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HomeMy WebLinkAboutMINUTES - 10131992 - 1.18 (3) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER 1.3 , 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 Sectif9k1%"915.4. Please note all °Warnings". CLAIMANT: BURKE, James D. SEP 2 31992 - 471 Hintz Ave. ATTORNEY: Tracy, CA 95376 COUNTY CDUWIIL Da �f J� ADDRESS: BY DELIVERY TO CLERK ON September 9, 1992 (via Risk Mgmt) BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 22, 1992 QHIL gATCHtELOR, Cler DATED: p ell: Depu y II. FROM: County Counsel TO: Clerk of the Board of Wervisors ( ) 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: 11YZBY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated /J IL PPHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code se ' 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina 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: /O�/LP�9 L BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator i i t f r 14 t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims, The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Clair. 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.personal relating ,to causes of.action for-death or for injury to person or to personal property or growing.-crops and which accrue on or after January 11 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later.than .one, 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 D. Burke RECEIVED 9 y Against the County of Contra Costa SEP — 9M or District) CLERK BOARD OF stTPERvisdRs M11 dn name) CONTRA COSTA CO. The undersigned-claimant-hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ UnkQwn and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) See attached sheet 2. Where did the damage or injury occur? (Include city and county) _ae� 'attached -sheet -—-—-—-- 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached sheet —--- - ------ ------------- 4. What particular act or omission on the part of county or district officers, servants or .employees, caused the injury or damage? (over) 7. wnat are the names of. county or district officers, servants or employees causing the damage or injury? --See -attached -sheet 6. What damage or- injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.- _ See attached sheet 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) - See attached sheet-------- —------------ B. Names and addresses.of.witnesses,,. doctors and. hospitals. See attached sheet _—----------------_-----..--------_. -----w_.. __�..---------------..-------�-_-••_- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT See attached sheet Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) _ or b some person on his behalf:"- Name and Address of Attorney Claimant's Signature 471 Hintz Ave Address Tracy , GA. 95376 Telephone No. Telephone No. (2 0 9) 835-3658 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 1. July 11, 1992 at approximately 10:30 pm. 2. On Delta Way by the town of Knightsen, Contra Costa County. 3. When the front tire of my motorcycle became caught in the area on the bridge where a missing plank had been. Upon approaching the end of the bridge with my tire still caught in this area my bike struck a 6" bolt protruding from the grove where the plank was missing. 4. Proper maintenance was not performed on the bridge. 5. Unknown. 6. Repairs to my Harley-Davison Motorcycle amount to $1463.56. To date my doctor's bill is $44.00. I have had continuous pain in my back and knee. I am still under a doctor care. 7. Not computed as of yet. 8. Witnesses: John & B.J. Seidl Lee Mullins 3229 Barbara St. 1846 Locust Stockton, CA. Livermore, CA. 94550 (209) 463-7066 (510) 443-4699 Marilyn'Largert 2305#A Peppermint Dr. Modesto, CA. 95355 (209) 522-9381 9. Date Item 8/12/92 Dr. Visit 44.00 6821192 PATIENT FINANCIAL HISTORY Page 1 Jay Patel, N.D. Accounts 3483 - 3483 All Dates Acct Date Dep 1 Name DN Procedure Diag Units Amount ------------- ------_ ----- _------------------------- ------------------------_-------------- ----- 3483 BURKE,JANES Previous Balance 8.81 08/12/92 1 BURKE,JANES 1 91058 EST.PT.LINITED VISIT 129.1 1.11 44.11 -------- ------------ TOTALS FOR ACCOUNT 3483 PAYMENTS 1.01 ADJUSTS 1.11 CHARGES 44.11 1.11 44.11 REFUNDS: 1.A0 ------------ ------------ ------------ ------------ 0.00 1.11 44.11 44.11 it 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 13, 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: $3,68-.57 Section 9_J,3Fa @15.4. Please note all "Warnings". CLAIMANT: FLEMMER, Daniel SEP 2 3 1992 ATTORNEY•• Farmers Insurance Group COUNTY OOUN.SEI So. Bay Area Property Branch Date--re W " ADDRESS: Claims office BY DELIVERY TO CLERK ON September 9, 1992 (via Risk .Mgmt) P'.0. Box 4370 Santa Clara, CA 95054 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JqDATED: September 21, 1992 IL ATCHELOR, Clerk Deputy II. FROM: County Counsel TO: Clerk of the. Board of S ors ( ) This claim complies substantially with Sections 910 and 910.2. ( vJ'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: &-t Z 3 /9�L 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 ( phis 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: �� f � � �G 2- PHIL BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov. code sects ) 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 16; 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: J� �� (o Icj Z BY: PHIL BATCHELOR by �4Deputy Clerk 1/ 117 CC: County Counsel County Administrator i I i ADDITIONAL WARNING This warning does not apply to claims which are -not subject to the California Tort Claims Act such. as actions-, -inverse condemnation, actions for specific relief such as mandamus or injunction, or'Feal` derCivil Rights claims. The above list is.,,.not,.. exhaustive and legal consultation is essentiah� to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. . Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions notisubject to the California Tort Claims Act. i 1 i i i i i I ' I I NOTICE OF INSUFFICIENCY AND/OR NON,-ACCEPTANCE OF CLAIM TO: Farmers Insurance Group So. Bay Area Property Bunch Claims Office P.O. Box 4370 Santa Clara, CA 95054 Re-, Claim of EnSIAEf-S Daniel Remmer ruill-y 7vu-2—ul Please Take Notice as' Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: —1. The claim fails to state the name and post office address ;7 of the claimant. —2 The claim fails to state the ' post office address to which the person presenting the claim desires notices to be sent. V3. The claim fails to state the date, place or other circum- stances of the occurrence or .transaction which gave rise to the claim asserted, The claim fails to state the 'name(s) of the public employee(s causing the injury, damage, or loss, if known. V/15, 0 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 ($10,000) , th( claim fails to state whether jurisdiction over the claim woulc rest in municipal or superior court. 6. The claim is not signed by the claimant or by some person on his behalf. 7. Other: VICTOR J. STMAN, County Counsel By; DepuCdtinty Counsel/ Y CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evid. C. §§ 641e 664 ) My business address is the County Counsel"s Office of Contra Costa County, Co.Admin.Bldg. , P.O. Box 69* Martinez, California 94553, and I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non- Acceptance of Claim by placing it in an envelope(s) addressed as shown above (which is/are place(s) having delivery service by U.S. Mail) , which envelope(s) was then sealed and postage fully prepaid thereon, and thereafter was, on this day deposited in the U.S. Mail at Martinez/Concord, Contra Costa County, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: September 24, 1992 at Martinez, California. cc: Clerk of the Board of Supervisors /riginal) Risk Management (NOTICE OF INSUFF) 3NCY OF CLAIM: GOVT. C. ' §§ 910, 910. 2 , 920 . 4 , 1 AIpi'ljC:— !-2-0 - 92 THU 1 4 C 2 1 Mar W Mede r Farmers Insurance Group '..COMPANIES G SO. BAY AREA PROPERTY BRANCH CLAIMS OFFICE Date: 8, 10/92 2945 DEMOCRACY DRIVE P.O. BOX 4370 SANTA CLARA, CA 95054 PCC :onservatorship Guardianship Program. 408-982-088$ , G P.O. 3ox 8, Mart. ine2,CA 94553 RECEIVED Att k1 Flanigan !N RV".Y PLEASE REFER TO: SEP r1 9 M o+,r,n�: Dan:.el Flemmer JC[" Date of Loss 7/1'492 Our Pw cy mo 908'-29681 CLERK BOARD OF SUPERVISORS SALNL N1 176543 CONTRA COSTA CO. AcculentLocatiore 984 South 7th St, San Jose Total Amount(*3,68''.57 Claim to Oats (incl.our Ina. Deduct A nevi-w of the facts of the loss indicates that our insured is entitled to recover damages from you. There, ire. we have the right to make claim for these damages in our insured's behalf. This letter is to notify you of our subrogation rights and to advise you that nQ one-has authority to give you a release for our interest except a representative of this Company. It you .3rried liability insurance to protect you for such losses, we shall present our Claim to your Company.Please complf-te the following information and return to us. In•curance Company Name: Policy No. At(dress N�me and address of Agent or Adjuster _ If you --e not insured, please send us your check for the amount due. If you are unable to fulfill this obligation, please -•ontact the undersigned immediately. Very truly y Signed FINE I ER G G 'NE LDRE GATION CLAIMS Pe son that caused the damage to our Insured's house was:�James Zaratoga. t7 assv_arar_rroi.srrzan.c uNrFni.. WE_ARE MEMBERS OF THE INTFO rnKADAMY ADRITO ATWnwr A/`ncca&ra T 2 AUG-20-1992 14:27 415G4G2853 P•00 f'Fd E Farmers insurance Group '......A.W. SO. SAY AREA PROPERTY BRANCH CLAIMS OFFICE Dore: g 10/92 2945 DEMOCRACY DRIVE P.O. BOX 4370 SANTA CLARA. CA 95054 PCC :onservatorship Guardianship Program. 408-982-0888 P.O. 3ox 8, hartLnez.CA 94553 Att tl Flanigan RECEIVED N R&1.Y PLEASE REFER TC: 4 Ourl�ureo Dan..el Flemmer oats a Lose 7/1'./92 SEP 21992 our potay fto 948'.?9681 sALN� N1 176543 ACI-den L=W, 984 South 7th St, San Jose CLERK BOARD OF;;UPERVISORS� Total Amount ora,68''.57 CONTRA COSTA Co. Carm to Data (tnd.our im Deduct 1 A revi-w of the facts of the toss indicates that our insured is entitled to recover damages from you. There-re. we have the right to make claim for these damages in our insured's behalf. This W ttar Is to notify you of our subrogation rights and to advise you.thatno one-has authority to give you a release for out Interest except a representative of this Company. if you arried liability insurance to protect you for such losses,we shall present our claim to your Company.Please complr�te the following information and return to us. ln"turance Company Name: Policy No. At ldress N:mo and address ! of 4gent or Adjuster If you ,,tie not insured, please send us your check for the amount due. If you are unable to fulfill this obligation, please ~ontact the undersigned immediately. 4 Z;FI e truly Signed i E I EX G'YE LDRE TION CLAIMS Pe son that caused the damage to our Insured's house wasJames Zaratoga. u ARE MEMBERS OF TNF INTFRrf1MDAMV ADaITD ATrrUar P.002 AUG-247-1 +92 14=27 4156462953 /- / 0 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 13, 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 9 1 r_d 5.4. Please note all "Warnings". CLAIMANT: LARGENT, Marilyn SEP 2 3 1992 2305 #A Peppermint Dr. ATTORNEY: Modesto, CA 95355 COUNTY GOUwEL Da to AMA19i UCAllft ADDRESS: BY DELIVERY TO CLERK ON September 9, 1992 (via Risk Mgmt) BY NAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September pp 21, 1992 g�IL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: "'` llYz 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 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: / �1 Z PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (.Gov, code se ion 3) 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. EOR 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 Notice to Claimant, addressed to the claimant as shown above. Dated: /a�/� /9� BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator r ADDITIONAL WARNING This warning does not apply to claims which are not. subject to the California Tort Claims Act such as . actions' ^iwinverse condemnation, actions for specific relief such as mandamus or injunction, or. Federal:Civil Rights claims. The above list is not exhaustive and legal consultation is es°sentfal' to understand all the separate lilnitati.ons periods that may apply.- The limitations period within which `suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County' of Contra Costa does not waive any of its Tights under California Tort, Claims Act nor does it.,waive rights under the statutes of limitations applicable to actions not. subject to the California Tort Claims Act. l Clair.: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUN'T'Y 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 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 Marilyn Laraent ) 'z`" RECEIVE® ✓+(�- tis �" Against the County of Contra Costa ) SEP 9 b r ) CLERK BOARD OF SUPERVISORS fstr Ct) CONTRA COSTA CO. ... The undersigned-claimant, hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ unknown and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) See attached sheet 2. Where did the damage or injury occur? (Include city and county) See attached sheet 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached sheet -------------------=------- ---------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or .employees caused the injury or damage? See attached sheet (over) wnat are the names of county or district officers, servants or employees causing the damage or injury? See attached sheet 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See attached sheet —rrww----e -------- 7. --- .r—r7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) See attached sheet ..s—.er.rr_rrar.r..w---- $. Names and addresses of witnesses', doctors and hospitals. See attached sheet rrrrrwrrrrrr—reerrrrrrrrrerrsrrrrwrrrrr —r......e+.—r—rewwree.rwe.i.awo®sem 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT - See attached sheet Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES T0; (Attorney) or by some person on his.behalf." Name and Address of Attorney lai 's ignature 2305 # A* Peppermint Drive- Address Modesto, CA. . 95355 Telephone No. Telephone No. (2 0 9) 522-9381 # V 1i 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, isIpunishable 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. July 11, 1992 at approximately 10:30 pm. 2. On Delta Way by the town of Knightsen, Contra Costa County. 3. When the front tire of the motorcycle I was riding upon became caught in the area on the bridge wherea missing plank had been. Upon approaching the end of the bridge with the tire still caught in this area my bike struck a 6" bolt protruding from the grove where the plank was missing. 4. Proper maintenance was not performed on the bridge. 5. Unknown. 6. To date my doctor's bill is $179.56. I have had continuous nightmares and have not been able to get back on a motorcycle. 7. Not computed as of yet. 8. Witnesses: John & B.J. Seidl Lee Mullins 3229 Barbara St. 1846 Locust Stockton, CA. Livermore, CA. 94550 (209) 463-7066 (510) 443-4699 9. Date Item Amount 7/12/92 Dr. Visit 179.56 -=O-/l 9 2 ST4TEIENT D A T.:-- 07/20/92 P v I c F. E;AT E U T Y DE. c r I p 1 1 ON A CJ N T RVS No* C,7 1 1 DEMEROL LNj 75t-,G 15. 06 99 C, PHEFNIERGAN INJ EOMG 14o39 99 HA R j.,k A C Y 9 TOTAL-- 0-? I n2 I E.P 4 C0MPL£k 143, 11 33 07/1//22 1 a F T P HiR ;-q C t-4,F'GE ER 7. 00 .33 k"Z N,C y Rom; SUB TOTAL-- 150. ! 1 ICTAL C ijA9GF -s THIS L-- !39, 56 CLAIM v 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 13. 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 $1,2 34.09 (Paragraph IV below), given pursuant to Government Code Amount: SectionR913 a'0D915.4. Please note all "Warnings". CLAIMANT: RENTUMA, Vincent F. ry9 640 Second Street `SEP J �9�6q ATTORNEY•' Brentwood, CA 94513 OOUNTY CbUN% Dat#&Wda]LS AUR ADDRESS: BY DELIVERY TO CLERK ON September 10, 1992 (hand delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppH gg DATED: September 22, 1992 BUIL OeputyLOR, Cler II. FROM: County Counsel TO: Clerk of the Board of Sup sors ( his 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: 23 �99Z BY: �� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( V) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: LCAybe-r /A/99ZPHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sec ' 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. Dated:-/O Ll�, &L BY: PHIL BATCHELOR by Deputy Clerk I If CC: County Counsel County Administrator y \ i l 1 This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. 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` 3anuary 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 945530 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 fora. RE: Claim By } Resery for a k's fi ing stamp C; Against the Gaunty of Contra Costa } E� „ 1199 y District} CLERK �s/'�oppA� aDqp of�1Fjs(l}�}PERVISCRS (Fill-in name } .. LVi1V11�/V7 7I1 Lo• n/ f The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ /, ,2_�W • 07 ,and in support of this claim represents as follows: 1. When did the damage orinjuryoccur? (Give exact date and hour) .5a rYc 2. Where did the die or in_jpry occur? ancon y) 3. How did the damage or injury occur? (Give full details, use extra paper if required)d G.ar, e> ;-re- I/InAb P01 •rent, +he. C: n-fra- Costa. CO• t�ubl�c tle� l�h Fbxkinj LD-t” 0-t Ilff_ dt3 ttk Vt. FtAtuOM onA.n . cf tdect 0/7 dor p�1�r CS t nj ex1'e.�Sive. �- i5 ecus; irr fur ( ack ljarel (Zdjocu� -the- CP-4tc� �s�in5 Gaf. _____P___•MI_a.,11.__a__YYii�tls__IpwO__N�_ M.O'.�__M____Y_YI_ _Ma+f______s._.w__Y�4+IpN_ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �r�e. �.i rn b /o c�-f� a� ��rttr-a �a�t�.. ;;moo • ��--���r--f-� (over) t �. wnat are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or, injuries do,you claim resulted? (Give full extent 'of injuries or .damages claimed. Attach two estimates for auto damage, .� rn = �jtei! �7a tech 01) M___Mrt___N.Y__+��111._.IMN.�._sNM____M__ e�M_w.N_�CY_M__a______ 7• `How was the amount claimed above computed? (Include the estimated amount_ of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. renc�cc erg `urn rya .�e1-Dnc .af en t4(- jwy't�d�i G _a_w______r_wo_..—e_.r__--e__ —__w_—__—___r. _.r_a+ao._..__.w• 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 91M provides% "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) ot by some persqn on his. behalf."_ . Name and Address of Attorney Claimant's Signature kAddress) Telephone No. Telephone No.c20 ' 4/ — 7 �3 7 NOTICE Section 72 of the Penal Code provides: '- "Every person who, with intent to defraud, presents for allowance or for payment to. any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing; is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. DAVE'S TRAILERS SERVICE ' 155 O'Hara Ave. P. O. Box 262 Oakley, CA 94561 '(415) 625-3622 AS L=ED FOR LABOR AND MAIALS ESTIMATE OF REPAIRSVERBALAGREEMENTS NOT BINONG �ESTIMATESFREE OWNER - DATE ADDRESS PNONE ES'r.N . INSURANCE CO. ORDER NO. Z SONE LICENSE NUMBER ADDRESS . YEAR-MAKE MODEL MILEAGE --JMOTOR NO. SERIAL NO. 0 37 bWo Vd -Q L Wfa — I .M 11"Q-- . o I i oo v1" Asiol, �v ; ; o,v -ko,v' a- I 122 p42 1-46( I -o �J I P, l ;'l i 3 jqo 46 4t I a .PARfS•PR[fE :BASED:G3�k5F1lG�lETAtBk. ][TAEFICrPRF TOTAL / AtF7EC�t7fatG1 x / EfSKt1 =� MATERIAL L G o � f F VLY I�J"K1aF'IK[R� v:..:... � ���^•- LYF!nW` �• TOTAL LABOR 7� r y 'E3iSA8>rfSSf�f5,StsE.E�T.Uiiff� f3i3R?`lLVfii•?EGLIONc!��1�liQ>KKt�.YlBii%It]DTR7tiNACl+il� � .OR.i`ABQL�a1VH[�!'Y1NA�BLG72E�F1f �FLER"IFtEWCSitfC.ltlk5'8EP!!fE9FQiQ1�tllf2'1G�'/F�ERr v>tas�Ict�A� ratzr�tr� �t�Efl it�E sKsO TOTALMATERIAL s L�c'y.'°n'�� '' �'•'�.�,:•K f� ,T�az3�:�'k^�•�"P.,c�. .y�� � x."' 'c'".�a:y�.�.? - -7 i/' � .a,..0 "t, •h vL.. >w � `cwr ice,x��^�sss./� ¢.isd'�•x�""' ��,�.�,�.�h� �c "e ,,, wen �."� TAX �,J 7/ a� ," s:: z:. L�K �SIED"S,l s��".��z'��•'•"�a 2e ��kEa�`�'s�`'t _. a xc� z sYx \ Lv2n'^ a l ,. PAIDOUTTOW&STORAGE .�� ��TI"F -�..zwsws� ��✓?,r L� , `�y��;���: `��'r4 Y��e k��SL sz<ara"�ax�s•,.,s�,. x..�� ;. y,'ewe� >. SUBLET REPAIRS +i�.. .,.sey y,..:,wy E�..#?, '.�'w`�i y$s�9� a ,A�„y�.^ :c;� :. ""',e 4- �.: • 3 It- -• s.