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MINUTES - 01051993 - 1.29
r q RECEIVED CLAIM DEC 91992 • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OOIJMY COUW 4tWINE7, CWK Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 5, 1993 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $435.20 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: BOLEN, Marian ATTORNEY: Date received ADDRESS: 2020 Grant Street, Apt. 206 BY DELIVERY TO CLERK ON December 3, 1992 Concord, CA 94520 BY MAIL POSTMARKED: via Risk Mgmt I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, DATED: December 7, 1992 JyIL BAATTCHELOR, Cler uty II. FROM: County Counsel TO: Clerk of the Board of Tupervisors ( i/� 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 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 (1/) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. C e® Dated: JAN 5 "I 1993 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 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. JAN 8 ^^ Dated: hj:iJ BY: PHIL BATCHELOR by 40kDeputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause, of action. Claims relating to causes of action fordeathor for injury to person or to personal property or growing crops and which accrue on or after January it 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 itis 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 Reserved for Clerk's filing stamp R E C E N E DD� Against the County'of Contra Costa DEC - 31992 or CLERK BOARD OF SUPERVISORS District) C (F ill-in name) ONTRA COSTA U0 The undersigned�claimaht,- hereby makes claim against the County of Contra Costa or the above-named District in the sum of and in support of this claim represents as follows: 1. When. did the damage or- injury occur? (Give exact date and hour) J-o Aoo 2. Whe—;zdld the. damage or injury occur? (Include ciey and county) 3. How did e damage' or injury occ&? (Give full details; use extra paper if required)&-UJad.W"- Al It,P4a&Ake. 4. What particular ac i t or omission on the part of county or district officers, servants or employees caused the injury or damage? Al J�6 (over) 7. wnat are the names of county or district officers, servants or employees causing the damge or injury? ----------------------------------------------------------.. ---__-_-_____----___ 5. What damage or. injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated account of any prospective injury or damage.) ? � _--_-______-__ ___ _—____..___..�________.__�_... $. Names and addresses of witnesses, doctors and.-hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT get' zRWO .�� �!� �f�� x.3,:5 S�d =��a.��ce �" • Gov. Code See. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES 10: (Attorney) or by some person on his.behalf.". . .. Name and Address of Attorney Claimant's Signature Address Telephone No. - _ Telephone No. 1/6 * * art N 0 T I C E luauk@EUE � Section 72 of the Penal Code provides: Z66L T 0 3 G "Every person who,' with intent to defraud, presents m�or for payment to anstate board or officer, or to an co t � r�ct board or Y � Y �s � 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. ABC 1"OWING, 1121 Lardtnr Lang MIMI% CONCORD CA 9450 r 24 Hl ur Emerrierlcy I 5 Ice S:e 1 v. �e," (51,0)'685 0$60 (5t0},944 1170 ;= DATE - 4 TIME .` REQUESTED BY, P.O NO - P..M �. NAME - .,. - PHONE ADDRESS CITY STATE ZIP - L CATIO OF VEHICLE ' �• YEAR,MAKE,MODEL- COLOR DRIVER STA LIC�PLATE NO. VEHICLE LD. - REGISTERED OWNER MILEAGE. SERVICETIME EXTRA PERSON FINISH' '•=" FINISH FINISH START -' START START' TOTAL -- TOTAL _ TOTAL - REASON FOR TOW SPECIAL EQUIPMENT El ACCIDENT ❑ABANDONED v T TIRE ❑SINGLE UNE WINCHING ❑ARREST - ❑.STOLEN CAR ❑OUT OF GAS ❑DUAL LINE WINCHING ❑UNREGISTERED ❑BREAK DOWN ❑IMPOUNDED ❑SNATCH BLOCKS y ❑TOW ZONE ny❑LOCK OUTS b ❑ ❑SCOTCH BLOCKS y H s yf SNOW REMOVAL ❑aSTART ❑ - ❑DOLLY TYPE OF TOW TOWED PER ORDER OF VEHICLE TOWED TO; }„`,. +-.IE FIRST TOW d. ❑SLING!HOIST TOW STATE POLICE ❑FLAT BED/RAMP ❑LOCAL POLICE SECONDTOW. {. ❑WHEEL LIFT. ❑OWNER ❑ ❑DEALER .• A STORAGE FROM ' + ,. TOWING CHARGE TO DAYS 0$ MILEAGE CHARGE PAID BY 1 EXTRA PERSON. DRIVERS - ❑CASH ❑CHECK, _.uc NO SPECIAL ..:., . EQUIPMENT EXP ❑CREDIT CARD ❑MC C'❑'VISA X DATE LABOR CHARGE I CC NO, STORAGE :.OPERATOR'S SIGNATURE - DATE .'TRUCK NO. SUB-TOTAL A RIZED�SI/A URE I” DATE TAX q � •VEHICLE.RME ED TO ,.�. DATE - TOTAL 3L.5J I <, 4 .. Not responsible for loss or damage to vehicle Than You-" in case of fire,theft or any other cause beyond our control.. = 25727 ;,. r r 7.26,9,'0 � TAME DATE. ' ,DORESS r � - MDSE SOLD i. MDSE RETURNED n: tio.f+:SALESMAN,!'+' t F y,,,,CUST.PO NO v.`. ,CODE ` ✓ }air, "',,,; t CASH'•. CHARGE CASH + CREDR i p,�F` a�.** r• a: s. "" TfS, 3 x i - w t"�� #w,^'f. .:: e t+5,��` r 'x ,,;.:+F 9l'<•+ :5�S.a.<,.e;� Fa Y � ' JUAN w��REM NOAN DESCRIPTION ,� �,�°LIST �*� N�T�' �AMOUNT� r�� tat. �s" '3" i',Yarxvnr. &�,� ,x' rass g�oi ,.,; r . ' } to VFV6 l� x R• lNxr..$'Sx£+'`vr bF '�"'.11z'�##; 'P�+ d..i6Bt�r.M` a a�;x ;s'ham i., .q lam ,� - r > . " '.y:# t`skan' ,t*aa Y e N - n a "s «'i `�:' �•. SG� y, v �r y � St .��t, t tT, xra.. Ii smco Y fft •-e.`i7 z..,A+'{d`aa '�Sw Hall' �a 3 •'{U J-rr �� f` = s3 -' Y tx,,^4. n x a e+.i T[ s a '+••:syc"ctr z�F*;. .p„n 3y S4 3` r. LL: �.. y,�a y� s i��i.3'' >�tr.� 6 f/ ��0�m W. q r n E t{ t k V, k y n,i^ r �..� 3"a•..d' ''ri�'�,kt`�.izr y $i�tL3eki" r,{�z .s5 4j"v$�#t�� LSS 'nm}z�7" ;. "si r t a � ? u is t ? 'v t °.tom x i t t sra e s + t_o C) x .€d �,` -�. Iry -€i Y j �'} '� �'�mY. { 1�'• �{" �x' +�� e.,f i 5" .y.�. �"y yrs f ,f F ! D:.'C• u, e+ } N " a}� in.r "Yr yyY i -t k-ti, t 1 U�♦�� /� S.„ 1�Y .SSs L i 7Y J .L Lt � F }�} l.•R �S4 �' t 15' dVX �- i x0" x+. 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(/Ft; 3. `m�¢UDQmQt"\ m^k w5;>'w mF""i- W- Wa U.omo.mW iaQ mt - s; W N' 7 41 N 2 Z. r�•^ f x; gv,Q'.3{5 m.CI;J=�p}'O+'p(' ' �) . firf tt [ .3a. a `�•r,'� t=, pp m'migg'.E• m m m G. �o]>.m'' t l9 =.. r2,6 d t ( CY Y t z m m D H$p 1,00 41 G ¢r • ` pOO a mocco = o. , WW �. _ E W 4 m J 3. `�y\� ppT': W¢. •�' a M /� WW• P 4- m .. L J.]m�rQ�CZ�N \\: V (nZ T L V � /,. Q - Qd • N - a m q w2 aW-t9 '_ z n`��o QUO �'� JJ "� W- W.' Z O m m C Ot Z _JZ � ¢ g N _>.E>°c_5comm N¢ a� m C F,.- aMf- F _ LLL O a U �? 0Qc �\ �I Work Order Ir 40-" WHOLESALE No_ 4408 TIRE CENTER PRICING Tire Shop Hours: #40-Martinez,CA M-F—10:30-8:00 THIS PORTION TO:BE COMPLETED BY MEMBER: Sat.-9:30 6:00 .. ... Sun.-10:00-5:00. Name Address ` �i.i//OG1 Ole C.`y /����P✓�f/1/�? State c�'" Zip Phone 76 Membership# �� Make of Vehicle /���'� �'`Pf/ Model ��� Year Vehicle License# - Color Ti 1S PORTION TO BE COMPLETED BYTIRE SALES PERSON: SLIP PRINT " TY ITEM# DESCRIPTION AMOUNT (Must be accompanied by Date h �` L Q PER TIRE register receipt to be valid.) 4. Tire Mfg£ = Lifetime Balance and Rotation— includes mounting Type,.: �( Per wheel on same wheel Price iriaudli tA`dis Sizesi 'fee 2 6850 Auto $5.50 Salesper. 6861 LightTruck/Van 87.25 X205/70RIMS 72.99 � h air pressure Motorhome&Dual Wheels: 6857 ; (16.5 and smaller) $9.25 X245/70RISMS 72,99_ Frani Rear 7 83343 F84" D.0 s covered under lifetime No 6850 bah e&rotate:-and Road Hazard if Battery installation Charge 28.00 accepted + . - Road Hazard Warranty iiALAhtC . 11.00E'. 285.50 �;�n^ 8225 ROAD HAZARD ACCEPTED= $1.00 ROAD HAZARD 2.04E ?j 3.� See reverse fordetails $225 Covers,non-repairable'road hazards 231.00 must be purchased at time of tire purchase 171.02 TOTAL 0 ROAD HAZARD"DECLINED— 5913 1414 b.15Pi� (Customer must initial) Q ROAD HAZARD ADJUSTMENT— Mount/Balance no charge THIS PORTION TO BE COMPLETED BY TIRE SHOP: Time In: Time Out: Work Time Mileage Warehoute#doing work if other than above WORK TO BE DONE: \ Vehicle Condition& (" Body Condition: ` r Special information: MISSING: Ll S TOvt► �. . ( fff---��� L/F R/F ;❑ Haps ❑ R/F LjR R/R ❑ C-Caps ❑ L/F •All claims and returned goods must be accompanied by this bill and register receipt. O ❑ Brings ❑ R/R •Costco is not responsible for articles left in vehicle. ❑ L-Nuts ❑ L/R •Retighten lug nuts after first 25 miles of mounting. ❑ None •The~customer is responsible for correct tire sizes,performance and speed ratings as ❑Best to Spare recommended by the vehicle manufacturer. Costco is not responsible for damage of any ❑Static []Dynamic D CUtOmer keeps tlre(s) r,.._, kind caused by the mounting of non-standard tire sizes,performance&speed ratings. ❑Blackwall Out I have read the above conditions and information and hereby consent. El Whitewall/WL Out 0 Carry in nms" t, ya _- Work Done By: / v� Off Mount a1lance On Spare Torque Customer approval for work to be done. White-Customer copy Yellow-Tire Shop/Sales Audit copy Pink-Front End copy/Sales Audit JIM, `_�4 n�P i r 7 i • THIS PORTIQN"TO'BE OMPLETED BY TIRE SALES PERSON t .. AMOUNT SLIP PRINT Date •'- `�. QTY ITEM# DESCRIPTION !Must be accompanied by PER TIRE register receipt to be valid.) Tire Mfg. L Lifetime:Balance and Rotation— Includes mounting Type x Per wheel on same wheel Size Price includes CA disposal flee 68501 Auto $5.50 Salespe. 1 6861 Light Truck an $7.25 N X2u5/74R151S 72,99 Reei78334 f► air pressure Motorhome&Dual Wheels: (16.5 and smaller) $9.25 X205/70RISMS 72.99 intlil Rear . 78334 b �.._ � _ _6$4 .,—....__Rim swap. _ _.., __..x _ $5.50 T.IRESMOR _- .00 D.0 s covered under lifetime 6830. bafa e&rotate,and Road Hazard if Battery installation Charge 28.00 accepted.'.. BALABC , 11.001 2 Road Hazard Warranty 2135.50 8225 ~" ROAD HAZARD ACCEPTED— $1.00 ROAD HAZARD 2.001 See reverse fordetails 8225 Coversnon-repairable road hazards 281.00 7 must be.purchased at:time of tire purchase 171.02 TOTAL ROAD HAZARD'DECLINED— 5913 14.14 6.15PM (C006mer must initial) [� ROAD HAZARD'ADJUSTMENT— Mount/Balance no charge THIS PORTION TO BE COMPLETED BY TIRE SHOP: ' Time In: Time Out: Work Time Mileage Wareftouise#doing work if other than above t WORK TO BE DONE: Vehicle Condition& Body Condition: ` e Special Information: ` QL F R/F MISSING: L�Sl✓irL7 cL •""" ci' C O ❑ H-Caps ❑ R/F Caflk r Mo L/R R/R ❑ C-Ceps 0 L/F ®All claims and returned goods must be accompanied by this bill and register receipt. O ❑ &rings ❑ RIR a Costco is not responsible for articles left in vehicle. ❑ L-Nuts ❑ L/R ®Retighten lug nuts after first 25 miles of mounting. ❑ None •The customer is responsible for correct tire sizes,performance and speed ratings as ❑Best to Spare recommended by the vehicle manufacturer. Costco is not responsible for damage of any ❑Static ❑Dynamic ❑ Cutamer keeps tire(sa F" ;,,, kind caused by the mounting of nonstandard tire sizes,performance&speed ratings. ®'I have read the above conditions and information and hereby consent. ❑Blackwall Out ,._. ❑Whitewall/WL Out Carry in rims Work Done By: Off cunt Balance n pyre orque Customer approval for work to be done. White-Customer copy Yellow-Tire Shop/Sales Audit copy Pink-Front End copy/Sales Audit n ! 'I I i i � �'t•, _ .�, Esq .. � I If u ' t � � t f _II I r� x t Z,le�le ZY� r i ' costoo. Work Order NQ 40.- _ WHOLESALE N_ 4408 TIRE CENTER PRICING Tire Shop Hours: #40-Martinez,CA M-F-10:30-8:00- THIS'PORTION TO BE COMPLETED BY MEMBER: Sat.—9:30-6:00 �Q Sun.-10:00-5:00 Name Zee- � Z Address ..3�� City ���'�-� � State zip J"7�� Phone 76 Membership# �� Make of Vehicle /��e'����/ Model Year Al�� a 3u 3SY3 6d :u3w SNO3 Ill j3IION rsnn:aµln aDlauheH a�ppntat{.. 117t iCQ'0.4J gU �„ oaz F m wy O I 7 U W U N r a W W a N W - 'd QQ U rw m a d ¢ Wa w J U Uti Na Nr tL? a3 ar Nm a3 m? cr .S I ¢ Q y� W •:e�. Q aCC N W Q 01 ?j X d N yam{ � �`f� Q a vJi O H U 0 cn ez o y CG X ►: g' .X v C i z w 00 4 v a �!} cl r ,ct{` •4 J g U sui U = t t] a ® ) o °.10. 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L•d$" r ftY a,'a CI 0 '��": ITL S � � T •)ITr is * � z f�t� �'° � �+ �j� y �,p q� r� Q¢ ROJ1VED CLAIM DEC 91992 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY ODUNM 4WINE& am% Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 5 -', 1993 and Board Action.' All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CAMPBELL, Robert ATTORNEY: Michael N. Padway Padway & Padway Date received ADDRESS: A Professional Corporation BY DELIVERY TO CLERK ON December 4, 1992 One Kaiser Plaza, Ste. 1930 Oakland, CA 94612 BY MAIL POSTMARKED: December 3, 1992 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 7, 1992 JaIL DeputELOR, Clerk y II. FROM: . County Counsel TO: Clerk of the Board of Supervisors ( 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 isnot timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: J Dated: ,/��� /� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (VrThis Claim is rejected 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. Dated: JA5 19AA PHIL. BATCHELOR, Clerk, By Q40AAIL, 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 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 & certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JAN 8 W' 1993 BY: PHIL BATCHELOR by ° Deputy Clerk r... FM 4 CC: County Counsel County Administrator 1 MICHAEL N. PADWAY, ESQ. RECENED PADWAY & PADWAY 2 One Kaiser Plaza, Suite 1930 DEC - 4 1992 Oakland, CA 94612 3 (510) 839-7999 1 1CLERK B0-A--RDOF SUPERVISORS 4 Attorney for Plaintiff CONTRACOSTACO. 5 6 7 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA 8 9 10 ROBERT CAMPBELL, 11 Claimant, 12 V• CLAIM AGAINST GOVERNMENTAL ENTITY 13 BOARD OF SUPERVISORS, 14 COUNTY OF CONTRA COSTA, 15 Defendant. 16 17 18 CLAIM AGAINST GOVERNMENTAL ENTITY 19 (Government Code 910 et seq. ) 20 a. The name and address of claimant is: 21 Robert Campbell 42 Chantilly Pl. 22 Oakley, CA 94561 23 b. The post office address to which. claimant desires 24 notice to be sent: 25 26 c/o Michael N. Padway Padway & Padway 27 A Professional Corporation One Kaiser Plaza, Suite 1930 28 Oakland, California 94612 1 C. The date, place and other circumstances of the 2 occurrence or transaction which gave rise to the claim 3 asserted: 4 Claimant was assaulted on July 13, 1992 by an inmate of Merrithew Memorial 5 Hospital in Martinez who was known by them to be dangerous. Due to the failure of Merrithew 6 Memorial Hospital and its staff and employees, the inmate, who was suffering, from and being 7 treated for psychological disturbance, got 8 loose and attacked claimant. 9 d. general description of the indebtedness, 10 obligation, injury, damage or loss incurred so far as it may 11 be known at the time of presentation: 12 Claimant received personal injuries as a 13 result of the attack, which required and will in the future require treatment. Claimant has 14 incurred and will in the future incur medical and related expenses. Claimant has incurred 1.5 and will in the future incur loss of income and earnings. 16 Claimant's primary injury is to his back, 17 and the incident aggravated pre-existing pathology in the back. Insofar as they are 18 known, special damages are: 19 Medical expenses totalling: $1, 306. 00. 20 Earning loss to date totalling: $6, 000. 00. Future medical expense and earnings loss 21 cannot be calculated at present. 22 General damages including pain and suffering in the amount of $1,500, 000 or according to 23 proof at trial. 24 e. The name or names 'of the public employee or employees 25 causing the injury, damage, or loss, if known: 26 27 Unknown at this time. 28 2 - 1. f. The amount claimed if it totals less than ten 2 thousand dollars ($10, 000. 00) as of the date of presentation 3 of the claim, including the estimated amount of any 4 prospective injury, damage, or loss, insofar as it may be 5 known at the time of the presentation of the claim, together 6 with the, basis of computation of the amount claimed. If the 7 amount claimed exceeds ten thousand dollars, ($10,000-00) , 8 no dollar amount shall be included in the claim. However, 9 it shall indicate whether jurisdiction over the claim would 10 rest in municipal or superior court. 11 12 The amount of this claim exceeds ten thousand- dollars, and jurisdiction over the claim is 13 anticipated to rest in the Superior Court. 14 15 Dated: December 3, 1992 . 16 PADWAY & PADWAY 17 18 000, 19 BY: 4 Michael N. Padway 20 21 22 23 24 25 26 27 28 3 2 PROOF OF SERVICE BY MAIL - CCP 1013(a) , 2015.5 3 4 I, Jane Scrivener, declare under penalty of 5 perjury as .follows: 6 7 I am a citizen of the United States, over the g age of eighteen ,years and not a party to the 'Within g action. I am employed in the City of Oakland, County of 10 Alameda, mybusiness address is Padway & Padway, One 11 Kaiser Plazla, Suite 1930, Oakland, California 94612 . 12 13 On of , I served a copy of the 14 attached document by placing copies thereof in envelopes 15 addressed to the following at their respective addresses, 16 postage prepaid and deposited in the United States mail at 17 Oakland, California: 1$ Document: 19 Clerk of the 20 Board of Supervisors County of Contra Costa 21 651 Pine Street Martinez, CA 94553 22 23 Executed on , at Oakland, California. 24 , 25 Jane rivener 26 27 28 1 MICHAEL N. PADWAY, ESQ. RECEIVED PADWAY & PADWAY 2 One Kaiser, Plaza, Suite 1930 DEC r 419W Oakland, CA 94612 3 (510) 839-7999 CLERK BOARD OF SUPERVISORS 4 Attorney for Plaintiff ° c0s1ACO. 5 6 7 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA 8 9 10 ROBERT CAMPBELL, ) ) 11 Claimant, ) 12 V. ) CLAIM AGAINST } GOVERNMENTAL ENTITY 13 ) COUNTY OF CONTRA COSTA, ) 14 ) Defendant. ) 15 ) 16 17 CLAIM AGAINST GOVERNMENTAL ENTITY 18 (Government Code 910 et seq. ) 19 a. The name and address of claimant is: 20 Robert Campbell 21 42 Chantilly Pl. Oakley, CA 94561 22 23 b. The post office address to which claimant desires 24 notice to be sent: 25 c/o Michael N. Padway 26 Padway & Padway A Professional Corporation 27 One Kaiser Plaza, Suite 1930 Oakland, California 94612 28 1 1 C. The date, place and other circumstances of the 2 occurrence or transaction which gave rise to the claim 3 asserted: 4 Claimant was assaulted on July 13, 1992 by an inmate of Merrithew Memorial . 5 Hospital in Martinez who was known by them to be dangerous. Due to the failure of Merrithew 6 Memorial Hospital and its staff and employees, the inmate, who was suffering from and being 7 treated for psychological disturbance, got loose and attacked claimant. 8 d. A general description of the indebtedness, 9 obligation, injury, damage or loss incurred so far as it may 10 be known at the time of presentation: 11 12 Claimant received personal injuries as a 13 result of the attack, which required and will in the future require treatment. Claimant has 14 incurred and will in the future incur medical and related expenses. Claimant has incurred 15 and will in the future incur loss of income and earnings. 16 Claimant's primary injury is to his back, 17 and the incident aggravated pre-existing pathology in the back. Insofar as they are 18 known, special damages are: 19 Medical expenses totalling: $1, 306. 00. Earning loss to date totalling: $6, 000. 00. 20 Future medical expense and earnings loss 21 cannot be calculated at present. 22 General damages including pain and suffering in the amount of $1,500,000 or according to 23 proof at trial. 24 e. The name or names of the public employee or employees 25 causing the injury, damage, or loss, if known: . 26 27 Unknown at this time. 28 2 1 f. The amount claimed if it totals less than ten 2 thousand dollars ($10,000.00) as of the date of presentation 3 of the claim, including the estimated amount of any 4 prospective injury, damage, or loss, insofar as it may be 5 known at the time of the presentation of the claim, together 6 with the basis of computation of the amount claimed. If the 7 amount claimed. exceeds ten thousand dollars, ($10,000.00) , $ no dollar amount shall be included in the claim. However, 9 it shall indicate whether jurisdiction over the claim would 10 rest in municipal or superior court. 11 12 The amount of this claim exceeds ten thousand dollars, and jurisdiction over the claim is 13 anticipated to rest in the Superior Court. 14 15 Dated: December 3, 1992. 16 PADWAY & PADWAY 17 18 BY: 19 Michael N. Padway 20 21 22 23 24 25 26 27 28 .. 3 1 2 PROOF OF SERVICE BY MAIL - CCP 1013 (a) . 2015.5 3 4 I, Jane Scrivener, declare under penalty of 5 perjury as follows: 6 7 I am a citizen of the United States, over the 8 age of eighteen years and not a party to the w. th3n 9 action. Lam employed in the City of Oakland, County of 10 Alameda, my business address is Padway & Padway, One 11 Kaiser Plaza, Suite 1930, Oakland, California 94612 . 12 13 On 3, / � , I served a copy of the 14 attached document by placing copies thereof in envelopes 15 addressed to the following at their respective addresses, 16 postage prepaid and deposited in the United States mail at 17 Oakland, California: 18 19 Document: 20 Clerk of the Board of Supervisors 21 County of Contra Costa 651 Pine Street 22 Martinez, CA 94553 23 ! f Executed on at Oakland, 24 California. 25 26 Jane tbrivener 27 28 Q en •"1} co 41 w ri) o Com? cn > N as .4 41 cn w w 4A o w 0 0 >,H 4 P4 U Pq C3 ',o F O +,, a Vn 0 CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY RECEIVE MARTINEZ, CALIFORNIA DEC 1 41992 MEMORANDUM CLERK BOARD OF SUPERVISORS CGNITR,a COSTA CO. Date: December 11, 1992 TO: Clerk of the Board of Supervisors FROM: Victor 'J. Westman, County Counsel By: Gregory C. Harvey, Deputy County Counsel R$: Padway claim i Attached is a claim received by Health Services and forwarded to ouri,office. a RECENED errithew DEC 08 1992 emorial A N Oo W01MR3 D CLINICS RECEIVED December 4, 1992 DEC 1 41992 CLERK BOARD OF SUPERVISORS CW,!TRA CCOST, CO. Office of County Counsel Contra Costa County Re: Robert Campbell The attached claim for the above named patient was received by regular mail on 12/4/92 at the hospital. Mark Finucane Health Services Director enc xc: Ron Harvey 's Contra Costa County spa�_UKTi A-301A (3/87) 1 MICHAEL N. PADWAY, ESQ. PADWAY & PADWAY RECEIVED 2 One Kaiser Plaza, Suite 1930 Oakland, CA 94612 3 (510) 839-7999 DEC 1 41992 4 Attorney for Plaintiff CLERK BOARD OF SUPERVISORS 5 CONTRA COSTA CO. 6 7 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA 8 9 10 ROBERT CAMPBELL, ) } 11 Claimant, ) 12 V. } . . CLAIM AGAINST }. GOVERNMENTAL ENTITY 13 } Merrithew Memorial Hospital ) 14 and Clinics; et al. ) } 15 Defendant.- .16 efendant._16 1 17 18 CLAIM AGAINST GOVERNMENTAL ENTITY 19 (Government Code 910 et seq. ) 20 a. The name- and address of claimant is: 21 Robert Campbell 42 Chantilly P1. 22 Oakley, CA 94561 23 b. The post office address to which claimant desires 24 notice. to be sent: 25 26 c/o Michael N. Padway Padway & Padway . 27 A Professional Corporation ., One Kaiser Plaza, Suite 1930 ,. 28 Oakland, California 94612 _ 1 _ 1 C. The date, place and other circumstances of the 2 occurrence or transaction which gave rise to the claim 3 asserted: • 4 Claimant etas ;assaulted on July 13, 1992 by an inmate of Merrithew Memorial 5 Hospital in Martinez who was known by them to be dangerous. Due :to the failure of Merrithew 6 Memorial Hospital'7and its staff and employees, the inmate, who was suffering. from and being 7 treated for, .•psychological disturbance, got loose and attacked claimant. 8 d. A general description - of the indebtedness, 9 obligation, injury, damage or loss incurred so far as it may 10 be known at the time of presentation: 11 12 Claimant received personal injuries as a 13 result of the attack, which required and will in the future require treatment. Claimant has 14 incurred and will in the future incur medical and related expenses. Claimant has incurred 15 and will in the future incur loss of income and earnings. 16 Claimant's primary injury is to his back, 17 and the incident aggravated pre-existing pathology in the back. Insofar as they are 18 known, special damages are: 19 Medical expenses totalling: $1, 306. 00. Earning loss to date totalling: $61000: 00. 20 Future medical expense and earnings loss 21 cannot be calculated at present. 22 General damages including pain and suffering in the amount of $1,500, 000 or according to 23 proof at trial. 24 e. The name or names of the public employee or employees 25 causing the injury, damage, or loss, if known: 26 27 Unknown at this time. 28 2 - 1 f. The amount claimed if it totals less than ten 2 thousand dollars ($10,000.00) as of the date of presentation 3 of the claim, including the estimated amount of any 4 prospective injury, damage,. or loss, insofar as it may be 5 known at the time of the presentation of the claim, together 6 with the basis of computation of the amount claimed. If the 7 amount claimed exceeds ten thousand dollars, ($10,000-00) , 8 no dollar amount shall be included in the claim. However, 9 it shall indicate whether jurisdiction over the claim would 10 rest in municipal or superior court. 11 12 The amount of this claim exceeds ten thousand dollars, and jurisdiction over the claim is 13 anticipated to rest in the Superior Court. 14 15 Dated: December 3, 1992 . 16 PADWAY & PADWAY 17 18 10 19 BY: Ax" Michael'61�. Padway 20 21 22 23 24 25 26 27 28 3 2 PROOF OF SERVICE BY MAIL CCP 1013 (a) . 2015.5 3 4 I, Jane Scrivenerr, declare under penalty of 5 , perjury as follows: 6 7 1 am a citizen of the United States, over the 8 age of eighteen years and not a party to the within 9 action. I ,am employed in the City of Oakland, County of 10 Alameda, my business address is Padway & Padway, One 11 Kaiser Plaza, Suite 1930, Oakland, California 94612. 12 13 On 1�4 I served a copy of the 14 attached document by placing copies thereof in envelopes 15 addressed to the following at their respective I addresses, 16 postage prepaid and deposited in the United States mail at 17 Oakland, California: 18 Document: 19 L/ 20 Merri'thew Memorial Hospital and Clinic 21 Risk Management Department 2500 Alhambra Avenue 22 Martinez, CA 94553 23 Executed on Zfl,7,, at Oakland, 24 California. 25 26 —4i' Jane sc ivener 27 28 irk waauaus... • 11�f�.y� i. : 1 ct 4J 1I11�u � j 1r1 t 1 2 i r j o j_ CI +) p •rl W C14 U) +� o �+ - x a. ri W r M cd A W cr) r I P to +-+ d �t o G ON E� W w U b0 3 •r•I cd cd � = W r. G ,C N 4-) •r� U •r-I �4 x o +J aa) G co o� ro N C4 N " N ; C7) r. C3c� .1 , C� O A a A U co ti cd o cd w c0 1 d 3 C> 'n o corn d �ou) erritew emonal UQ5P0tVad ao DEC p g �gg2 December 4 , 1992 Office of County Counsel Contra Costa County Re: Robert Campbell The attached claim for the above named patient was received by regular mail on 12/4/92 at the hospi al. Mark Finucane Health Services Director R CEN enc DEC -IR 1992 I'"c: Ron Harvey CLERK BOARD OF SUPERVISORS CONTRA COSTA CO, syn_ s Contra Costa Count �O.... emi". A_3M A 11/R71 1 MICHAEL N. '!PADWAY, ESQ. PADWAY & PADWAY 2 One Kaiser Plaza, Suite 1930 Oakland, CA 94612 3 (510) 839-7999 4 Attorney for Plaintiff 5 6 7 . SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA 8 9 10 ROBERT CAMPBELL, } } 11 Claimant, } } 12 V. ) CLAIM AGAINST GOVERNMENTAL ENTITY 13 ) Merrithew Memorial Hospital } 14 and Clinics, et al. ) 15 Defendant. ) 16 17 18 CLAIM AGAINST GOVERNMENTAL ENTITY 19 (Government Code 910 et seq. ) 20 a. The name and address of claimant is: 21 Robert Campbell 42 Chantilly P1. 22 Oakley, CA 94561 23 b. The', post office address to which claimant desires 24 notice to be sent: 25 26 c/o Michael N. Padway Padway & Padway 27 A Professional 'Corporation One Kaiser Plaza, Suite 1930 28 Oakland, California 94612 1 f ' 1 C. The date, place and other circumstances of the 2 occurrence or transaction which gave rise to the claim 3 asserted: 4 Claimant was assaulted on July 13, 1992 by an inmate of Merrithew Memorial 5 Hospital in Martinez who was known by them to be dangerous. Due to the failure of Merrithew 6 Memorial Hospital and its staff and employees, the inmate, who was suffering from and being 7 treated for psychological disturbance, got loose and attacked claimant. 8 d.. A general description of the indebtedness, 9 obligation, injury, damage or loss incurred so far as it may 10 be' known at the time of presentation: 11 12 Claimant received personal injuries as a 13 result of the attack, which required and will in the future require treatment. Claimant has 14 incurred and will in the future incur medical and related expenses. Claimant has incurred 15 and will in the future incur loss of income and earnings. 16 Claimant's primary injury is to his back, 17 and the incident aggravated pre-existing pathology in the back. Insofar as they are 18 known, special damages are: 19 Medical expenses totalling: $1, 306. 00. Earning loss to date totalling: $6, 000. 00. 20 Future medical expense and earnings loss 21 cannot be calculated at present. 22 General damages including pain and suffering in the amount of $1, 500,000 or according to 23 proof at trial. 24 e. The name or names of the public employee or employees 25 causing the injury, damage, or loss, if known: 26 27 Unknown at this time. 28 2 - 1 f. The amount claimed if it totals less than ten 2 thousand dollars ($10, 000. 00) as of the date of presentation 3 of the claim, including the estimated amount of any 4 prospective injury, damage, or loss, insofar as it may be 5 known at the time of the presentation of the claim, together 6 with the basis of computation of the amount claimed. If the 7 amount claimed exceeds ten thousand dollars, 8 no dollar amount shall be included in the claim. However, 9 it shall indicate whether jurisdiction over the claim would 10 rest in municipal or superior court. 11 12 The amount of this claim exceeds ten thousand dollars, and jurisdiction over the claim is 13 anticipated to rest in the Superior Court. 14 15 Dated: December 3, 1992 . 16 PADWAY & PADWAY 17 18 19 BY: . Padway 20 21 22 23 24 25 26 27 28 3 - M 1 2 PROOF OF SERVICE BY MAIL - CCP 1013 (a) , 2015.5 3 4 I, Jane Scrivener, declare under penalty of 5 perjury as follows: 6 7 I am a citizen of the United States, over the 8 age of eighteen years and not a party to the within 9 action. I am employed in the City of Oakland, County of 10 Alameda, my business address is Padway & Padway, One 11 Kaiser Plaza, Suite 1930, Oakland, California 94612 . 12 13 On A, I served a copy of the 14 attached document by placing copies thereof in envelopes 15 addressed to the following at their respective addresses, 16 postage prepaid and deposited in the United States mail at 17 Oakland, California: 18 19 Document: Yw/i u 20 Merri thew Memorial Hospltal and Clinic` 21 Risk Management Department 2500 Alhambra Avenue 22 Martinez, CA 94553 23 �p Executed on I , at Oakland, 24 California. 25 26 Jane ScVivener 27 28 RECEIVED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA DEC 9 1992 COUNTY COUNSg Claim Against the County, or District governed by) BOARD ACTIONLMNIM a" the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 5, 1993 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1050.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CARR, Rufus Kendall E. Hobbs ATTORNEY: Law Offices of Adams & Hobbs Date received ADDRESS: 1390 Taylor Street, Suite 21 BY DELIVERY TO CLERK ON December 3; 1992 San Francisco, CA 94108 BY MAIL POSTMARKED: via County;-Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. e g DATED: December -_7, 1992 BUIL BATCHELOR, Clerk eputy II. FROM: County Counsel TO: Clerk of the Board of S&Misors ( ✓) 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: q 9 Z BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD/ORDER: By unanimous vote of the Supervisors present (VI This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. �1 Dated: JAN 5 � 199 PHIL BATCHELOR, Clerk, B ndANA 01 JJA,000° , 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. Dated: JAN 8k, 1993 BY: PHIL BATCHELOR by J AAAJ Deputy Clerk CC: County Counsel County Administrator CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY R� �® MARTINEZ, CALIFORNIA ,DEC 319 MEMORANDUM p OF SUPERVISORS CIF. MA COSTA CO• Date: December 3, 1992 TO: Clerk of the Board, Attention Jeannie FROM: Victor J. West pan, County Counsel By: Gregory C Harvey, Deputy County Counsel RE: Claim of Rufus Carr We were reviewing a file regarding procedures for the abatement of vehicles and found the attached claim. I have checked with Risk Management and with the 92 index of the claims and this claim doesn't appear to have been sent to you by the Building Inspection Department. I am sending it to you for filing and processing. LAW OFFICES ADAMS & Hm3iBs J fl�r 8 f 1390 TAYLOR STREET, SUITE 21 -V lt� RICHARD MADAMS SAN FRANCISCO,CALIFORNIA 94108 ALL E.HOBBS TELEPHONE 771-6145 AtIG I C) August 14, 1992 RECEIVE® Contra Costa County X11 Attn: Mickey Perez Building Inspection/Housing Dept. DEC 31992 651 Pine Street, 4th Floor Martinez , California 94553-1295 CLERKgOAR 1 OF SUPERVISORS CONTRA COSTA Co. RE: CLAIM OF RUFUS CARR Dear Ms. Perez: On July 30, 1 talked on the phone with Mr. Clyde Beard of your department, and the next day with you about the loss by Mr. Rufus Carr of his 1975 automobile, California license 421ZOT which was given a tow slip by your department and junked by the auto wreck- er who towed it. All this was done without any notice to Mr. Carr. When he learned on July 1.4 , that the car had been towed, he phoned Mr. Beard and phoned again on July 15. Getting no response Mr. Carr phoned for Mr. Beard, I believe, on July 25, and again on July 27. The call was returned later and Mr. Carr was told that the vehicle had been junked. A June 22, 1992, NOTICE OF ATTEMPT TO ABATE ABANDONED VEHICLE was delivered to a person known as Rickey on July 7, and Mr. Carr's sister-in-law, Elro, learned of the Notice on that same day. The Notice cites the registered owner as Elro Carr, the location of the vehicle as 525 Verde Avenue, Richmond, and the owner of the land on which it was located as Edgar and Dorothy Madden. These data are false. You and Mr. Beard undertook to send me some material bearing on the notice given, but it has not arrived. Apparently, Mr. Beard was informed by the Maddens that there was no vehicle on their property, but no attempt was made to give Mr. Carr notice. Mr. Beard cited Vehicle Code Section 22669 as authority to have the vehicle removed from private property following a determination of abandonment pursuant to Vehicle Code Section 22523 . Vehicle Code Section 22523 forbids abandonment of a vehicle on a highway, on public property or on private property without the owner's consent. There was no lack of consent by the property owner in this case; the Maddens, who were given notice, owned a different piece of property. Contra Costa county August 14, 1992 Page 2 Vehicle Code Section 22669 allows removal of abandoned vehicles by persons who have been granted authority (which apparently Mr. Beard was not) only after the mailing or personal delivery of a report to the CHP office nearest the vehicle. Authority was thus lacking for the removal and junking of the vehicle. Pursuant to Government Code Section 910, you are given the following information: 1. The claimant is Mr. Rufus Carr (507 - 11th Avenue, San Francisco, CA 94118) ; 2. Correspondence intended for him should be sent to our address which is on the letterhead; 3 . The vehicle was towed on or about July 7, 1992, and apparently junked prior to July 15. The circumstances are set forth above. 4. The vehicle junked was worth approximately $750; tools and other personal property in the trunk are valued at $300; 5. Mr. Clyde Beard is the only known public employee involved in this matter; 6. The amount claimed is based on Mr. Carr's knowledge of what he spent for the automobile and other personal property, and his estimate of what it would cost to replace them in their condition existing in early July, 1992. Please give favorable consideration to this $1,050 claim. Very truly yours, ADAMS & HOBBS Kendall E. Hobbs KEH:mfh cc: Mr. Rufus Carr CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA RECEIVE® Claim Against the County, or District governed by) BDE ATW 9 9 2 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 'Jj�1i�''�•b&-itr 1993 and Board Action. All Section references are to The copy of this document mailed to you McONX GALfte of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Undetermined Section 913 and 915.4. Please note all "Warnings". CLAIMANT: CITY OF CONCORD and OFFICER LARRY LEE ATTORNEY: Louis A. Leone, Esq. Stubbs , Hitti & Leone Date received ADDRESS: g BY DELIVERY TO CLERK ON December 8 , 1992 (certified Fox Plaza, Suite 818 1390 Market Street BY MAIL POSTMARKED: December 7 , 1992 San Francisco, CA 94102 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 14 1992 HHIL BATCHELOR, Clerk DATED: l: 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: 11. rl `I q 7 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 OR ER: By unanimous vote of the Supervisors present I ( ) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JAN 5 , �gg� 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 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 1 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. 0 Dated: JAN 8 Edi 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator 1 LAW OFFICES STUBBs, HITTIG & LEONE A PROFESSIONAL CORPORATION GREGORY E.STUBBS TELECOPIER FOX PLAZA,SUITE 818 H. CHRISTOPHER HITTIG (415) 861-6700 LOUIS A.LEONE SAN FRANCISCO 94102-5399 (415) 861-8200 1 7[0EC EIVE® g W2December 7, 1992 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. VIA CERTIFIED MAIL Clerk of the Board of Supervisors 651 Pine Street Martinez, California 94553 Dear Sir/Madam: Enclosed please find a Governmental Claim brought by the City of Concord and Officer Larry Lee, pursuant to Government Code Section 910. Very truly ours, LOUIS A. LEONE LAL: jb Enclosure cc: Peter T. Edrington, Esq. (w/encl. ) Jenks\CvrLtr.GC RECEIVED LOUIS A. LEONE, ESQ. (CSB #099874) 2 STUBBS, HITTIG & LEONE DEC 81992 A Professional Corporation 3 Fox Plaza, Suite 818 1390 Market Street CLERK BOARD O SSUPERVIS 4 San Francisco, California 94102 CONTRA COSTA CO. (415) 861-8200 5 Attorneys for Claimants, 6 CITY OF CONCORD and LARRY LEE 7 8 9 IN THE UNITED STATES DISTRICT COURT 10 NORTHERN DISTRICT OF CALIFORNIA 11 12 MICHAEL L. JENKS, DEBRA JENKS, NO. C 92-3747-EFL individually and as GUARDIAN AD 13 LITEM for GENE DONALD SMITH, CLAIM AGAINST THE COUNTY A MINOR, OF CONTRA COSTA; CHILD 14 PROTECTIVE SERVICES OF Plaintiffs, THE COUNTY OF CONTRA COSTA 15 PURSUANT TO CALIFORNIA v. GOVERNMENT CODE §901, ET, 16 SEQ. 17 LOUISE HULL, DIANA MURDOCH and FRAN CLARK, individually and as 18 Social Workers of CONTRA COSTA COUNTY CHILD PROTECTIVE SERVICES, 19 JAMES A. RYDINGSWORD, PERFECTO VILLARREAL, Officer LARRY LEE, 20 individually and as an Officer of the CONCORD POLICE DEPARTMENT, 21 CONTRA COSTA COUNTY CHILD PROTECTIVE SERVICES and the 22 CONCORD POLICE DEPARTMENT, 23 Defendants. 24 1. The name and post office address of the claimant is 25 the CITY OF CONCORD, 1950 Parkside Drive, Concord, California, and 26 Officer LARRY LEE, also at 'that address. GOVERNMENTAL - 1 - CLAIM 1 2 . The post office address to which the individuals 2 presenting the claim desire notices to be sent to the law firm of 3 Stubbs, Hittig & Leone, 1390 Market Street, Suite 818 , San 4 Francisco, California 94102-5399. 5 3 . The date, place and circumstances of the occurrence 6 or transaction which gave rise to this claim are as follows: 7 On or about October 13 , 1992 , plaintiffs Michael Jenks, 8 Debra Jenks, individually and as Guardian Ad Litem for Gene Donald 9 Smith, a minor, filed a complaint in the United States District 10 Court, Northern District of California, which named the CITY OF 11 CONCORD and its police officer, LARRY LEE, as defendants. The 12 allegations contained within the First Amended Complaint alleged 13 that as a result of the conduct of various employees of the County 14 of Contra Costa, and its Child Protective Services unit, plaintiffs 15 suffered damages and injuries. 16 The allegations contained within the complaint serves as 17 a basis of a claim of equitable and implied indemnity by the CITY 18 OF CONCORD and its police officer, LARRY LEE, against the Contra 19 Costa County Child Protective Services, and the County of Contra 20 Costa. Specifically, if any liability is extended to the CITY OF 21 CONCORD and its police officer, LARRY LEE, it would be a result of 22 and as a proximate cause of the conduct of the Contra Costa County 23 Child Protective Services, and the County of Contra Costa. 24 4 . A general description of the indebtedness, 25 obligation or injury, as it relates to this particular claim, 26 relates to a claim for indemnity by the CITY OF CONCORD and its GOVERNMENTAL - 2 - CLAIM i police officer, LARRY LEE, against the Contra Costa County Child 2 Protective Services, and the County of Contra Costa. 3 5. The names of the public. employees causing the 4 injury, damage or loss, are set forth within plaintiffs' First 5 Amended Complaint, specifically, Louise Hull, Diana Murdoch, Fran 6 Clark, James Rydingsword, and Perfecto Villarreal. 7 6 . The amount claimed as damages as of the date of 8 presentation of this claim, is for indemnity. In that regard, the 9 CITY OF CONCORD and its police officer, LARRY LEE, seek full 10 indemnity from any loss they may suffer as a result of the conduct 11 of the aforedescribed employees, the Contra Costa County Child 12 Protective Services unit, and the County of Contra Costa. 13 14 Respectfully submitted, 15 STUBBS, HITTIG & LEONE A Professional Corporatio. 16 17 Dated: December 7, 1992 18 LOU . LEONE, T SQ. At orneys for Claimants, the 19 CITY OF CONCORD and LARRY LEE 20 21 22 23 24 Jenks\Claim 25 26 GOVERNMENTAL - 3 - CLAIM W J V tM C-,j WV r O N .H 04 LO � N M Lo Pa _. 0) 4-1 " v O td H �4 I O -P4-+ fY.l N •r-I Q 41 r-I W -P U) H H w O N P4 or- a) w •� � N �4 4-) ® H r I t!1 fd fU rq CO 174 M S'do M o d�, w Z �� v Oz rn J9 J a co T ¢ ( N w 0: F U (, u Q) U. J N U a U O F- OZ N Q = m U m a Z lA x Q m o O LL m a LLZ a Q H N rr CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA RECEIVED Claim Against the County, or District governed by) D WRI id 0&2 the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT4U Y 5 , 19 93 and Board Action. All Section references are to ) The copy of this document mailed to ,ybtRTBNWoMpotice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1 , 374 . 38 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: COWARD, John ATTORNEY: Date received ADDRESS: 2815 Glenside Drive BY DELIVERY TO CLERK ON December 11 , 1992 Concord, CA 94520 BY MAIL POSTMARKED: December 10 , 1992 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 14 ,: 1992 �aIl �ep�tyLOR, Cler 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: /4g Z BYDeputy County Counsel U 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. I,� (1 Dated: ,JAN 5 M.. 1993 PHIL BATCHELOR, Clerk, 8y 00 ' 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. Dated: JAN a.0 UP BY: PHIL BATCHELOR by d Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 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 19 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 Distri -- 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 ,elaims, Penal Code Sec. 72 at the -end 'oft.this form. RE: Claim By ) Resery lrji,'s filin stamp } RECEIVED j DEC 1 1 1992, Against the County of Contra Costa ) or ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) 1 . Fill-.in name The undersigned'claiment hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 11 3'7 `t.3 S and in support of this claim represents:as follows; e5 !��"_'.a�ese-✓i CC) 1. When did the damage_or injury occur? (Give exact date and hour) QV GSM,`)ea t✓l/ maww�.. ' 2. Where did the d ...we__ age or injury occur? (Include city and county) VI C) G c d Ave tif_ C ,.s��"^ V1_ p� :.�.. ?Iconc1�C.C.C�' y AS"f"�8uL.. n 3. How did the damage or injury occur? (Give full details; use extra paper if required) -•~� see a q CA Tp\V\ e�.a .C;_ ter, 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? ? O C k vj a N u^ �I. farraCcWAe wa..y I -} 1�� a5-F \e_ -+ (over) wnat are the names of county or district officers, servants or employees causing the damage or in, ury? .. -.._._______------_------ 6.~-What-damage or• injuries do you claim resulted? (Give full extent 'of injuries or damages claimed. Attach two estimates for auto damage. 7. How Was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) -Names and addresses of witnesses, doctors and hospitals. j rv►,, \/J a++ � 32oU Var+Vwwood 7c. Apt.350.)C6mcord SCA 7yS20 C 1,4 _� �Qe�-�3 _'S_�l�, a,-cr.� �1' � 1e- ah M/1 CAIt S 23----- 9. List-the expenditures you made on account of this accident or injury: DATE ITEM Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or by some person on his- behalf." Name and Address of Attorney J r9L- Claimant's Signature C�le.v►Stde Address Co kIC40r 9 l C-4 Ll C Telephone No. Telephone No'. tp Z - 7 ) q 9 * * +t ; ;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 c5r officer, authorized to allow or pay the same if genuipe,-Pany_- 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)1 or by both such imprisonment and fine, or by imprisonment in the state ,p'r�ison`, �by 'a 'fiiie of not exceeding ten,thousand dollars ($10;000; or by both such imprisonment ,and. .fine. Civ, cDrra Awe t-vo,rcVO"Se IS buil+,. 1 Was a rc)aclnJ,. + �le --- - - L dole . _w_ e.v�_-- _ _✓�o-{-t c�c1_---a.v_�__Rv�.n1_� �. ______ �------Ao c)_ _ e.S.,d P �►-�e- __.5�-r_�,,c_t� -� h e -- ------ - ✓ar(_Qc.AC�.C_ _._ -C -._C�vi_ J_�.a.yv�a�-1 -.- -�.C� �o.✓tf G ►'fid _-_s_fcl e__o_ __v_► y__-�r_�,c i�___I_�e_� c,f_e e_vl_o - - -- -- --C�.�.o,�n�Q_._-C o!^c5--c�r��.5 �c�,.r_.�,5_ __�.-,L__ o__(.✓_ar✓L__!�►!►G�O_r • - - UP J' l5v y✓�ao ------ - v_1o.u,5(Y-an- I T 3720 t;• AU .CO * B0DY P' BAR #-AR.107867 211.0 Mi AR *;1' S'T'REET CONC()PD CA 94520 (510) 680-694 OXX 680-6961 EST=MZ�TE # 3 7 2 0 -by JON GVT. ;SON x Date: 1J.-JI-199'(2 10 36 hj Gustom�x- ir��EorxY��.t i Name COWARD, JOHN make 1.988 TOYOTA--TRUC(s... Address 281.5 (',I,FNSTI)E DR style STI) Cty St Zp CONCORD CA 94520 I, cense. ! Work Phone 682=7598 Werk: N0NV _ _Sf-1: # f=..: # DESCRIPTION F;ST PRICE T_AT:it)I2 T-'AIN'T' ; 1 REPLACE GRILLE ASSM 103.67 0.5 F 2 RLI FT BBMPER ASSM f.i•8 3 REPLACE HOOD PANEL 1 04.65 1.0 : 2.7 4 REFINISH HOOD UNDERSIDE >1-•3 j 5 REPLACE LT FENDER PANEL 70.>1_ 2.3 2.0 i 6 REFINISH LT FENDER JAMBS K EDGE 0.5 7 REPLACE LT FT CORNER LAMP ASSM 38.22 ��.. 8 BAG CAR FOR PAINT 001 0.1 9 COLOR MATCH 4 0.5 10 CLEARCOAT 1.•4 1.1 COLOR SAND h RUB 1 .0 12 BLEND PAINT 1 i�,j{S�• E13TIMATE S[TMMAItY-- T_,�i,1 r firs c:r� at tve�'�i�1''-'�'ernmss i30DY . A 6.2 @ 52.00 322.40 REF MAITRTAL, 1,97.40 FRAMF, t✓a 0.0 @ 52.00 0.00 BDY MATPRTAi, 0.00 MECH TA 0,0 (J 52.00 0.00 SUBL,FT' SERV 0.00 0.0 t 0.o a 0.00 T/'S`IO AGE 0.00 00 @ 0.00 0.00 1 GLASS PARTS r. 0.00 <r 0..0 @ 0.00 0.00 HAZARD WASTE 0.00 A; T.`,:�._T; -> -yrs, - - _. _ems �ti.Z i:,alaor 811.20 Si�btor�aJ. 1,331.45 ' TA -;rand Tot,-41 fiJ-,374.38 -° ���,:111th:�:c1►�+ Part Prices°•:Subject to Invaice ---- 1.. sAUTHORIZED AND ACCEPTED: You are hereby authoriif.d.to make the ahov jsper.lfiod repairs. ,I undP'rstand than payment in fall {` ;will he due upon release of vehicle, incturltnc additional su 1Nment)J lama r, r,h gr and''hP eb rant' ou,and(or., our p - 1 'P 9 � E Y 9 Y Y employees, ermission to operate the car, truck or veh�c}e eratn descrih�rl on s.rret, highways or elsMere,for ithe :. purpose of Testing and/or inspection. An express mechanic's lien is hereby acknowledjed on a ove car, truck or vehicle to r�.. secure the amount of repairs thereto. You wi 11 not be held responsible for loss or damage to vehicle or articles }eft in vehicle in case or fire, theft, accident or any other cause beyond your control OLD PARTS ARE JUNKED UNUSS INSTRUCTED'• hW kN•. ESTIMATE authorized Thank you for coming to our shop for your rejka.irs. �f fJ�J, i f l ii .•y Serving all of Contra Costa Area Since 1972 "Our Goal is Total Customer Satisfaction" 2001 Fremont Street ' Concord, CA. 94520 .(510);- 686-1739 f Visual Damage Quotation #4361 by STEVE KELLY on 11-11-92 #` 3'OHN COWAD � s Style Insurer Lic. Plate: Adjuster : CONCORD, CA Paint code: Appraiser: 5' Phone: 682-7598 / Prod. Dater Claimant : < . 88 TOYOTA PICKUP Rate code : STANDARD InsuredT VIN: Deductible: 0.00 Policy ;¢ Mileage: 0 Claim # # Labor Op Description Price Labor Paint L/6 P/6 Part Number ' 1 RMV/REP FRT BUMPER FACE BAR 154.40 1.8 0.0 BODY NEW ORDER FROM DEALER • 2 RMV/REP GRILLE PANEL 103.67 0.5 0.0 BODY NEW 53100-89118 3 RMV/REP HOOD PANEL 104.65 1.0 2.7 BODY NEW 53301-89119 4 REFINISH HOOD UNDERSIDE 0.00 0.0 1.3 5 RMV/REP FRT BUMPER VALANCE PANEL 26.68 0.5 0.8 BODY NEW 53911-89106 ;yY 6 RMV/REPL FENDER PANEL 70.31 2.3 2.4 BODY NEW 53802-89184 7 REFINISH L FENDER EDGE 0.00 0.0 0.5 8 REFINISH L FRT DOOR OUTSIDE 0.00 0.0 2.2 9 REPAIR L FRT DOOR SHELL 0.00* 1.5* 0.0 BODY ± 10 COVER CAR 5.00* 0.3* 0.0* BODY NEW 11 COLOR MATCH 0.00 0.0 0.5* 12 CLEAR COAT 0.00 0.0 1.0 13 HAZARDOUS WASTE DISPOSAL 5.00* 0.0 0.0 NEW ` r Y# i sf i JP f AIN` 4 r } # 436'1 863 TOYOTA PICKUP COWAD Page 2 } f Summa ry 19 BODY 7.951 50.00 395.00 PAINT MATERIALS 11.401 22.00 250.80 T NEW 469.71 T ; REFINISH 11.401 50.00 570.00 Labor ( 19.3 hrs) 965.00 Material 250.80 Price Group 469.71 , Subtotal 1685.51 Y Tax 8.250% 59.44 �d GraY1e3 Tota 1 17 4 4 . 9 5 t; ***** Parts Prices Subject to Invoice ***** * SIGNIFIES ESTIMATORS JUDGEMENT f AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above specified repairs. I understand that payment in full wiLL be ytr due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and/or your employees, permission to operate the car, truck, or vehicle herein described on streets, highways, or elsewhere for the purpose of testing ' ; and/or inspection. An express mechanic's Lien is hereby acknowledged on the above car, truck, or vehicle to secure the amount of k, repairs thereto. You wiLL not be held responsible for Loss or damage to the vehicle or articles Left in vehicle in case of fire, "! theft, accident or any other cause beyond your control OLD PARTS REMOVED FROM CAR WILL BE DISCARDED UNLESS OTHERWISE INSTRUCTED. y` •.'ac Authorized by Date Thank you for coming to MIKE'S AUTO BODY! We appreciate your business! t 4 'A. Yt i "3a ,Ads .ua. I C ?p aC '. 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Ll„ x L 00 7� �Q ow a a � CO C4 X 16 CJ � �— a O D4 a a RUJI V®® CLAIM DEC 91992 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ODJNiY GOUNSa Claim Against the County, or District governed by) BOARD ACTIOOMON94 CUR the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY .5, 1993 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $60,000 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HENRY, Ethel HENRY, Marie ATTORNEY: John Diaz Coker, Esq. Coker & Ramirez Date received ADDRESS: 525 Marina Blvd. BY DELIVERY TO CLERK ON December 4, 1992 Pittsburg,. CA 94565 BY MAIL POSTMARKED: hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 7, 1992: PPHHIL BATCHELOR, Clerk DATED: Bl': Deputy II. FROM: County Counsel TO: Clerk of the Board of Su-Mr-visors ( tX This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). { ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ' ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. { ) Other: I certify that this is a'true and correct copy of the Board's Order entered i its minutes for this date. p' Dated: JAN 514 1993 : PHIL BATCHELOR, Clerk, By4 . AAA^ 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 warnina see reverse side of this notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and N 'ce to Claimant, addressed to the claimant as shown above. Dated: JAN S im 1993 BY: PHIL BATCHELOR by44 9JdAJ ° Deputy Clerk r�- CC: County Counsel County Administrator J 1A/ Af.d tna[y@.�� . RECEIVED s DEC - 4 i9 CLAIM AGAINST THE COUNTY OF CONTRA COSTA p;va p.rY, AND ITS AGENTS AND EMPLOYEES CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Ethel Henry and Marie Henry hereby present a claim for damages against the County of Contra Costa and its agents and employees. ADDRESS OF CLAIMANTS: Ethel Henry 176 West Catamaran Circle Pittsburg, CA 94565 Marie Henry 1201 Buchanan San Francisco, CA ADDRESS TO WHICH NOTICES SHOULD BE SENT: Ethel Henry Marie Henry c/o John Diaz Coker, Esq. Coker & Ramirez 525 Marina Boulevard Pittsburg, CA 94565 DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE: On June 9, 1992 , Claimant Marie Henry was at Claimant Ethel Henry's house, with her baby. Claimant Ethel Henry was absent from the house at the time. Marie Henry heard a knocking at• the door and an announcement "Police, search warrant, " but before she could get to the door, it was kicked in and several officers entered. Deputy Lee May entered with gun drawn and, pointing his weapon at Marie Henry, ordered her out of the house. He steadfastly refused to allow her to take the baby (age 2 months) with her. The child was thus unattended in the house for approximately 10 minutes. While this apparently illegal search was underway, a vehicle pulled up to the house. The vehicle belonged to Kim Carson, a friend of the family. Also in the vehicle were Sheree Frost, Kim Coleman, and Shelley Henry, whose persons and purses were searched. Cocaine pipes, listed on an inventory form as being taken from Claimant Ethel Henry's house, were in reality taken from the purses of these women. After a time Claimant Ethel Henry arrived at the house. The officers at that point came out of the house. They refused to let Ethel Henry enter her house. Despite the fact that Deputy Lee May knows Claimant Ethel Henry by sight (as he lives nearby) he asked for identification before he'd let her into the house. Ethel Henry asked her niece Elizabeth, who had arrived with her, to get her purse from the car. At this point Deputy Lee May said "Never mind. You're not going in anyway. " In response to a L request from Ethel Henry to see the search warrant, Deputy Lee May stated that he didn't have to show her a search warrant. The only copy of a search warrant Claimants have been able to obtain contains no signature by a magistrate. During his contact with Claimant Ethel Henry, Deputy Lee May said "I don't have to tell you anything, " and called Claimant Ethel Henry a "no good bitch. " In addition, when Shirley Henry, who was standing nearby and overheard this, told the Deputy not to talk to her mother that way, Deputy Lee May called Shirley Henry a "bitch" and a "whore. " During the apparently illegal search, the officers involved damaged property, including furniture, doors and walls, in addition to items unnecessarily thrown about the rooms. PARTIES RESPONSIBLE: Deputy Lee May and other officers, identities unknown, of the County of Contra Costa's Sheriff's Department. AMOUNT OF CLAIM: $20, 000 punitive damages against the individual officers; $20, 000 compensatory damages against the County of Contra Costa. GENERAL DESCRIPTION OF INJURIES AND BASIS OF COMPUTATION OF DAMAGES: Property damage resulted from the over-zealous and wrongful conduct of these officers. The front door was kicked in, necessitating replacement of the door. The wall behind the door needs repair. The fabric on the couch in the living room was slit with some sharp object and will require replacement. The back of the leather couch in the family room was ripped open and the pillow cushions were cut open, also requiring replacement. The door to the bedroom of one of Claimant Ethel Henry's grandchildren was kicked open and damaged, as was the wall behind the door. Claimant Ethel Henry requests the sum of $4, 000. 00 as compensation for damage to her property. Claimant Ethel Henry, as a result of the extreme and outrageous conduct of these officers, was compelled to seek medical care for her severe anxiety, nervousness and emotional distress. She requests the sum of $1, 000. 00 as compensation for medical expenses occasioned by the officer's misconduct. By reason of the above-described acts of these officers Claimants were placed in fear for their lives and physical well being. By reason of the wrongful and malicious acts of these officers we were injured in their self-respect, their sense of security and confidence in their rights as American citizens. Moreover, their sense of security was extremely shaken by the lawless, callous and utterly malicious conduct of these "peace officers. " Claimants request the sum of $15, 000. 00 as general compensatory damages. Punitive damages are based upon the outrageous, malicious nature of the officers acts. The above-described acts of these officers was willful , wanton, malicious, oppressive and fraudulent and done in conscious disregard of the peace of mind and civil rights of others. Claimants request the sum of $20, 000. 00 as punitive damages be assessed against the individual officers involved. Dated: December 3, 1992 /�/ Ethel Henry Marie Henry �' a� -A MOVED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA DEC 15 1992 Claim Against the County, or District governed by) BOA&LJMJ9QUNsEt the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT J AN U ,IF 19 9 3 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: $25 , 000 . 00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: LYONS , Kennie for Michael Fitzgerald ATTORNEY: Mary Stearns Attorney. at Law Date received ADDRESS: 2485 Salvio Street BY DELIVERY TO CLERK ON December 10 , 1992 Concord, CA 94520 BY MAIL POSTMARKED: hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 14 , 1992 IVIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supery rs ( � 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: 179 Z BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present 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 5 1993 PHIL BATCHELOR, Clerk, By Deputy Clerk 4 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 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. 0 Dated: JAN 8 W 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM AGAINST THE COUNTY OF CONTRA COSTA AND ITS AGENTS AND EMPLOYEES KENNIE LYONS on behalf of her son, MICHAEL FITZGERALD hereby presents a claim for damages against THE DEPARTMENT OF SOCIAL SERVICES, the COUNTY OF CONTRA COSTA, and its agents and employees. ADDRESS OF CLAIMANT: 920 W. 5th Street, #2; Antioch, CA 94509E ��EIVED C ADDRESS TO WHICH NOTICES SHOULD BE SENT: Dec Mary Stearns 0192 Attorney at Law vi 2485 Salvio St. CLERK BOARD OF SUPERVISORS Concord, CA 94520 CONTRA COSTA CO. DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE: The incident complained of occurred on or about July 12, 1992. Michael Fitzgerald, son of Kennie Lyons, was placed in the home of a foster mother, Betty Lyons by the Department of Social Services, Contra Costa County. Michael was seven years old at the time. Betty Lyons called the Antioch Police Department because Michael was having a temper tantrum. Betty Lyons' son apparently works at the police department. Police Officer Guy Worth arrived and took Michael to the police department. Michael was handcuffed to a chair in a room with three police officers. At some point, Michael was taken back to Betty Lyon's home. No criminal charges were filed against Michael. No police report was ever written documenting the episode. PARTIES RESPONSIBLE: Persons of the Department of Social Services of Contra Costa County for negligent placement of Michael in the home of the foster mother, Betty Lyons. . AMOUNT OF CLAIM: $ 25, 000 against individual employees of the Department of Social Services and against the County of Contra County and the Department of Social Services of the County of Contra Costa. GENERAL DESCRIPTION OF INJURIES AND BASIS OF COMPUTATION OF DAMAGES: By reason of the above-described acts of these officers and of the foster mother, Michael was placed in fear for his life and physical well-being. By reason of the wrongful and malicious acts of these officers and the foster mother, he was injured in his self-respect, his sense of security, and confidence in his rights as child in America. Dated: December 10, 1992 Mary St arns 1 ;a9 MANED CLAIM DEC 91992 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA COUNTY CouNa MARTINIZ CAUK Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 5, 1993 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $50,000 Section 913 and 915.4. Please note all '"Warnings". CLAIMANT:MC DONOUGH, James Michael ATTORNEY: Michael. V.W. Crain Korte and Crain Date received ADDRESS: 1407 Oakland Blvd, Suite 100 BY DELIVERY TO CLERK ON December 3, 1992 Wal but Creek, CA 94596 BY MAIL POSTMARKED: hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gg HH DATED: December'7 p, 1992 ByIL DeputyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY; Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD/ORDER: By unanimous vote of the Supervisors present (+I This Claim is rejected .in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. VL Dated: JAN 5 t% IS�3 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you fiave 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 Unified 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 N tice to Claimant, addressed to the claimant as shown Aabove. Dated: JAN " 1, 1944 BY: PHIL BATCHELOR b 6 Deputy Clerk CC: County Counsel County Administrator 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. 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, 198$, 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 Muse 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. �t i► tt e e it . a �t a �t e e �l �t e e �t �t * :t :t �t * s �t * a �t a �t e • * e :t :t �t :t RE: Claim By ) Reserved for Clerk's filing stamp JAMES MICHAEL MCDONOUGH ) Against the County of MEN Costa ) DEC _ 3 1992 or ) R CONTRA COSTA CNTY FIRE �� District) CLERK B(��'�r�p OF S JPERVIsoR`s Fill in name ) CCANTR COS) The undersigned claimant hereby makes claim against the County of Contra Costa for the above-named District in the sum of $ 5 0,0 0 0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 6/8/92 at 0730. hours 2. Where did the damage or injury occur? (Include city and county) Intersection of Treat Blvd. , and Candelero Drive, Walnut Creek, CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) Consolidated Fire District driven by Roberto Campos rear-ended claimant' s vehicle ? } 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Inattentiveness and ngeligence on the part of Roberto Campos, failure to observe stopped vehicles in front of him, collided with claimant' s vehicle and pushed claimant into vehicle driven by Edward Feinblum. (over) i D. w7at are the names of county or district officers, servants or employees causing the damage, or injury? Robert Varela Campos _-------------- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates foruto damage. Injury to back, neck, headaches, still under treatment of adoctor. 7.' How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Pain and suffering, medical expenses exceed , $4, 000. Continuing need for medical care-, estimated -at over $7,000.00 Permanent disability. 6. Names and addresses- _of .witnesses,..doctors."and-hospitals: Edward D. FeinblUm,' 2036 Cierra..Roadr #3 Concord,- CA William Ross, M.D. , 1850 Mt. Diablo Blvd. , Ste. 110, Walnut Creek, CA 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Medical treatment continuing. " Medical bills for physical therapy - and doctor' s treatment exceed $4,000.00. a ee �te :tee �t .� �t �te �teiteat -ee.* �teee * a +t • esaa � � esect * ate 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 Michael V.W. Crain . Claimant's Si ture KORTE & CRAIN 1407 Oakland Blvd; Ste. 100 "Pp Bepx 23A74 Walnut Creek, CA 94596 (Address) �L7,r Telephone No. " (510} '532-w66'50 " Telephone No r D) 6�''0 73 3 F 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. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA DEC 91992 Claim Against the County, or District governed by) BOARD ACTION COLIM COUWEL the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT JANUARY 5, " y 0"4 and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $473.51 Section 913 and 915.4. Please note all •Warnings". CLAIMANT: RISKEN, Jennifer & Philip Claim No. 05-0617-218 ATTORNEY: State Farm Insurance Companies Jeanne Howard, Claims Spec. Date received ADDRESS: Northern California Office BY DELIVERY TO CLERK ON December" 7,.-1992 6400 State Farm Drive Rohnert Park, CA 94926-0001 BY MAIL POSTMARKED: December 4, 1992 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 8, 1992 JAIL BATTCVELOR, Clerk epuII. FROM: County Counsel TO: Clerk of the Board of 54uperyjz6rs ( 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: a�u�ILe- . �� , ��z. BY: _ "t�• 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. Qn' Dated: . ►N 5'�4+ 1993 PHIL BATCHELOR, Clerk, By 01 J 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 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. 0 Dated: BY: PHIL BATCHELOR b AA. Deputy Clerk CC: County Counsel County Administrator STATE FARM State Farm Insurance Companies 4 i 1204 0) INSURANCE RECEIVED December 1, 1992 Northern California Office DEIN 71992 6400 State Farm Drive Rohnert Park,California 94926.0001 Board of Supervisors CLERK BOARD OF SUPERVISORS County Administration Bldg., Rm. 106 CONTRA COSTA CO. 651 Pine Street Martinez, CA 94553 IMPORTANT PLEASE WRITE OUR CLAIM NUMBER* ON YOUR REPLY OR PAYMENT. THANK YOU. Re: Our Claim Number: *05-0617-218 Our Insured: Jennifer & Philip Risken Date of Loss: September 17, 1992 State Farm Mutual Automobile Insurance Company on behalf of Subrogee Jennifer and Philip Risken hereby makes claim for $4,733.51 and makes . the following statements in support of the claim. 1. Notices concerning this claim should be sent to State Farm Insurance Companies, 6400 State Farm Drive, Rohnert Park, California 94926, referencing the above claim number. 2. The date and place of the accident giving rise to this claim are; on September 17, 1992 on I-80 in Walnut Creek, California. 3. The circumstances giving rise to this claim are as follows: Our policyholder, Jennifer Risken, was operating her vehicle, when your vehicle, a fire truck, negligently kicked up a rock and hit our insured's windshield causing damage. 4. There were no injuries reported. 5. Our total claim is as follows: Company's Net Payment $373.51 Insured's Deductible Interest $100.00 Total Property Damage $473.51 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 [STA�TE FARM State Farm Insurance Companies URANCE Board of Supervisors Northern California Office Page 2 6400 State Farm Drive December 1, 1992 Rohnert Park,California 94926-0001 NOTICE: This form is to provide notice of our claim for damages in accordance with the six (6) month statute. If this form is not acceptable for compliance with the statute, please rush the necessary forms to my attention for proper filing. -- STATE FARM INSURANCE COMPANIES -- —/ Dated: I By: JeavAe P. Howard Claim Specialist - ROAC (707) 584-6473 JPH/CM:ljl/30-014 AC-51 Encl: Supporting Documents cc: 2303 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 STATE FARM INS s NIE �� URANCE C y NORTHERN RNp "' OMPA S N \ NUMBECALIFp IA FF10E� , .• i r ,''- ; - ` r R N RTP c b O �, ir• t` # POC► ri AR .. INS CYlNUMBE ' K CALIFpR axl �lY „ NIA f VREO ~1� n Mhz R l:F to a'k r••'�Lr;, r• * Ali'w •♦ CA RlNp OAT OFLOSS ,!L s,ip4 O 1 5i'Y7 , _i AGENT 11�` ' pAYTOTHj1:7 ORDER OF ""'l a E .�• ` � l DATE OF CHECk p.. ACCOUNT Np TO CUSTpER 3E MERICA V '+.' ., P. AM . :'1aW GATEWAY ERICq$1233 .� r SA CONC BLVD. s. ; ORD,CALIFORNW 94820 '' COPY Er© 2 j � NOT NEGOTIABLE _,.. --� `_'.�` FILE COPY F I I ( =vsUcUUU '�UUU gUU >m-oma-z<=eon_ - �Dn S Z = Z S 3; myZ m s m a m om D� a>oa�csio E _ Ov zz �y ;. zr•.Nz oN� .o O z o z Z mra zasc>,s .s °Lo3s¢ Om mN �or.•�G'.= � HOZ 90 =�aoxs=�'^51-2=4y �. •- i TN O ATO Z< ^�m�>ao>d,nS �c� \ m20 SCOC io yo„x.a. , __ sN r 9 &E TNyn m-,i-� n= a s O� ;Tari > _~9 C 9� j e D Zm Og Z Zn xsvo o.o o� > O O a O s Z r 1 �" 7j m cy<N,r„yv B o o� r m r O m �. m Z _ G > ® C H a 1 a> D D �9NN �NTma S T ta Lit H -4 0m m m O �eT>i c29v~��f¢�y �1 tim fd- > ® > �� H ..Np� -Txr�- 32 2 w m O tom► 6.► ts+ M- > m n y 0 0 o O o-� Tz�°nyc;o mD rA o ;09 o� j9To m a�p Q Q m O 4Ats�o s�o f� -00 s�o �,�iAZ. S-2. ;o >JOS m 31 D m m m �. -i O OA� mZ r TE TN!^ON=omp r wm_ m J <O nv�NZ=no'Em TTp�Y m =ZO>Gmm l� o .T..=cCi..O.rmn 9 N�S90 'j m_ l - D m n v m n n m n m n n O ~ `< m m37 D O J m Z opm D O m 0 v n on rn 1 cn Zia c tm'om 0 O z C:n <<o3:sc m m C�l clO r- m mm 3aocD �C mponm< tvDC�� >� ^2 gn 70 u3 _N c„ rn m a> mgm M 7C co o_ ms n-n, Oc 0 p n y N x N m v r o3mo; C o g 8 8ca N a o r \ p Z Z O m > f S peYo m =A ma- o `v��� z 1 o 4 0� r nom � Ea z3�o m75 ZCJSv (n m D D _ v 2 a O Om m C) a m 0 m v vv rn --- - - - - - - -- - -- z Oc _J X N zVr Pr ,� a cTsi uN.in o� rn LC oz mNm ni is oa .� so of xN o D D - m CAL.Mfi LC.;A13 . 1• E.P.A. LD 0 CAD962017477 NOTICE TO CUSTOMER: PLEASE READ IMPO ANT INFORMATION ON BACK. � TOYOTA TOYOTA WALNUT GREEK INC. ESTIMATE OF REPAIR 2100 N. BROADWAY WALNUT CREEK,CALIFORNIA 94596 SHEET NO. OF._..-S (510)933-7912 . R.O. NO. F: Car Owner"�lo�J�'{ Address vc✓L� �. +�� t/u C..� Phone Make Year � '''S)erial Ne� ukia'�'�1 IV QpffS4 orz Body Style Mileage _, _0 License No. _CX.7.J Paint No. Trim No. K Insurance Co. Adjuster Phone No. File No. :. HOURS REPAIR REPLACE ESTIMATE OF REPAIR COST LABOR PARTS MlSC. SUBLET P.' k WALNUT +' 7YG!M CREEK, INC. MIKE PHILLIPS SERVICE MANAGER 2100 N. BROADWAY SERVICE: 933-7912 'r WALNUT CREEK, CA 94596 OFFICE: 933-7440 :r TOTAL ::. The undersigned agrees to complete the above repairs for$ Labor $ , Of this amount the above named insured is to pay parts $ � $ insurance deductible misc, $ depreciation Sublet $ work not covered by insurance Sales Tax $ 5 DAMAGED or WORN parts removed from car wiu be junked unless owner instructs us otherwise in wi iting.If NEW PARTS listed herein or required are NOT available, we reserve the right to REPAIR such damaged or worn parts, where,.::sstble, the ESTIMATE TOTAL $ CHARGE for which will be made nn an actual time basis at our prevailing labor rate per hour.The above is an APPROXIMATE r estimate of repairs required,based on!he inspection made.ADDITIONAL parts,or labor,may be required after the work has ADVANCE CHARGES $ started,which were not evident on the first inspection.SUCH ADDITIONAL LABOR AND MATERIAL WILL BE CHARGED FOR IN ADQF N T THE ABO .PARTS P CES OBJECT tNV CE. ALL ESTIMATES GOOD FOR 30 DAYS. !` GRAND TOTAL $ 1 tgc of O V 5a dC f. c`r- yLU m y 0 E W � W m �o w g O � chi Q � G dO o W r. 4 W r , m O'"`` YO O 4 Y .';•. �' 4r. N Z ,i a aEcDvED -,�-��+ CLAIM ,! BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA DEC' 9 19 92 Claim Against the County, or District governed by) BOARD A COUNSEL the Board of Supervisors, Routing Endorsements ) NOTICE TO CLAIMANT P 9 JANUARY 5, 1993 and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Undetermined Section 913 and 915.4. Please note all °Warnings". CLAIMANT: p1ANE, Susan ATTORNEY: Douglas K. deVries Mart & deVries Date received ADDRESS: 721 Ninth St. , Suite 300 BY DELIVERY TO CLERK ON December 7. 1992 Sacramento, CA 95814 via County Admin. BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 7, 1992 PpH�{IL ggATC ELOR, Clerk p� DATED: BT: Depu y II. FROM: County Counsel TO: Clerk of the Board of rvisors (V) This claim complies substantially with Sections 910 and 910.2. ( . ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: z BY: �, Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( V) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. 0 Dated: JAN . 1993 PHIL BATCHELOR, Clerk, BY-4 c Deputy Clerk r+. 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 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 No ice to Claimant, addressed to the claimant as gshown above. Dated: 1BY: PHIL BATCHELOR b AA,1 V � Deputy Clerk CC: County Counsel County Administrator 1 DOUGLAS K. deVRIES, ESQ. (#70633) 2 RIES 7721TNinth VStreet, Suite 300 y RECEIVED 3 (P.O. Box 1615, 95812-1615) Sacramento, California 95814 4 Tel: (916) 441-4994 OR 71992 Attorneys for Claimants CLERK BOARD OFSURRVISORS 5 CONTRA"COSTA c0. 6 7 In the Matter of the Claim of 8 9 SUSAN PIANE 10 Claimants, CLAIM FOR DAMAGES 11 (SECTION 910 VS. GOVERNMENT CODE) 12 COUNTY OF CONTRA COSTA, 13 MERRITHEW MEMORIAL HOSPITAL, and DOES 1 - 20 14 / 15 SUSAN PIANE hereby presents this claim to the COUNTY OF 16 CONTRA COSTA and MERRITHEW MEMORIAL HOSPITAL pursuant to Section 17 910 of the California Government Code. 18 1. NAME OF CLAIMANTS: SUSAN PIANE 19 2. CLAIMANTS' ADDRESS:. c/o of claimants' attorney, 20 Douglas K. devries, Mart & deVries, 721 Ninth Street, Suite 300, 21 Sacramento, California 95814 (916) 441-4994. 22 3. SEND NOTICES TO: c/o of claimants' attorney, 23 Douglas K. deVries, Mart & deVries, 721 Ninth Street, Suite 300, 24 Sacramento, California 95814 (916) 441-4994. 25 4. DESCRIPTION OF INCIDENT: This claim is based on the 26 negligence of the COUNTY OF CONTRA COSTA and MERRITHEW MEMORIAL d through their agents and employees who rendered 27 HOSPITAL by an 28 care and treatment to SUSAN PIANE and were negligent in the misdiagnosis of breast cancer. SUSAN PIANE discovered a one inch 1 1 lump in her breast two years ago and presented to Kay Severson, 2 F.N.P. for treatment. A mammogram was perf ormed and she was 3 told to return in six months for a recheck. She returned to be 4 checked every six months and in June 1992 presented to MERRITHEW 5 MEMORIAL HOSPITAL with severe back pain. Despite requests for 6 further testing, she was diagnosed with pleurisy and back 7 tension. In September 1992 SUSAN PIANE' was diagnosed with stage 8 4 breast cancer with metastasis to the spine. Defendant is 9 therefore liable to claimants all as provided in the California 10 Government Code. 11 5. NAMES OF OFFICERS OR EMPLOYEES CAUSING THE INJURIES 12 OR DAMAGE: KAY SEVERSON, F.N.P. Those unknown public entities, 13 employees or agents responsible are claimed against herein as 14 DOES 1 through 20, and their true names will be disclosed when 15 discovered. 16 6. AMOUNT CLAIMED: (a) General damages, the exact 17 amount of which is unknown to claimants at this time but 18 estimated at $750,000.00 (b) Medical and incidental expenses, 19 and other special damages, the exact amount of which are unknown 20 to claimants at this time, but which are estimated at $20,000.00 21 and continuing. (c) Interest, costs of suit and other 22 unspecified relief, the exact amounts of which are unknown to 23 claimants at this time. 24 DATED: December 4, 1992 MART & e IES 25 2By: 6 DOUGLAS K. deVRIES 27 28 2 1 PROOF OF SERVICE BY MAIL (CCP SECTION 1013 .a, 2015.5) 2 SUSAN PIANE v. COUNTY of CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL and DOES 1 - 20 3 I declare under penalty of perjury under the laws of the 4 State of California that the foregoing is true and correct. 5 I am employed in the County of Sacramento, State of California. I am over the age of majority, and not a party to 6 the within action. My business address is 721 Ninth Street, Suite 300, Sacramento, California. I am readily familiar with 7 the business practice for collection and processing of correspondence for mailing with the United States Postal 8 Service. 9 On this date, I served the within CLAIM FOR DAMAGES (SECTION 910 GOVERNMENT CODE) on all other parties by placing 10 a true copy thereof in a sealed envelope placed for collection and mailing in Sacramento, California, on said date, following 11 ordinary business practices and addressed as follows: 12 County of Contra Costa Administration Bldg. 13 651 Pine Martinez, CA 94553 14 Merrithew_Memorial Hospital 15 2500 Alhambra Avenue Martinez, CA 94553 16 Executed on December 4, 1992, at Sacramento, California. 17 18 J N GABE 19 20 21 22 23 24 25 26 27 28 : � m � Ll , g ./ to Q � r-A . G ® * ® ƒƒ\ a *® ƒ\ƒ >� ~ % � ,§ \ ` � � CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY ° MARTINEZ, CALIFORNIA RECEIVED MEMORANDUM DEC 1 O 1992 f Date: December 10, 1992 CLERK BOARD OF SUPERVISOR CONTRA COSTA CO. TO: Clerk of The Board of Supervisors FROM: Victor J. Westman, County Counsel By: Gregory C. Harvey, Deputy County Counsel RE: Susan Paine Claim Attached is a claim which we have received from Health Services . errithew emorial O�P�4Lad AND CLINICS RECEP40 December 8, 1992 DEC 091992 -VU" COUMM VARMW Office of County Counsel Contra Costa County Re: Susan Piane=-CLAIM The attached claim was received for the above named patient by Merrithew Memorial Hospital on December 8, 1992. Mark Finucane Health Services Director enc. xc: Ron Harvey `4 Contra Costa County ............ ; A-301A (3/87) 1 DOUGLAS K. deVRIES, ESQ. (#70633) 2 MART & deVRIES 721 Ninth Street, Suite 300 3 (P.O. Box 1615, 958121615) Sacramento, California 95814 4 Tel: (916) 441-4994 5 Attorneys for Claimants 6 7 In the Matter of the Claim of 8 9 SUSAN PIANE 10 Claimants, CLAIM FOR DAMAGES 11 (SECTION 910 VS. GOVERNMENT CODE) 12 COUNTY OF CONTRA COSTA, 13 MERRITHEW MEMORIAL HOSPITAL,. and DOES 1 —20 14 /. . .. 15 SUSAN PIANE hereby presents this claim to_ the COUNTY OF 16 CONTRA COSTA and MERRITHEW MEMORIAL HOSPITAL pursuant to Section 17 910 of the California Government Code. 18 1. NAME OF CLAIMANTS: SUSAN PIANE 19 - 2. CLAIMANTS' ADDRESS:. c/o of claimants' attorney, 20 Douglas K. deVries, Mart & .deVries, 721 Ninth Street, Suite 300, 21 Sacramento, California 95814 (916) 441-4994. 22 3 . SEND NOTICES TO: c/o of claimants' attorney, 23 Douglas K. deVries, Mart & deVries, 721 Ninth Street, Suite 300, 24 Sacramento, California 95814 (916) 441-4994. 25 4. DESCRIPTION OF INCIDENT: This claim is based on the 26 negligence of the COUNTY OF CONTRA COSTA and MERRITHEW MEMORIAL 27 HOSPITAL by. and through their agents and employees who rendered 28 care and treatment to SUSAN PIANE and were negligent in the misdiagnosis of breast cancer. SUSAN PIANE discovered a one inch 1 ' 1 lump in her breast two years ago and presented to Kay Severson, 2 F.N.P. for treatment. A mammogram was performed and she was 3 told to return in six months for a recheck. She returned to be 4 checked every six months and in June 1992 presented to MERRITHEW 5 MEMORIAL HOSPITAL with severe back pain. Despite requests for 6 further testing, she was diagnosed with pleurisy and back 7 tension. In September 1992 SUSAN PIANE was diagnosed with stage 8 4 breast cancer with metastasis to the spine. Defendant is i 9 therefore liable to claimants all as provided in the California 10 Government Code. 11 5. NAMES OF OFFICERS OR EMPLOYEES CAUSING THE INJURIES 12 OR DAMAGE: KAY SEVERSON, F.N.P. Those unknown public entities, 13 employees or 'agents responsible are claimed against herein as 14 DOES 1 through 20, and their true names will be disclosed when 15 discovered. 16 6. AMOUNT CLAIMED: (a) General damages, the exact 17 amount of which is unknown to claimants at this time but 18 estimated at $750, 000.00 (b) Medical and incidental expenses, 19 and other special damages, the exact amount of which are unknown 20 to claimants at this time, but which are estimated at $20,000.00 21 and continuing. (c) Interest, costs of suit and other 22 unspecified relief, the exact amounts of which are unknown to 23 claimants at this time. 24 DATED: December 4, 1992 MART & e IES 25 26 By: DOUGLAS K. deVRIES 27 28 2 1 PROOF OF SERVICE BY MAIL (CCP SECTION 1013 .a, 2015.5) 2 SUSAN PIANE v. COUNTY of CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL and DOES 1 - 20 3 I declare under penalty of perjury under the laws of the 4 State of California that the foregoing is true and correct. 5 I am employed in the County of Sacramento, State of California. iI am over the age of majority, and not a party to 6 the within action. My business address is 721 Ninth Street, Suite 300, Sacramento, California. I am readily familiar with 7 the business practice for collection and processing of correspondence for mailing with the United States Postal 8 Service. 9 On this! date, I served the within CLAIM FOR DAMAGES (SECTION 910 'GOVERNMENT CODE) on all other parties by placing 10 a true copy thereof in a sealed envelope placed for collection and mailing in Sacramento, California, on said date, following 11 ordinary business practices and addressed as follows: 12 County of Contra Costa Administration Bldg. 13 651 Pine Martinez, CA !94553 14 Merrithew Memorial Hospital 15 2500 Alhambra Avenue Martinez, CA 94553 16 Executed on December 4, 1992, at Sacramento, California. 17 18 J N GABE 19 20 21 22 23 24 25 26 27 28 errete �monal ° (DW O Ll Gr I r AND CLINICS NaNO� 'tot �JA December 8, 1992 ; Office of County Counsel DEC Contra Costa County CLERK BOARD OF ORS Re: Susan Piane--CLAIM CONTRA COSTA CO. The attached claim was received for the above named patient by Merrithew Memorial Hospital on December 8, 1992. Mark Finucane Health Services Director enc. Ron Harvey M Contra Costa Coun 1 DOUGLAS K. deVRIES, ESQ. (#70633) 2 MART & deVRIES 721 Ninth Street, Suite 300 3 (P.O. Box 1615, 95812-1615) Sacramento, California 95814 4 Tel: (916) 441-4994 5 Attorneys for- Claimants 6 7 in the Matter of the Claim of 8 9 SUSAN PIANE 10 Claimants, CLAIM FOR DAMAGES (SECTION I 11 VS. GOVERNMENT CODE) 12 COUNTY OF CONTRA COSTA, 13 MERRITHEW MEMORIAL HOSPITAL, and DOES, 1 - 20 14 / 15 SUSAN PIANE hereby presents this claim to the COUNTY OF 16 CONTRA COSTA and MERRITHEW MEMORIAL HOSPITAL pursuant to Section 17 910 of the California Government Code. 1� 1. NAME OF CLAIMANTS: SUSAN PIANE 19 2. CLAIMANTS' ADDRESS:. c/o of claimants' attorney, 20 Douglas K. .deVries, Mart & deVries, 721 Ninth Street, Suite 300, 21 Sacramento, California 95814 (916) 441-4994. 22 3 . SEND NOTICES TO: c/o of claimants' attorney, 23 Douglas K. deVries, Mart & deVries, 721 Ninth Street, Suite 300, 24 Sacramento, California 95814 (916) 441-4994 . 4 . DESCRIPTION OF INCIDENT: This claim is based on the 25 26 negligence of the COUNTY OF CONTRA COSTA and MERRITHEW MEMORIAL HOSPITAL by and through their agents and employees who rendered 27 care and treatment to SUSAN •PIANE and were negligent in the } 28 I misdiagnosis of breast cancer. SUSAN PIANE discovered a one inch 1 1 lump in her breast two years ago and presented to Kay Severson, 2 F.N.P. for treatment. A mammogram was performed and she was 3 told to return in six months for a recheck. She returned to be 4 checked every, six months and in June 1992 presented to MERRITHEW 5 MEMORIAL HOSPITAL with severe back pain. Despite requests for 6 further testing, she was diagnosed with pleurisy and back 7 tension. In September 1992 SUSAN PIANS was diagnosed with stage 8 4 breast cancer with metastasis to the spine. Defendant is, 9 therefore liable to claimants all as provided in the California 10 Government Code. 11 5. NAMES OF OFFICERS OR EMPLOYEES CAUSING THE INJURIES 12 OR DAMAGE: KAY SEVERSON, F.N.P. Those unknown public entities, 13 employees or ' agents responsible are claimed against herein as 14 DOES 1 through 20, and their true names will be disclosed when 15 discovered. 16 6. AMOUNT CLAIMED: (a) General damages, the exact 17 amount of which is unknown to claimants at this time but 18 estimated at $750,000.00 (b) Medical and incidental expenses, 19 and other special damages, the exact amount of which are unknown s 20 to claimants at this time, but which are estimated at $20,000.00 21 and continuing. (c) Interest, costs of suit and other 22 unspecified relief, the exact amounts of which are unknown to 23 claimants at this time. 24 DATED: December 4, 1992 MART & e IES 25 By: 26 DOUGLAS K. deVRIES 27 23 2 I y j PROOF OF SERVICE BY MAIL (CCP SECTION 1013 .a, 2015.5) 2 SUSAN PIANEv. COUNTY of CONTRA COSTA, MERRITHEW MEMORIAL HOSPITAL and !`DOES 1 - 20 3 I declare under penalty of perjury under the laws of the 4 State of California that the foregoing is true and correct. 5 I am employed in the County of Sacramento, State of California. J am over the age of majority, and not a party to 6 the within action. My business address is 721 Ninth Street, Suite 300, Sacramento, California. I am readily familiar with 7 the business practice for collection and processing of correspondence for mailing with the United States Postal 8 Service. 9 On this date, I served the within CLAIM FOR DAMAGES (SECTION 910 ''GOVERNMENT CODE) on all other parties by placing 10 a true copy thereof in a sealed envelope placed for .collection and mailing in Sacramento, California, on said date, following 11 ordinary business practices and addressed as follows: I 12 County of Contra Costa Administration Bldg. 13 651 Pine Martinez, CA ,94553 14 Merrithew Memorial Hospital 15 2500 Alhambra Avenue Martinez, CA 94553 16 ' Executed on December 4, 1992, at Sacramento, California. 17 13 f J N GABE 19 20 21 22 23 24 25 26 27 28 • I; CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA DEC 91992 MUNN Claim Against the County, or District governed by) BOARD ACTIONIMARTINj�' the Board of Supervisors, Routing Endorsements, ) NOTICE"TO CLAIMANT JANUARY 5, 1993 .and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. i, ) the action taken on your claim. by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $316.19 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: SCOTT, Clarice B. ATTORNEY: Date received ADDRESS: 782 Chestnut Drive BY DELIVERY TO CLERK ON December 4, 1992 Fairfield,. CA 9453;3 hand delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Sdpervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED December,...7, 1992 JJIL BATCHELOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days. (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: JJ . Dated: Se_4 NC,G _ J J. �2— BY: / Deputy County Counsel I i. III. FROM: Clerk of the Board i TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORD By unanimous vote of the Supervisors present ( This Claim is rejected�in full. ( ) Other: i. r I certify that this isla true and correct copy of the Board's Order entered in its minutes for this date. 1 Q � Dated: JAN 5 1993 PHIL BATCHELOR, Clerk, ByOV�j0Deputy Clerk WARNING (Gov. code .section 913) Subject to certain exceptions, yo6lhave 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 perjuryithat 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 d Notic to Claimant, addressed to the claimant as shown above. Dated: JAN 8ion 1gg3 !' BY: PHIL BATCHELOR by ° Deputy Clerk i CC: County Counsel County Administrator . Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later .than the 100th day after the accrual of the cause of. action. Claims relating .to, causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the, cause of action. Claims relating to any other cause of action must be presented not later,than .one, year.,,after.the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its .office in Room 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. 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 E"E" Against the County of Contra Costa ) or ) DEC - 41992 District) Fill-in name ) CLERK BOARD OF SUPERVISORS CONTRA COSTA in The imdersigned--claimant' hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: -_-----NN -M--N---NN-N--MM-----------N-_--N---N--N---NN-----N-ems-- 1. did the damage or injury occur? (Give exact date and hour) 2. . Where did-the damage or injury occur? (Include city and county) 3. How did the damage or inj y occur? i ^(Give fulA details; use expa papper�/if • required) CL 4. Whatarticular act or omission on they p part of county or district officers, ry s or .a Mloyeesused t njury or d A M ? -'� 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 injuriesor damages claimed. Attach two estimates for auto damage. An 0- claimed above computed. (Include the estimated unt of any 7. How was the amount p prospective injury or damage.) q $es 'a, Jaad wfthe s , �d�octors and h pi l ----_!.n__-- —--------------------w-_f0_wiOs_ 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 bm/; memerson on.hi . behalf." Name and Address of Attorney Cla' tis ignat (Address AM o7-IVA6f-Vo Telephone No. Telephone No.� NOTICE Section 72 of the Penal Code provides: ... ... . . . . ... "Every person who,; with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent elaim', •bill', account, 4oucher, 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 ($1,400), 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. r? ��F.i t=eD),Z"U r-t� 1 f '-� a `1 CUSTOMER H- .. hu. , IL'it0 f�,:, ilE r� Ifj `IfrLD,- cAv 9 533 . FH NE: 707ii_429-1379 HIGH' TECH. 'SEKJICE ^:* ..�, r - a,. .-•:"� a;Y, �' 'rich z Oka ;l x. SD 5, ,ka `� .. � .� ����' kk���m. ' �� k�,� a ������,k kk �k� '��•., � ..'� '" .F ; 4Atk,f I+a. 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'.� ,,�. 21" ,xFs �Ip, �y *�V—VA _. ,a: r.m.« .;'k ,>it l' a '' .; " �« �� k �«, q& gra Pe RM 4% k1wy"q � a a ypww ' ..4 4 �6, ,:b, u :�. €Y' �, +5�*. i.'�� £.. &"u k < �o a' MVI •� � �i � -i DISCLAIMER OF WARRANTIES Any warranties on.the products sold hereby are.those made;by the manufacturer.'The seller hereby expressly disclaims.all warranties, either'express or implied, including any implied warranty of merchantability or fitness for aparticular purpose, and the seller neither assumes.nor authorizes any otherperson to assume for it any liability.in connection with the sale of th2 saitY fir products. Buyer shall not be entitled to recover from the seller any' consequential damages, damages to property, damage for loss of use,loss of time,loss of profit oil income,or any other incidental damages.' -PARTS & LABOR MAY BE LIST-ED ON SEPARATE INVOICE: r � -ALL PARTS INSTALLED ARE NEW UNLESS SPECIFIED OTHERWISE. MISCELLANEOUS SHOP PARTS-&-HAZARDOUS,WASTE REMOVAL'. _. ' Anl itemized charge may be included on your repair order for miscellaneous shop parts used on your vehicle.Such miscellaneous shop parts are. individually .detailed. A. charge may,also be includes)on your repair order for the costs of meeting legal requirements for hazardous waste e removal. f I! ALL PARTS REMOVED WILL BE '. Y� t 1 I DISCARDED UNLESS NOTIFIED = • ' ''' OTHERWISE PRIOR TO THE START OF REPAIRS. r I SAVE OLD PARTS ElN` _1F._• 1. Customer is hereby, notified that the said'property is not insured or !-.7. The Repair Garage is authorized to deliver the vehicle descr<i )rei�fen ,protected to the amount-of.the actual cash value thereof, or otherwise, +' or any of its contents to any person presenting this receipt�6 { � against loss..occasioned by theft, fire or vandalism while the:propert}T remains with the Repair Garage. �I;I 8. In addition to any and all other legal remedies available iq 'arthe I, r' Repair Garage to have a lien on the vehicle descril3+sz3 re;all :'2..Customer states no articles of personal property have.been left in the + 'charges for repairs,including labor and parts,storage and7tf ��,� and vehicle and Repair Garage is not responsible'for inspection thereof. Y to enforce such lien, the Repair Garage is hereby expressl l�ulY rized. % dS� , jr to'sell said vehicle at public action after giving a twenty(20)day wntteh;,.. 3. The Repair Garage is not responsible for unavailability of parts or delays ," notice by certified mail .to the legal owner, registered owner, 'and in parts shipment beyond Repair Garage's,co�ntrol. i Department of Motor Vehicles of intent to do so. On the sale date, the' *., Ili a vehicle shall be sold to the highest cash bidder and the proceeds of sale Due to' of service''reque"sted'some repairs rriUst be sublet; r, must be used first to satisfy the lien plus storage costs and costs incident` II' to sale,and the balance.shall be forwarded to the legal owner,or if none, 5. All charges for repairs including labor and materials furnished are due *� to the registered owner,or if the-address is unknown,it shall be forwarded; and payable simultaneously with the delivery of the.,within described>� ` �''.•to the Department of Motor Vehicles. vehicle-or prior to delivery upon the expiration of-three.(3) dgys after notice that the repairs have been completed4:Notice shall be deemed to Said'expenses,.for sale shall also include a reasonable attorney's fee, have been given-upon the deposit in the I rq'ited•States trail,-postage A, which may be necessarily incurred. prepaid,'f written notification to that effecYlladdressed to the customer y f• at the address given,on.the ceveree'_side hejeof 1 If any of"such,chargW remain unpaid for thirty (30) days after such I .request for payment, the Repair Garage may also refer such charges to 6. If,fhe•vehicle described herein is not called foI{r within three.(3)days after its attorneys for collection and the customer will pay a reasonable'.' ,such notice.is given, a per diem storage charge will be,made for each f;attorney's fee. day thereafter. L_ , sU-SAVE AUTO RENTAL° Bill Easley, Proprietor* DBA TRI-CITY MOTORS 2135 North Texas Street• Fairfield, CA 94533 Coast-to-Coast Reservations I 707 425-2967 7069 1-800-272-U-SAV *An independently owned and operated franchise of U Save Auto Rental® RA Gusto r r I' Pho SS# earTMa; t - Vehicle# I li ^F �D 133o H e Ad 'e /��I. -_. ity Sta t Zip - del Cn�lor Tag v j, I Driver' ii nse# z Exp. to --t Birth VIN If Ins rance'Co an r Policy No. gent, .' - `Phone -W- ,IT me Due In AM Of P Y Odom / 30 Employer ( II Title .i' How Long ate Time Ext. �A jl 'Out �T - � a 3 P Employer's Address '. Phone Supervisor Date/Time Ext. PM e Miles Driven 2- Emergency Contact R Address Phone Date/Time n� -` AM Miles Allowed _ No person other than Customer,!,or other person authorized by Lessor AND listed below, or authorized byI Date/Time 0u law, may rive or use this Vehicle for any purpose. ABSOLUTELY NO DRIVERS UNDER 21t YEARS OF AGE. �,t PM- Excess Miles riv Dr.iic.# State Exp.Date Date of Birth Ad i i I r Ilnsurdnce C mpany , Policy Number Agent 1'Phone Prepaid Rent Deposit Adddional'Driverj Dr..,,Lic,,N -lir i State -. t;a Exp.Date Date of Birth Rates- .t f , I , Charges. 'Insurance Company Policy Number Agent Phone , miles@ per mile Vehicle ondition ' >� Collision Damage Weever HHour$s ut In By Initiali4''t.Ustomer for the addi- /9T'� tional dally rate shown accepts Lessor's Colli 4`. Days,_$ TI� sion Damage Waiver. Customer acknowledges he is responsible,.for loss or, damage caused by @ e$ theft,`vandalism tire, flood'or other` acts of Months j / `} nature'-and�otfiercauses not covered�by Collison ? @ $ Darna"a Waiver. 9 Total time COLLISION DAMAGE WAIVER IS YOID•,,IF an,limllea e ICUSTO�ER VIOLATES THE TERMS F. -CDW @,g^-> -, -„ Checked,OutBy CheckedlnBy'” rTH 1A( 'REEMENT. } i' i per day ' Right y initialing, Customer declines Less- Add.Charge O o�s Collison Damage,Waiver and agreesao°pay tet II O �Ifor arl`damage.and/or loss to-..Vehicle. Subtotal ct % IIII Personal Accident insurances ! Sales tax p or surcharge By initialing,Customer-accepts Personal Accident Insurance at the additional daily,,rate Gas Ij shown. Not Offef0d PAI @$ X-Dent Lett 6-Scratch �� �®t Offered Rates Do Not Include Gas �' per day M t � By initialing,Customer declines Personal In E 1/4 1/2 3/4 F Accident Insurance. PEC @$ 51 r Out E 1/4 '1/2 3/ F 1 PER DAY of 0 ter d i Personal Effects Coverage," .. Subtotal j By.initialing,Customer accepts Personal Add Charge,. v ¢._.. .4 Effects Cove7ege at,the additional Flaily rate for i, 1 reV vra uNM021 shown Y tlOt 0 -ed Minus Refund NO DRIVER UNLESS ADS _. for N-REW&r�^� By initialing,Customer declines Personal vRe[m Effects Coverage. .____.._.._.,... Authorized To Drive Only In Net Due e 0 Local�50/ mile radius only;or Net Due Customer ❑ Originating State;or ❑ ALL CHARGES SUBJECT TO FINAL AUDIT Customer,rents',the Vehicle inCheck Method of Payment AE condition AE MC VISA noted above subject to the terms and conditions stated above and on the reverse side of this Cash Direct bill Other �I Agreement;If Customer has presented a credit Refund received by: II card for payment of deposit or for rental charges,all rental charges, including parking X citations, may be billed:to said credit card Remarks: and Customer's signature below shall have . �I been considered made Xt�heppli ca le cre itcar voytche�` X / stom er's Signature �i greement not validrf i more than one month. ;89CA FORM 101 0 - i', _ ,1 _} • li t R TIME IN / t D T. OUT ?