). s IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected i,n full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. t� Dated: o�YT - 6 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. FOR AT)DTTTONAL WARNING SEE REVERSE SIDE OF THIS NOTICE. 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 toI imant, addressed to the claimant as shown above. O 0 Dated: O o,9=tg92 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator r i r y 37 II RECEIVED 1 �� AIG 2 51992 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 1E. °r y , , t p .ate,-+�• - e tZZ � � 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 proIty 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 're y elating to -any_.other__cause__o,f action._mast be presented riot g later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed ;vith the Clerk of the Board of Supervisors at its office in Roam 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.. fraiadulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By y ) Reserved for Clerk's filing stamp AUG 2 51992 Again -the Coun y_of Contra Costa, ) N RFs � f�g CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. The undersigned claimant 'iIhereby.makes claim against the County of Contra Costa or the above-named District' in the sum of $Zr/2 A::-/ N - � 7`and in support of this claim represents as 11 follows: ---------------------- =` --------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) a IF� 2. Where did the damagepor injury occur? (Include city and county) T.yc: ,aiy�/1 3. ow did the damage or ink occcur Gi e 1 a s• use Xtra r if required) -- 4.' What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (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. /.. /P�6 ,eig��s � �Aecs __� cam _ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) A Ze / -e- -- ��,e X 4�>,/ e'7`e -------------------------------------- --------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. 12,o T 7i`f/S T'/m f/�©.e.✓G W/I��'7�/� `�: oz , ------------------------------------------------------------_-------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT n yv r 4-r- 1105F7/7-? �i�I,6�� it ki gym. D/-S 2/cv. 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 Ad ess ToMphone No. �,� '��g —moo/j Telephone No6:: / r�, 0 a L/ N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allwance *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. 1 r , . w • �� ,� tom,. f i ,33 �d ��1+ "'� Claim'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAD%NT 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 m st -be presented not later than one year after theaccrual ,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 91553. 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: Clam By ) Reserved for Clerk's filing stamp Against the County of Contra costa ) AUG'2 51992 ss ) M,ERK BOARD of SUPERVISORS District) colvrRA cosrA 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 asT'follows: _ 1. When did the damage or injury occur? (Give exact date and hour) .P-T -*;C sOVc>O -------------- 2. Where did the-damage or injury oce ? (Include city and count - ���-----------------------��_ � Pape 3. How did the damage or injury occur? (Give full details; use extra r if reqs A -fin 4. What parrt`ic ar act or omission on the par of f county or distr et officers; N servants or employees caused the injury or damage? / _ _ g 5. What are the names of county or district officers, servants or employees causing the damage /ori injury? ------------------------------------------------------------------------------------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ------------------ —"_ 'u c_ o 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors ?.nd 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 some person on his behalf." Name and Address of Attnn�e ��� • Claimant's Signature Addre Telephone No. Telephone N N O T I C E Section 72 of the Penal Code provides: "Every person who,_with intent to .defraud, presents .for allowance or for payment to any state board or officer, or to any county, ,city or district board or officer, authorized to allow or -pay-•the same if genuine, any false or• fraudulent claim,-bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand- ($1,000), or-by both such imprisonment and fine, or by imprisonment in the state prison, by. a. fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. i 7d� i a 4 Y u Cz O� Gtr C CP NN �ACIV f 'Y�d �� tt a • S (� 3 e 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 6, 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: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GOODEILL, Edwin ATTORNEY: Jeremy A. Archdeacon, Esq. 47 Quail Ct. , Suite 205 Date received ADDRESS: Walnut Creek, CA 94596-5574 BY DELIVERY TO CLERK ON September 3, 1992 (hand delivered) BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 8, 1992 IVIL BBATCHELOR, Clerk BY: Deput 11. FROM: County Counsel TO: Clerk of the Board of sors 0 ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: Z BY: t l% . t�-��`= Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected i,n 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 - 6 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. FOR ADDTTTONAT, WARNING SEE REVERSE SIDE OF THIS NOTICE 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 - 9 1992 BY: PHIL BATCHELOR by v Deputy Clerk CC: County Counsel County Administrator • J RECEIVE® TO: Board of Supervisors SEP 3 M Contra Costa County C-I', co P.m 651 Pine ST Room 106 CLERK BOARD OF SU?ERVISORS Martinez, CA 94553 CONTRA COSTA CO, NOTICE OF CLAIM FOR PERSONAL INJURIES DUE TO NEGLIGENCE (PURSUANT TO GOVERNMENT CODE SECTION 910.2) 1. CLAIM AGAINST: County of Contra Costa 2. NAME AND POST OFFICE ADDRESS OF CLAIMANT: Edwin Goodeill c/o Jeremy A. Archdeacon, Esq. 47 Quail Court, Suite 205 Walnut Creek, CA 94596-5574 3. THE DATE, PLACE, AND OTHER CIRCUMSTANCES OF THE OCCURRENCE OR TRANSACTION WHICH GAVE RISE TO THE CLAIM ASSERTED: Date: March 14, 1992 Place: Century Boulevard at the intersection with Pier 1 access road, Pittsburg, California. Circumstances: Claimant was exiting the Century Plaza shopping center next to Pier 1, turning left onto Century Boulevard where his view is blocked to the left by the natural curve of the roadway, coupled with the proximity of the Pier 1 building to the street, preventing him from being able to see traffic proceeding from his left to his right. Negligence of Contra Costa County consists of its failure to control this dangerous intersection with a "right turn only" sign, or reducing the speed limit on Century Boulevard, given the placement of the Pier 1 building. 4. GENERAL DESCRIPTION OF THE DAMAGE OR LOSS INCURRED SO FAR AS KNOWN AT THE TIME OF PRESENTATION OF THE CLAIM: Medical Treatment in excess of $1,000.00. Lost Wages - Not applicable. General Damages - Unknown Property Damage - Approximately $23,500.00. Loss of Consortium - Claimant is disabled and depends upon his wife for assistance in daily activities, which she is not able to give due to her fractured shoulder. 1 f s NOTICE OF CLAIM FOR PERSONAL INJURIES DUE TO NEGLIGENCE (PURSUANT TO GOVERNMENT CODE SECTION 910.2) 5. THE NAME OR NAMES OF THE PUBLIC EMPLOYEES CAUSING THE INJURY, DAMAGE OR LOSS, IF KNOWN: Unknown 6. AMOUNT CLAIMED IF UNDER $10,000.00 OR STATE WHETHER JURISDICTION LIES IN MUNICIPAL OR SUPERIOR COURT: Jurisdiction lies in the Superior Court Dated:3 � Signature ' J A. HDEACON Attor!n!eyy--tdr Claimant 2 CLAIM �� BOARD'OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA ;P Claim Against the County. or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements. ) NOTICE TO CLAIMANT OCTOBER 6, 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: Unknown Section 913 and 915.4. Please note all 'Warnings". CLAIMANT: GOODEILL, Mary ATTORNEY: Jeremy A. Archdeacon, Esq. 47 Quail. court, Ste. 205 Date received ADDRESS: Walnut Creek, CA 94596-5574 BY DELIVERY TO CLERK ON September 4, 1992 (hand delivered) BY NAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 8, 1992 IVIL BAT &e7. CHELOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of S pervisors ( 4 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: ec 1 '%! BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Admini rator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (rte This Claim is rejected i.n full. i ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. ee Dated: OCT • U �g�2 PHIL BATCHELOR. Clerk, BYL , Deputy Clerk 0, 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. FOR AnDTTTONA_L WARNING SEE REVERSE SIDE OF THIS NOTICE 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: QCT 9 1992 BY: PHIL BATCHELOR b CL P.1 Oj Deputy Clerk CC: County Counsel County Administrator RECEIVED SEP 3 � TO: Board of Supervisors j};10 P.!yl Contra Costa County CLERK BOARD OF SUPERVISORS 651 Pine ST Room 106 CONTRA COSTA CO. Martinez, CA 94553 NOTICE OF CLAIM FOR PERSONAL INJURIES DUE TO NEGLIGENCE (PURSUANT TO GOVERNMENT CODE SECTION 910.2) 1. CLAIM AGAINST: County of Contra Costa 2. NAME AND POST OFFICE ADDRESS OF CLAIMANT: Mary Goodeill c/o Jeremy A. Archdeacon, Esq. 47 Quail Court, Suite 205 Walnut Creek, CA 94596-5574 3 . THE DATE, PLACE, AND OTHER CIRCUMSTANCES OF THE OCCURRENCE OR TRANSACTION WHICH GAVE RISE TO THE CLAIM ASSERTED: Date: March 14, 1992 Place: Century Boulevard at the intersection with Pier 1 access road, Pittsburg, California. Circumstances: Claimant was a passenger in a vehicle exiting the Century Plaza shopping center next to Pier 1, turning left onto Century Boulevard where driver's view is blocked to the left by the natural curve of the roadway, coupled with the proximity of the Pier 1 building to the street, preventing him from being able to see traffic proceeding from his left to his right. Negligence of Contra Costa County consists of its failure to control this dangerous intersection with a "right turn only" sign, or reducing the speed limit on Century Boulevard, given the placement of the Pier 1 building. 4. GENERAL DESCRIPTION OF THE DAMAGE OR LOSS INCURRED SO FAR AS KNOWN AT THE TIME OF PRESENTATION OF THE CLAIM: Medical Treatment in excess of $10,000.00 , plus surgery. Lost Wages - Not applicable. General Damages - Unknown Property Damage - Approximately $23,500.00. 1 NOTICE OF CLAIM FOR PERSONAL INJURIES DUE TO NEGLIGENCE (PURSUANT TO GOVERNMENT CODE SECTION 910.2) 5. THE NAME OR NAMES OF THE PUBLIC EMPLOYEES CAUSING THE INJURY, DAMAGE OR LOSS, IF KNOWN: Unknown 6. AMOUNT CLAIMED IF UNDER $10,000.00 OR STATE WHETHER JURISDICTION LIES IN MUNICIPAL OR SUPERIOR COURT: Jurisdiction lies in the Superior Court Dated: \ r C� �. Signatlre"M MY A. H CON Attorney or Claimant 2 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 6, 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: $732.18 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: GURNSEY, Steve 2141 Firwood Ct. ATTORNEY: Byron, CA 94514 Gate received ADDRESS: BY DELIVERY TO CLERK ON September 4, 1992 (via Risk'iMgmt) BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel - Attached is a copy of the above-noted claim. GATED: September 8, 1992 VIL BeATTCHELOR, Clerk puty 11. FROM: County Counsel TO: Clerk of the Board of SuiperVisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to complypsubstantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ��'^" '" l� 1�J� By: ` —`�^-_� Deputy County Counsel t ,9 111. 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 Wf'�This Claim is rejected i.n full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. F Dated: - 6 1992 PHIL BATCHELOR, Clerk, By jA. . 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. FOR AI)I)TTTONAT WARNING SEE REVERSE SIDE OF THIS NOTICE. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Noti a to Claimant, addressed to the claimant as shown above. Dated: �C 1 C( �� BY: PHIL BATCHELOR by °. Deputy Clerk CC: County Counsel County Administrator Clair. to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMMIrr 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 prop growing property or. gwing crops and which accrue on or. after January 19 1988, must be presented not later than six months after the accrual of the cause of action. Claim& 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 5911-2.) 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 f-2"ana <7r- RECEIVED Against the County of Contra Costa) 4 W2 124 k- M L, Oft District) CLF9K BOARD OF SUPEW1 CONTRA COSTA (Fill-in--n-a-m7e ,! ,, The undersigned claimant--,hereby makes claim 1 i L72t the-raunty of Contra Costa Or the above-named-DistriA -in the sum of $ and in support of this claim represents as follows; 1. When did the damage or-iniury occur? (Give exact date and hour) 6 2. Where did-the damage" or injury occur? (Include city and county) 3. How did the e or injury occur? (Give full details; use Bxtm Paper if ired) 7 cS 4. What particular actior omission on the part of county or district off vers, servants or employees caused t ,he injury or damage? /07 (over) 7. 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 twoestimates �for auto damage. �� � �'�.^ �'/� f�'r' ,n cj. t.�'�c��/•�/.r/r ��,,z7: cam"'" _•O-rM___°«Rhe_N11.Ni1M_________ir___O_M_M__J NII �N__.IM____.Y__-___ 7. How was the amount claimed above computed? (Include the estimated unt of any prospective injury or damage.) ' Tr, . All ley 0 8. Names and addresses ofj witnesses, doctors and hospitals. ;Z Yr &C, o-.-apl -e- 9. -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 some person on,his. behalf.". Name and Address of Attorney 1 tts S'gmPdre Address , Telephone No. Telephone No. d " NOTICE n +++ Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance .or1for 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. y 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 6, 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: $127.08 Section 913 and 915.4. Please note all •Warnings". CLAIMANT: LEWIS, Valera 1310 5th Street ATTORNEY: Rodeo, CA 94572 Date received ADDRESS: BY DELIVERY TO CLERK ON August 25, 1992 (via Risk Mgmt) BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 8, 1992 pp��IL ATCHELOR, Clerk DATED: BY: Deputy 2&123.2:a 11. FROM: County Counsel TO: Clerk of the Board of Su isors ( ~�) 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: BYDeputy County Counsel JA 111. 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 This Claim is rejected i.n full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this dates Dated: OCT 6 1992 PHIL BATCHELOR, Clerk. By 0 ° . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. FOR ADDITIONAL WARNING SEE REVERSE SIDE OF THIS NOTICE 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. _\tL Dated: 0 GT - 9 1992 BY: PHIL BATCHELOR b AA Deputy Clerk CC: County Counsel County Administrator ECS AUG 2 81992 CLERK DO ERVISORS $ - IbG TO CUSTOMER:PLEASE READ NAME DATE ^ INVOICE - a IMPORTANT INFORMATION ON BACK )PY OF INVOICE FOR ANY WARRANTY STREET _�`� ,crcr STATE ZIP 7-NEW ❑REBUILD STOREL WORK PHONE HOME PHONE / J SALESPERSON COLL.BY ET OTHER OF 'f. - - �� Com'/p \ O O R COMPUTER VOICE- LICENSE NO. C MAKE CA �O,EL ED YEAR MILEAGE, TIME PROMIS REPLACE ^ 2A.>^1 ( CGf _f7 d• �'r':j J �'�'� C S CHECK CHARGE CARD CHARGES APPROVAL ROA ECEIP MERCN. CASH CUSTOMER P.O.NUMBER LO O RI O RG RECEIPTS 'RETURN REFUND :EPACK ❑F ❑R FOUR WHEEL BRAKE AND VEHICLE INSPECTION/SPECIAL INSTRUCTIONS SE SEALS OF 17 R 'N OF OR DES O F OR ALD O NEW I GRANT BIG O TIRES PERMISSION TO OPERATE THE VEHICLE HEREIN DESCRIBED FOR THE REPLACED PARTS REQUESTED PURPOSE OF TESTING,INSPECTING,INCLUDES REMOVAL OF WHEELS AND_DRUMS FOR THE BY CUSTOMER - PURPOSE OF INSPECTING THE BRAKES,SERVICING,OR DELIVERY.I RELEASE BIG 0 TIRES FROM .O YES O NO RESPONSIBILITY FOR LOSS OR DAMAGE TO VEHICLE OR CONTENTS THEREIN,IN CASE OF FIRE, WORK GONE 8Y-TECHNICIAN THEFT OR OTHER CAUSE BEYOND BIG 0 TIRE'S CONTROL.I AUTHORIZE THE REPAIR AND SERVICE WORK LISTED ON THIS INVOICE TO BE PERFORMED FOR THE AMOUNT SHOWN BELOW.' JMS/ROTORS .ACT AMOUNT SIGNATURES ` . . .ACT . • -7 : .- � � MS/ROTORS TIRES �/�. 7G I(���7~ .ACT- -ACT- . BRAKES; , ACT_ACT_T. BRAKES ❑FRONT O REAR•, ^7A t`- r L^ >, ya>af„ ",.",,,.�„a,' "a„ c,p, L �:v4 .rfr,.+`'r._ - a, xpu -j '.'„a „ � SHOCKS ry.. LIZERS O F OR i a:.,-J.,..w'��. :::_,1 -.iz:..-..t. u.� .-W_+,c p USED TIRES u: i_LR- WHEELS IDLER O PITMAN w I - TUBES I UPPER GLOWER - - VALVES RUBBER O METAL O CHROMED iINTS-MFGR'S` C„� `_ ti.t u„-"" - BALANCE STATIC❑ COMPUTER H.S.❑ I UPPER'-`R L MISC. ROTATION O MINT.O I - IOWER ''-R% LABOR FLAT REPAIR O OTHER O NGS ALIGNMENT y .. ❑SHOCK NER O R OL O STRUT 1 FRONT END LITER O R O L I 1 LO ❑RI ❑RO BRAKE =I MISC.PARTS/OIL CHANGEMum - I r O 4 WH ENVIRONMENTAL CHARGE I =RONT END ' PI III • ' TOTAL PHONE NO. DATE CALLED WORK AUTHORIZED PARTS ,/r TIME BY TOTAL M, AUTHORIZED BY ADD AMOUNT NEW TOTAL LABOR - SUB TOTAL PHONE NO., DATE CALLED WORK AUTHORIZED SALES ^"') MiSr+•- AUTHORIZED BY TIME BY ADD AMOUNT NEW TOTAL TAX ORE TERMS:(NET 10th PROX.1 PAST DUE CHARGE IS COMPUTED BY A ARE "PERIODIC RATE'OF 2%PER MONTH ON UNPAID BALANCE WHICH IS OR AN ANNUAL PERCENTAGE RATE OF 24%.IF NECESSARY TO INSTI- TUTE LEGAL ACTION TO ENFORCE COLLECTION OF THE AMOUNT DUE - 'EF. UNDER THIS INVOICE,BUYER AGREES TO PAY ALL NECESSARY COSTS YEfIICLE RECEIVED BY y f AND ATTORNEY'S FEES. PLEASE SIGN /� t + ..n l I 1 � Y-ate r } �.t s? CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA C� Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER 5, 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: $150.00 Section 913 and 915.4. Please note all OWarnings". CLAIMANT: WALLS, Dorian 130 Dempsey ATTORNEY: Rodeo, CA 94572 Date received ADDRESS: BY DELIVERY TO CLERK ON September 2, 1992 (via RiskMgmt) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 8, 1992 p� D IL BATCHELOR, Clerk DATED: B : eputy 11. FROM: County Counsel TO: Clerk of the Board of S er sors ( ) This claim complies substantially with Sections 910 and 910.2. ( 1J1� 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: �2_ BY: t-= leDeputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Admin trator (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: �y� 6 1992 PHIL BATCHELOR, Clerk, By 0 ..Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. FOR ADDTTTONAL WARNING SEE REVERSE SIDE OF THIS NOTICE AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and No ice to C1imant, addressed to the claimant as s shown above. Dated:— OGT 9 1992 BY: PHIL BATCHELOR by J0 Deputy Clerk CC: County Counsel County Administrator NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Dorian Walls 130 Dempsey Rodeo, CA 94572 Re: Claim of aI)kN u)60CLL:� 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: t/' 1. The claim fails to state the name and post office address of the claimant. V,,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 circum- stances of the occurrence or .transaction which gave rise to the claim asserted. 4. The claim fails to state the nanie(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 thar 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 woulc 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 B Deput C unty ounse CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015. 5; Evid. C. §§ 641, 664 ) My business address is the County Counsel-Is 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: /Y / ,4 � , at Martinez, California. T cc: Clerk of the Board of. Supervisor (original) Risk Management (NOTICE OF INSUFF) .NCY OF CLAIM: GOVT. C. ' §§ 910, 910.2, 920 . 4 , "� ^ . 1 Cr� -- - - ----=---�---=-�--- ,� �h--- - WC�kIs----i=�---Was- --�-^vo_lV.�� __�- V1 a, ' L ' `` _. . - . . -b�- =�FF ,cer. � c ��ce Tu`� - ��r -s� � "� - .G n'`t _w•6l'Q� c.ic` - I1 kC VIN , I�G ,Qo PGC a RECEIVE SEP x,1992 CLERK BOARD OF SUPERVISORS 5- CONTRA COSTA CO. s s _ r CA d 9� v p S c-1 d � � D � a r, v ' f s u vel q _ _ e A sc, j I� r. ,I J. /Z be 2 - ._ JPERV CLERKCQNTRA COSTA CO.ISGRS '�i ga N S Q v y 4>