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HomeMy WebLinkAboutMINUTES - 10051993 - 1.21 SEP 3 CLAIM BOARD OF RV OF CONTRA COSTA COUNTY CALIFORNIA Claim Against the County. or DiI6TO y.ned by) BOARD ACTION the Board of Supervisors, Routing . orsemen NOTICE TO CLAIMANT OCTOBER 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: $5,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: HOUSKA, Helen L. ATTORNEY: Date received ADDRESS: 5826 San Pablo Dam Road BY DELIVERY TO CLERK ON September 2, 1993 E1 Sobrante, CA 94803 BY MAIL POSTMARKED: September 1, 1993 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 3, 1993 IVIL BATCHELOR, Clerk DATED: eputy II. FROM: County Counsel TO: Clerk of the Board of Supery s ( ) .This claim complies substantially with Sections 910 and 910.2. ( ✓J This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: t �� BY: L• 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. BOARDD ORDER: By unanimous vote of the Supervisors present (1') This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: OCT 5 1993 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code sec 913) Subject to certain exceptions, you have only six (6) months from the date this notice was_personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnina see reverse side' of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: OCT 5 1993 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator I t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases . applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions ' not subject to the California Tort Claims Act. NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Helen L. Mouska 5826 San Pablo Dam Road E1 Sobrante, CA 94803 RE: CLAIM OF: Houska, Helen L. Please Take Notice as Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails .to comply substantially with the requirements of California Government Code Section 910 and 910 .2, or is otherwise insufficient for the reasons checked below: [ ] 1 . The claim fails to state the name and post office address of the claimant. [ ] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [xx] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [xx] 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ J 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000) . If the claim totals less than ten thousand dollars ($10,000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ( $10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. . [ ] 6 . The claim is not signed by the claimant or by some person on is behalf. [xx] 7 . Other: The primary difficulty with the claim is that no acts are described which are attributable to Contra Costa County or its employees . AC Transit is not an part of Contra Costa County. VICTOR WESTMAN, County Counsel By: v Deou Co my C6unsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. SS 1012, 1013a, 2015.5; Evidence Code SS 641, 664) I declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez, California 94553; I am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non- acceptance of Claim by placing it in an envelope addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in the U.S. Mail at Martinez, California. I certify under penalty of perjury that the foregoing is true and correct. Dated: September 8, 1993 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE SS 910, 910.2, 920.4, 910.8) " Clair. to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clams 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 causeof action-. (Govt. Code §911.2.) B. Claims must be filed with 'the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the"name of the District should be .filled in. D. If the claim is against more than one public entity,' separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Clai By ) Reserved for..Clerk's filing stamp oars RECEIVED;#"i: ) ) Against the County of Contra Costa ) , 2 or ) CLER CONTRA OCOS A CO•ISORS District) Fill in name ) The undersigned claimant- hereby makes claim against County of Contra Costa or the above-named District in the sum of $ � ,��p �— and in support of this claim represents as follows: _-______ .__ ___ _____ _...y__________®_ .__�____a___�__�_____�___________ 1. When did the damage or injury occur? (Give exact date and hour) /fZ1ou r �°Z_1' �'-------------- _-_--- 2. Where did the damage or injury occur? (Include city and county) C�`�l O /t./ tFt�e4 C©s7.q 3. How did the damage or injury occur? (Give full details; uie extra paper if G Q' required) _ __- _________ 4. What particular net or omissi on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. Wnat are the names of county or district officers, servants or employees causing the dar.age or injury? -------------------------------------- -- -—-------------------------------- 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 cifimed above computed? ( clude the estimated amount of any prospective injury or damage.) -«--------------------------------------------------------------------------------- 6. Names and addresses of witnesses, doctors and hospitals. . -------------------------�------- 9. List the expenditures you made on 'aceount 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: (Attorne ) orbv s me erson on hi behalf." Name and Address of Attorney Claimant's Signature O� Address Telephone No. Telephone N( s� V K V I W * * +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 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. Ir 1w s On December 8 , 199.x, Tuesday evening about 7 p.m. , a dark rainy night, driving along on San Pablo Dam Road, about 25 mph, approaching May Road, (a signal light and an access for a left hand turn . ) Just before May Road approximately 100 yards there is a bus stop. An A.C.Transit bus was pulling away from the bus stop and pulled out in front of me into my lane that I was driving in. He didn ' t have his turn signal on indicating his move -into my lane. I could see a free lane ahead and to my left , so I entered into the free lane to avoid getting hit . By entering the lane to my left , I was not forewarned nor did I see that the island was curved . Consequently, I hit the curved section of the island and blew the front left tire, subsequently the left rear tire became flat. As it was raining fairly hard , and I was holding up traffic I inched my way very carefully to the extreme right (about 3 lanes to my right ) on San Pablo Dam Road . I tried to get help by ringing the doorbells of two homes, 4712 and 4728 San Pablo Dam Road . One home were elderly people and they wouldn ' t phone AAA nor the police. (The lady spoke with a foreign accent and conversation was exchanged through a closed door) . The other home (4712 ) lights were on but no one came to the door. A young boy about 13, Sean Watson, came out of his house (4736 ) and offered the use of his family ' s telephone. I received help from E1 Portal Towing Service. I had to be towed as I had only one spare tire. I got home about 10 p.m.that evening drenched and miraculously didn ' t catch cold; however, two days later I had extreme back pain. Phoned my doctor for an appointment; and Dr. Berman said oftentimes there is delayed reaction from an accident . He advised me to rest and take hot baths . Early morning presents discomfort and pain in my lower back. I now must be careful with physical activities; therefore I rely upon my daughter for help (she resides in Santa Rosa ) and I also need help with housework and yardwork. This accident also started incontinence, which is embarrass- ing and uncomfortable, and face surgery for relief. Phoned A.C.Transi�- 12/18/92 ( 891-7228 ) . Gave my report which was recorded . The person who took my report said that she would get back to me. Mge 2 ,� ,.: 'POWt t 4 Helen L. Houska 5826 San Pablo Dam Road E1 Sobrante, Ca 94803 As I didn ' t hear from A.C.Transit, I phoned back 5/12/93. Talked with Harry Gunderson. He stated that he couldn ' t understand why I had not heard from A.C.Transit and said that he would get back to me. When I didn ' t hear by June 2 , 1993 , I phoned again. I reached the Claims Dept of A.C.Transit ( 891-4700) . Then was referred to 891-4812, spoke with Mae, apparently the recep- tionist, who gave me my Claim Number 922743 then referred me to ( 891-7228) Winnie Pearson. Ms Pearson was the person I spoke with on December 18th. She said that she tried to reach me by phone several times. I have an answering machine and never received a message from her. She also related that she had been on vacation. She subsequently sent me a form to fill out which I returned within 10 days . I also filed a claim with the City of Richmond , which was denied, then a follow-up letter from me. I have not received an acknowledgement from my last letter. Letters and Claim Forms are attached . i July 8, 1993 1� �1 � t t l !h wt-L i L � t i 1 �� I _QLD F VEHICLE LICENSE II 1,9d it 7fI1�+E COLOR /, ORDERED BY ODOMETER low 12601,39139 fl ' h lnBAt� ,5(x•7.?� T lPE 89.95A I'tHm'rsyun t ?f i',i.�Pllfl;l,^L. 6.'?'11 r• ra��e +� {�„ 9�y('1��� t-n'S�x�N�l <4 jt`��lN.�tyr '7 i >� 1 71q��1� \ 'tyY y� P �7r I 4f1,1+,i. 1114. 1 1r�.T 1�'.IJw Q 6.It,rt 11 nS N. Al L 4 P. 0.M1 P.M1 P.l R.L 4.4 P./.l•A J �� ��G ��`h��� �I e} s,/ n < .i1 11,n •" PR'1/P R4P A 11 N,L P.Il R'KK'R'R'.VV V"N PYR'R'RV V1'4TTPd474'P Q, 21. f n 1 lltU,99 fi�,t�`.EA 4' GALLr�i St�►7s 5��£" i:i,F:GI; 200.99 i r:hiln391 +E TNP-I�SELE'�I�'T�rF,�p�R^► ELI } 1. tf ? .r �'+ iiia tau rku v T•!'3? •y,.K1 —6, 15� <,Y '.�,} wi 'jtrYaryl irl ;1�✓i�it } � y7� (• �tt. Frti,y'r �F. _ OTS. 3 Ni4i t ' tic t� �1� 'tc •ys � � f NO. AUTHOR. ���t'1'�"' fi �`i j i Ali�;s,��+1 Fj�tr y a�.�;uL";s*•-. . TIRE STORAGE RELEASE— . o + MISSING: H-CAPS B-RINGS ❑AIR PRESS. } ❑WHITE ❑BLACK i El TORQUE PRESS. I EIKOT ❑BEST TO SP. LIF R/F t C-CAPS L-NUTS NONE MISSING:❑ 1:1 STATIC El DYNAMIC I L/R in COMMENTS: I i O { Mimi!] ilia o All claimsand returned goods must be accompa ed b ice. j Price Club°Tire Service is not responsible for art' les left in vehicle. Member is responsible for correct the size. TIME Member authorizes the above work to be done along with the necessary material, and hereby grants the OUT f Price Club,permission to operate the vehicle herein described on streets,highways or elsewhere for the purpose of testing and/or inspection. (MINUS) Pre-existing vehicle condition report may not be all inclusive. TIME Member waives all warranties and liabilities, expressed or implied,with respect to any damages to alloy or custom wheels except when said damage is due to actual negligence on the part of Price Club*Tire Service IN and/or its employees. (EQUALS)TOTAL . X �_i 4, { �'�`� _. �rL !(V,1C.�`t. MEMBER SERVICE MEMBER APPROVAL FOR ABOVE WORK COPY TIME I TOYOTAOF . BERKELEY 2400 SHATTUCK BERKELEY, CALIFORNIA 94704-2023. (510) 845-2530 WHOLESALE DIRECT LINE (510) 841-4919 WHOLESALE HOURS 7:30 - 4:30 RECEIVED 8Y: "NOBODY BEATS BERKELEY" SOLD�7: RETAIL SALE'S REF# 073-77 . BERKELEY CASH CALIFORNIA 9471'.)2 NAL►# 00 .950 502 76 CP OI:► MP 18/190 004 12/10/92 005 11 : 49: 11 PART NUMBER DES R I PT QTY L IST 'SELL XSELL BIN NOTE TOY426113216003 WHEEL, 111 1 142.00 142.00 142. 00 R2 D r1 r:r 1S�p 142. 01:1 TAX 11 . 72 TOTAL LINES 1 INVOICE TOTAL 153. 72 PARTS AND SERVICE ARE NOW OPEN ON SATURDAY, 9: 00 AM TO 4: 30 PM PAI 3E 001 OF 001 YOUR ORDER WAS FILLED BY WAYNE E. BUCKNER NO REFUNDS ON SPECIAL ORDERED OR ELECTRICAL PARTS. 20%HANDLING CHARGE ON ALL PARTS RETURNED. a NO REFUNDS WITHOUT ORIC31NAL INVOICE. NO RETURNS AFTER 30 DAYS. ON LINE COMPUTER INVOICING a " ' BY UNIYEASAL COMPUTER 9Y8TEM8.INC., ,. ' ��ye®yE x ," r7e ALIGNMENT''�H�P w, LIC.:No: AF5401:8 550 2311D STREET High Speed Wheel Balancing RICHMOND; Ll .'"9'8 Specializing in 4 Wheel Drive Repair 232-2926 } I % And Hot Rod JOHN CEZ 'RIOT { I NAME f DATE " �f if ( ADDRESS rl f t -ONE o r 1 ❑NO If \, YR AND MAKE TYft OR MODEL LICENSE ODOMETER WRITTEN BY 11� IJ 1 DMR.no INSTRUCflONS AMOUNT...' E Not responsible for loss by Fire or theft or any TOTAL LABOR ZJ other cause beyond our control. I hereby outhoeire the above repair work to be done with TOTAL PARTS I the necessary material and grant permission to operale •+" I equ ipmnnI for purpose of testing and inspection.An express — mechanic's lien is ocEnowledged to secure the amount of O(L gnYGREASE •�� . �j 0 ' 1 repairs. I r > ;? TOTAL PARTS TAX NO*GOODS HELD AFTER 30 DAYS x TOTAL f. .� ❑ ❑ ❑ ❑ ❑ (n m N ^ X o 00 Y m Z � r I' f 00 — r x 1 m o 6 0 m QO " n m (^i\ A ITL w IV > $�_ {0 9 m I(� m Ln C s m m CO 01 D Z I p 0 00 x 0 �^' ED— a 2 b. y Q rn ,,v N O ;; In 5 r0 ~ OI .' -mi z v V' m F' a co m m oo z n < 7 0000❑❑ m ! C00 1c7A r— —I Tn -�O _ � 0 n m zD 0 0 xm E s r Z 0 pom2 I� map 1 a it mZ D x e^ \ � I ?►y D l�J AD']MED 44 CLAIM SEP I&RD U ORS OF CONTRA COSTA COUNTY CALIFORNIA Claim Against the Cunty; orCBLii r= vernik'b ) BOARD ACTION the Board of Supery ) NOTICE TO CLAIMANT OCTOBER 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: Unknown Section 913 and 915.4. Please.note all "Warnings". CLAIMANT: Mc CLURE, Joe ATTORNEY: Merrill Haber Jacoby and Meyers Date received ADDRESS: 100 Bush Street, Suite 700 BY DELIVERY TO CLERK ON September 2, 1993 San Francisco, CA 94104 BY MAIL POSTMARKED: September 1, 1993 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg BATED September 3, 1993 IVIL DepuLyLOR, Clerk 100, 11. FROM: County Counsel TO: Clerk of the Board of S ors ( 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: f f 3 BY: C:• Deputy County Counsel II1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:-OCT J I.QgJ PHIL BATCHELOR, Clerk, Deputy Clerk WARNING (Gov. code esti 13) 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: 0 C T 5 1993 BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator a `r v This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. JACOBY& MEYERS LAW OFFICES p p PERSONAL INJURY UNIT RECEIVED E 100 Bush Street,Suite 700,San Francisco,CA 94104 415/399-8951; FAX:415/399-1939 I�,rR 2 1993 �+ 4 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. September 1, 1993 Clerk of the Board of Supervisors Room 106 County Administration Building 651 Pine Street Martinez, CA 94533 RE: Claim of Joe McClure To Whom It May Concern, On August 26, 1993, I received a NOTICE TO CLAIMANT which purported to return the claimant's claim because it "was not presented withing six months of the event or occurrence as required by law. " I immediately called Mr. Harvey and notified him that we had in fact filed a timely claim and then asked him to look on page 4 of the claim package for the date when claimant's cause of action accrued: February 16, 1993. Mr. Harvey graciously acknowledged that he overlooked this date and asked me to submit an amended claim indicating the discovery date of claimant's injury in item #1 of Contra Costa County's claim form. You will find enclosed an AMENDED CLAIM. Please. file it and return an endorsed copy to our offices in the self-addressed stamped envelope provided. Thank you for your cooperation. SincerlAnvy �.vt�LO Laura v LNA We use recycled paper. C_la im „to: BOARD'OF SUPERVISORS'-OF CONTRA COSTA -COUNTY h. INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for .injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this To—rm. RE: Claim By ) Reserved for Clerk's filing stamp Joe McClure ) �p 1671 Clark Avenue RECO) ED Concord, CA 94521 ) Against the County of Contra Costa ) L ,L=2 IW3 or ) Merrithew Memorial Hospital CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ presently unknownand in support of this claim represents as follows: 1.- When dhid the damage or injury occur? (Give exact date and hour) T at on or about February 16 , 1993 , cldimaht�-discovered an injury that he received while under the care and treatment of Merrithew Memorial H2spitaiaug1Z _contra 2. Where ad_F e&d6%1e18Frii6bry occur? (Include city and county) Martinez, Contra Costa County ------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if required) That Merrithew Memorial Hospital and/or Contra Costa County in conjunction with others, were negligent and careless in and about said care, _ treatment and diagnosis of claimant' s condition; in that, among other things, they failed to remove the pins in a timely fashion, thereby proximately axeelafflet5eS hutu±li Er_L --- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5b What are the names of county or district .officers, servants or employees causing the damage or injury? The employees of Merrithew Memorial Hospital and/ ' or Contra Costa County responsible for the occurrences- identified in are presently unknown. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. As a proximate result of the acts and omissions of Merrithew Memorial.-Hospital and/or Contra Costa County and its governing board of trustees and its agents and employees , aQ-5 e DYL f'L 1 c i r c-cum..6` - �2'22]'C1ZZL S ?17C� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) but not limited to, improper healing of the left femur, emotional distress plus special damages, including medical expenses , lost earnings , loss of earning capacity, general damages and other injuries. presently undiagnosed. $. Names and addresses of witnesses, doctors and hospitals. ------------------------------------------------------------------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT presently unknown Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by s erson on his behalf." Name and Address of Attorney Merrill Haber Jacoby and Meyers Claimant's Signature 100 Bush Street, Suite 700 &W 3nffZ,/-- 04�7,j� , f� San Francisco, CA 94104 N� (415) 399-8951 Address Telephone No. (415) 399-8951 Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding . one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. FII_IG.l=ice =,144 F - _ JACOBY & MEYERS Attorneys for Claimant CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL, CONTRA COSTA COUNTY TO: MERRITHEW MEMORIAL HOSPITAL, CONTRA COSTA COUNTY: The following claim for damages is hereby made by Joseph McClure against you, and each of you, and the particulars of. the claim are as follows: A. NAME AND ADDRESS OF CLAIMP�NT: JOSEPH McCLURE 1671 Clark Lane Concord, CA 94521 B. THE .ADDRESS TO WHICH NOTICES ARE TO BF SENT: Merrill Haber, Esq. Jacoby & Meyers 1-00 Bush Street, STe. 700 San Francisco, California 94104 C. DATE AND PLACE OF OCCURRENCE; That on or about August, 1992, and prior thereto and thereafter, claimant was under the care and treatment of Merrithew Memorial Hospital and/or Contra Costa County, Martinez, California. D. OTHER CIRCUMSTANCES OF OCCURRENCE: That on or about August, 1992 , and prior thereto and thereafter, claimant wae . admitted to Merrithew Memorial Hospital and/or Contra Costa County, Martinez , California for treatment of a broken left femur. Fil_b_ •t-tom :11 =' !:=TIAIICK -TEHIIJ #: =11` =1c 1 =8144 _ F That -Merrithew Memorial Hospital and/or Contra Costa County its nurses, and. other medical personnel undertook and agreed to diagnose and to care and treat claimant and do all . ° th_ings necessary and proper in connection therewith, and said Merrithew Memorial Hospital and/or Contra Costa County thereafter entered into such employment, individually and by and through their employees and agents. That Merrithew Memorial Hospital and/or Contra Costa County in conjunction with others, were negligent and careless in and about said care, treatment and diagnosis of claimant's condition, in that, among other things, they failed to remove the pins in a timely fashion, thereby proximately causing the injuries and damages herein alleged. At all -times mentioned herein, claimant did not know, and did not reasonably have grounds upon which to know, that the medical care described hereinabove was negligent and otherwise careless and improper, and that said care proximately caused said injuries and did at all times rely upon the medical personnel involved, and each of them, and, until after February 16, 1993 , did assume that the care and treatment claimant had received from said medical personnel was in all respects proper. Prior to that time, claimant had no cause to believe that his injuries were the result of negligence on the part of the Merrithew Memorial Hospital and/or Contra Costa County its governing board of trustees and its agents and employees, and each of them. E. EMPLOYEES CAUSING INJURY AND DAMAGES : The employees of Merrithew Memorial Hospital and/or Contra Costa County responsible for the occurrences identified herein are presently unknown. F. NATURE AND EXTENT OF DAMAGES; As a proximate result of the acts and omissions of Merrithew Memorial Hospital and/or Contra Costa County and its governing board of trustees and its agents and employees, Joseph McClure was caused to sustain bodily injuries, including but not limited to, improper healing of the left femur, emotional distress plus special damages including medical expenses , lost earings, loss of earning capacity, general damages and other injuries presently undiagnosed. G. AMOUNT OF CLAIM: Unknown at this time, however, the value of the claim is in excess of $10, 000 , 00 in general and special damages. The jurisdiction over the claim would rest in Superior Court. +: r: .TEHII`I # 411-" 21 -;144 " P. f t DATED: August : ,' 1993 JAC BY & MEYER .. By: IjAt Merrill Haber Attorneys for Claimant a rA 2rA w � OQ OM IrA rA �,- V O N O �-rA rA a ID cin cYt, 0' 0 e� t�? °v v N d C t N U 7 's 6 as U CD O N N d 05 of `� �% ,� j j .- r +:_ I 1 I :� , �� ,,' 1 i �� �� . ;. . � :� �-� � ��\