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Home My WebLink AboutMINUTES - 10191993 - 1.26 , CLAIM OCT ` 41993 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA i COUNTY COUNSEL Claim Against the County, or Oistrict ;governed by) BOARD AC13,0NNEZ,CAUE the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER 177-1- 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: Undetermined Section 913 and 915.4. Please note all *Warnings,-. CLAIMANT: WOIZESKI, Katherine ATTORNEY: Paul Tl Klobas Attorney at Law Date received ADDRESS: P_ . Box 20030 BY DELIVERY TO CLERK ON September 16, 1993 El Sobrante, CA 94820-0030 17717L ftftud BY MAIL POSTMARKED: September 14. 1993 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. H gg DATED: October 1, 1993 IVIL Deputy OR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Stperlisors ( 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: ow", BY: e Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( 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. PHIL BATCHELOR, Clerk, 8y 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 ao 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: OCT 20 IM BY: PHIL BATCHELOR b �, Q Q�� )_Deputy Clerk CC: County Counsel County Administrator Claim of KATHERINE WOIZESKI CLAIM FOR INJURY TO REAL PROPERTY _ against RECEIVED CONTRA COSTA COUNTY nse 1/44,CLERK OF SUPERVISORS CONTRA COSTA CO. To Clerk, Board of Supervisors, Contra Costa County: 1. Claimant, KATHERINE WOIZESKI, whose address is 4133 Barranca Street, El Sobrante, California claims damages from the Contra Costa County in an amount that exceeds $25,000 for injury to claimant's improved real property located at 4133 Barranca Street, El Sobrante, California. 2. Jurisdiction over this claim will rest in Superior court. 3. This claim is based on subsidence damage to the aforementioned real property that happened on or about December, 1992 at the above site under the following circumstances: Contra Costa County negligently and improperly approved, consulted, planned, designed, constructed, improved, re-modeled, controlled, and/or maintained the culvert below El Portal Drive and located downstream from Claimant's improved real property, to wit, the Super Span Culvert Bridge, El Portal Drive, Subdivision 4593, Sobrante Glen. Due to said negligence, Claimant's property was damaged by severe subsidence as hereinabove alleged. Claimant will sustain further damage if the defective, improperly designed, constructed and maintained culvert is not corrected. 4. Claimant does not know the names of the public employees who caused claimant's injury, damage and loss. 5. The injury, damage and loss sustained by claimant consists of severe subsidence damage to her improved real property located at 4133 Barranca Street, El Sobrante, California. 6. The injury, damage and loss expected to be incurred in the future includes further injury, damage and loss to the said property and structures thereon caused by continuing, further and successive subsidence of the real property owned by Claimant. 7. All notices and communications concerning this claim should be sent to: PAUL T. KLOBAS Attorney at Law 4515 San Pablo Dam Road P.O. Box 20030 El Sobrante, California 94820-0030 Telephone: (510) 223-5073 Fax: (510) 223-5306 Date:4 KATHERINE WOIZESKI y,4' Q^n /l UIN t!t Qj N tt~ O G N Z a }y a v a a a a. CC r � � rn C?- n aQ t-u � esir , O. ttS d � �� U - w CLAIM • �� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER 19 1993 and Board Action. All Section references are to ) The copy of this document mailed to you ?s 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: WOIZESKI,Katherine ATTORNEY: Paul t. Klobas Attorney at Law Date received ADDRESS: 4515 San Pablo Dam Road BY DELIVERY TO CLERK ON September 21,1993 P.O.Box 20030 El Sobrante, CA 94820-0030 BY MAIL POSTMARKED: September 14 1993 Gert. P 912 661 391 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 22.1993 (aiL �epuiy OR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓J 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: ZZ 3 BY: - C Deputy County Counsel 1II. 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. C ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. n Dated: u, 19 , (Qq 3 PHIL BATCHELOR, Clerk, ByDeputy 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 Postai 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 2 0 10 BY: PHIL BATCHELOR byTJ Deputy Clerk CC: ,County Counsel County Administrator NAND DELIVERED RECEIVE EP21 10 CLERK BOARD OF SUPERWSORS Claim of KATHERINE WOIZESKI CLAIM FOR INJURY _ conrrRA CosTA co. TO REAL PROPERTY against CONTRA COSTA COUNTY FLOOD CONTROL & WATER CONSERVATION DISTRICT To Board of Contra Costa County Flood Control & Water Conservation District: 1. Claimant, KATHERINE WOIZESKI, whose address is 4133 Barranca Street, El Sobrante, California claims damages from the Contra Costa County Flood Control & Water Conservation District in an amount that exceeds $25,000 for injury to claimant's improved real property located at 4133 Barranca Street, El Sobrante, California_ 2. Jurisdiction over this claim will rest in Superior court. 3. This claim is based on subsidence damage to the aforementioned real property that happened on or about December, 1992 at the above site under the following circumstances: Contra Costa County Flood Control & Water Conservation District negligently and improperly approved, consulted, planned, designed, constructed, improved, re-modeled, controlled, and/or maintained the culvert below El Portal Drive and located downstream from Claimant's improved real property, to wit, the Super Span Culvert Bridge, El Portal Drive, Subdivision 4593, Sobrante Glen_ Due to said negligence, Claimant's property was damaged by severe subsidence as hereinabove alleged_ Claimant will sustain further damage if the defective, improperly designed, constructed and maintained culvert is not corrected. 4. Claimant does not know the names of the public employees who caused claimant's injury, damage and loss. 5. The injury, damage and loss sustained by claimant consists of severe subsidence damage to her improved real property located at 4133 Barranca Street, El Sobrante, California. 6. The injury, damage and loss expected to be incurred in the future includes further injury, damage and loss to the said property and structures thereon caused by continuing, further and successive subsidence of the real property owned by Claimant. 7. All notices and communications concerning this claim should be sent to: PAUL T. KLOBAS Attorney at Law 4515 San Pablo Dam Road P.O. Box 20030 El Sobrante, California 94820-0030 Telephone: (510) 223-5073 Fax: (510) 223-5306 Date: l3 C/�J r ,KATHERINE WOIZESKI J J c 4 J P y F^y, NW y` y cco ocr fen Zia ZU fill WA W. CID •- o cc X90 W CLAIM BOARD„OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 19,1993 Claim Against the County, or District,governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $1,0001000.00 Section 913 and 915.4. Please note all "Warnings”. CLAIMANT: HELDT, Michael Andrew ATTORNEY: Cartwright, Slobodin, Bokelman,Borowsky, ,�- r Wartnick, Moore & Harris, Inc. Date received ADDRESS: 101 California Street, Suite 2600 BY DELIVERY TO CLERK ON Sent ember 16,1993 San Francisco, CA 94111 Hand Delivered BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. BHp q 1 DATED: September 20,1993 CyIL DATCELOR, Clerk: eputOd y I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ✓) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed.' The Clerk should return Claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 4&.1". :<- !+ 1 qq 3 BY: C • Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( /) 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: PHIL BATCHELOR, Clerk, By ��_ l'A, flQ„�J . 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: r OCT 2 BY: PHIL BATCHELOR by _1J , lVti Deputy Clerk CC: County Counsel County Administrator RECEIVED �I ' 1 COUNTY OF CONTRA COSTA 16M 2 ID. 00 a, rN I CLERK BOARD OF SUPERVISORS 3 TO: CLAIM AGAINST THE COUNTY OF CONTRA COSTA CONTRA COSTA CO. _ 4 Pursuant to Government Code Section 910. 5 Amount of Claim: $1, 000, 000. 00. 6 Claimant' s Name and Address: Michael Andrew Heldt 3100 Maplenut Avenue 7 Modesto, CA 95350 8 Telephone Number: (209) 549-7881 9 Address to which claimant desires notice to be sent: x 10 Steven M. Kesten, Esq. 3 °a Cartwright, Slobodin, Bokelman, Borowsky, o ,j ^ - 11 Wartnick, Moore & Harris, Inc. m ? < a 101 California Street, Suite 2600 a a ; < 12 San Francisco, CA 94111 F < g � (415) 433-0440 0X 13 4 � °m w < Place of, Accident: San Miguel Road at or about 920 San Miguel o ? o " 0 14 Road, Concord, California. 3 a ° G U 40 m JoYiri 15 Date of Accident: April 29, 1993 . N V < < i � oZ 16 Date, place and other circumstances giving rise to the claim: < N 3 < 3 17 At or about 7 : 34 p.m. on April 29, 1993 claimant Michael aAndrew Heldt was traveling at approximately 25-27 mph north bound v 18 on San Miguel Road. As he rounded a turn he saw a truck driven by James Kenneth Smith, Sr. , exiting the driveway at or about 920 San 19 Miguel Road. Claimant Heldt traveling at or about the posted speed limit, and unable to observe James Smith's vehicle due to a 20 curvature of the road, applied his brakes and doing so, under emergency circumstances, was unable to stop in time and he collided 21 with the vehicle driven by James Smith. As a result of the collision claimant has suffered, in addition to other injuries, a 22 broken back, punctured lung, hematoma and facial abrasions. In addition to personal injuries suffered by claimant, claimant's 1992 23 Harley Davidson Motorcycle sustained significant damages as a result of the above-described collision. Medical expenses, to 24 date, exceed $40, 000. 00. Property damage estimates are approximately $5, 100. 00. 25 Claimant contends that he was caused to come to an abrupt stop 26 as he was proceeding north bound on San Miguel Road as a result of the acts and omissions of the County of Contra Costa in improperly 27 constructing, improving, signing, maintaining, inspecting, and regulating said roadway in a grossly negligent manner. More 28 I particularly, the County posted an inappropriately high speed limit on said road causing motorists, including claimant, to assume it 2 was safe to travel at the posted speed limit. Said dangerous condition was created by the negligent and wrongful acts and 3 omissions of the County of Contra Costa and its employees, agents and/or servants. In the course of construction, excavation, 4 renovation, improvement, design, inspection, maintenance, signing, regulating, and controlling of said roadway the County of Contra 5 Costa and its employees, servants and agents acting within said employment, agency, and/or service, negligently caused or otherwise 6 permitted said San Miguel Road to be left in a dangerous condition as a result of their negligent and wrongful acts and omissions. 7 As a proximate result of said acts and omissions of the County 8 of Contra Costa, claimant, as stated above, was caused to apply his brakes in response to Kenneth Smith's vehicle in such a manner that 9 he was caused to fall from his motorcycle as above described. 10 Prior to claimant sustaining his injuries, the County of Contra Costa had actual notice of said dangerous condition in that 11 they had actual knowledge the curve on San Miguel Road in and about the area of 920 San Miguel Road constituted a dangerous condition 12 or trap and knew or in the exercise of reasonable care should have known, of its danger to unsuspecting motorists such as the claimant 13 herein. 14 Prior to claimant sustaining his injuries, the County of Contra Costa had constructive knowledge of the existence of said 15 dangerous condition in that the dangerous condition had existed in substantially the same state or condition for a long period of time 16 Prior to claimant sustaining his injuries and was of such an obvious nature, that both its existence and its dangerous character 17 should have been discovered by the County of Contra Costa with the exercise of due care and reasonable diligence and could have been 18 discovered by a reasonably adequate inspection system maintained and operated with due care. 19 The County of Contra Costa failed to take any measures to 20 protect against the said dangerous condition in that they did not properly prepare, inspect, sign, remedy, repair or correct said 21 dangerous condition or provide any safeguards against it, or warn claimant or other members of the public using said roadway of the 22 dangerous condition or trap. As a proximate result of the County of Contra Costa's failure to take any measures to protect against 23 a dangerous condition of which they had actual and/or constructive knowledge, claimant had an inadequate time within which to stop his 24 motorcycle thus causing the above-described accident. 25 Amount of Claim: $1, 000, 000. 00. 26 Name of employees who caused injury if known: Upon information and belief, the employees in charge of performing, 27 maintaining, controlling, managing, constructing, repairing, signing, inspecting, and designing said roadway. 28 1 Itemization of Claim: Claimant has incurred past and continuing medical expenses, the exact amount of which is unknown 2 at this time. Claimant will seek general and special damages in an amount no less than $1, 000, 000. 00. 3 Signed by and on behalf of claimant: 4 DATED: September 9, 1993 5 CARTWRIGHT, SLOBODIN, BOKELMAN, BOROWSKY, 6 WARTNICK, MOOR & HARRIS, INC. 7 8 TEVE M. KESTEN 9 Attorneys for Claimant 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT OCTOBER 19,199 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:$500-000:00 Section 913 and 915.4. Please note all •Warnings". CLAIMANTBETTENCOURT,Judith ATTORNEY:Robert B. Galler, Esq. Bennett, Johnson & Galler Date received ADDRESS: 1901 Harrison Street, Suite 1650 BY DELIVERY TO CLERK ON September 20,1993 Oakland, CA 94612 BY MAIL POSTMARKED: $egtember 17, 1993 Cert. # P 880 262 415 1. FROM: Clerk of the Board of Supervisors l TO: County Counsel Attached is a copy of the above-noted claim. ppHH1L ATCHELOR. Cler DATED: �( .r /.�� 21 1493 BY: �eputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ✓f 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 A BY: lY 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. n Dated:�i't&-A eA Ct Cf ?ij PHIL BATCHELOR. Clerk, By Y. . n, . 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 2 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant aas shown above. 1 Dated: -OCT 2 0 BY: PHIL BATCHELOR by �� 0„ /,,' Deputy Clerk LC: County Counsel County Administrator 0 1 GOVERNMENT CLAIM FOR DAMAGES 2 TO CLAIMEES: EL CERRITO POLICE DEPARTMENT 3CITY OF EL CERRITO c/o City Clerk 10890 San Pablo Avenue 4 E1 Cerrito, CA 94530 5 RC I E ;-1, CONTRA COSTA COUNTY SHERIFF COUNTY OF CONTRA COSTA 6 c/o Clerk of the Board of � 2 � 19 Supervisors 7 651 Pine Street, Suite 106 BOAROOPSUPERVISORS Martinez, CA 94553 8 C COPITRA COSTA CO. BAY AREA RAPID TRANSIT DISTRICT 9 c/o Insurance Division 800 Madison Street 10 Oakland, CA 94607 11 AC TRANSIT DISTRICT c/o Claims Department 12 1600 Franklin Street Oakland, CA 94612 13 14 FROM CLAIMANT: JUDITH BETTENCOURT 6251 Plymouth Avenue 15 Richmond, CA 94805 16 ADDRESS TO WHICH NOTICES ARE TO BE SENT: ROBERT B. GALLER, ESQ. 17 BENNETT, JOHNSON & GALLER 1901 Harrison Street, Suite 1650 18 Oakland, CA 94612 19 AMOUNT OF CLAIM: $500, 000.00 20 DATE CLAIM ACCRUED: March 18, 1993 21 PLACE CLAIM ACCRUED: E1 Cerrito BART Station 6699 Fairmount Avenue 22 El Cerrito, California 23 CIRCUMSTANCES OF CLAIM: Claimant JUDITH BETTENCOURT was a passenger on board an AC Transit bus 24 parked at the E1 Cerrito BART station when she suffered an epileptic seizure 25 leaving her disoriented, incoherent and agitated. As a result of Claimant's 26 seizure and resulting behavior, Claimants, and each of them, negligently and carelessly responded to 1 1 her needs and/or failed to appropriately respond to her needs, 2 assaulting and battering her and ultimately physically and/or medically 3 restraining her. 4 Claimees failed to properly care for and supervise 5 Claimant JUDITH BETTENCOURT and failed to adequately and appropriately provide for her safety and well-being 6 while attempting to attend to her medical needs and transport her to 7 a medical care facility, despite Claimees knowledge of Claimant's 8 medical condition, as indicated on the epileptic medical tag worn on her wrist 9 at the time of this incident. 10 As a direct and proximate result of the negligence of Claimees 11 as alleged herein, Claimant JUDITH BETTENCOURT sustained 12 severe personal injury. 13 ITEMIZATION OF DAMAGES: The medical bills incurred as a result of the personal injury to JUDITH 14 BETTENCOURT as well .as her pain and suffering. In addition, Claimant 15 JUDITH BETTENCOURT has suffered humiliation, anxiety and mental 16 anguish, as well as damages as a result thereof which are unknown at present. 17 All of these damages will be proven at an appropriate time. 18 19 DATED: Sept. 15, 1993 BENNET N f N & GALLER 20 21 22 ROBER B. GAL R Attorney for Claimant 23 24 25 26 1 PROOF OF SERVICE 2 I, CINDY L. HERMANSON, am employed in the County of Alameda, State of California. 3 I am over the age of eighteen (18) years and not a 4 party to the within action. My business address is 1901 Harrison Street, Suite 1650, Oakland, California 94612 . 5 On September 17, 1993, I served the within: 6 GOVERNMENT CLAIM FOR DAMAGES 7 on the parties to this action by placing a true copy thereof 8 in a sealed envelope, addressed as follows: CONTRA COSTA COUNTY SHERIFF 9 COUNTY OF CONTRA COSTA c/o Clerk of the Board of 10 Supervisors 651 Pine Street, Suite 106 11 Martinez, CA 94553 12 / x / (BY MAIL) I placed each such sealed envelope with postage thereon fully prepared for first-class mail, for 13 collection and mailing at Oakland, California, following ordinary business practices. I am readily familiar with the 14 practice of BENNETT, JOHNSON & GALLER for processing of correspondence, said practice being that in the course of 15 ordinary business, correspondence is deposited in the United States Postal Service the same day it is posted for 16 processing. 17 / / (BY PERSONAL SERVICE) I caused each such envelope to be delivered by hand to the addressees(s) noted above. 18 (BY FACSIMILE) I caused said document to be 19 transmitted by Facsimile machine to the number indicated after the address(es) noted above between the hours of 9: 00 20 a.m. and 5: 00 p.m. 21 I declare under penalty of perjury under the laws of the State of California that the foregoing is true and 22 correct. Executed at Oakland, California, on September 17, 1993 . 23 24 G u01 .CINDY L HERMANSON 25 26 � L � ul O Oul w Loin ON °cr, �. O � N ��' o N Ul C S 22 O - _�- p l 00 � � � W A-) jd vv � cn o a z , , PEARCE & FRANKMAN INC. INSURANCE ADJUSTERS RECEIVED MAIN OFFICE .MAILING ADDRESS �I 2380 Junipero Serra Blvd. P:O. Box 527 OCT 510 Daly City,California 94014 Daly City,California 94017 (415) 756-7400 FAX:(415)756-3948 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Reply to: DALY CITY, CA October 1, 1993 j Contra Costa Count Sheriff Icy County of Contra Costa $ Clerk of the Board of Supe=rvisors 651 Pine Street, Suite 106 Martinez, CA 945153' RE: BART Claim No: 07986 Date of Loss: 3-18-93 Claimant: Judith Bettencourt � Our File No: 07986 BA 05 Dear Sir or Madam e: 1 We are the third party liability claims administrators for the Bay Area Rapid Transit District. The undersigned has been assigned the handling of this �lcaptioned claim. I As we have been named co-claimees by claimant Bettencourt, it would. seem that contact with your claims representative should be made so that we may discuss our further handling of this matter. Please have the assigned adjuster contact our office at their earliest opportunity. Thank you for your cooperation. Very tr 1t y—, S' PEA C FR ANII , INC. 1 t hatz . bm CIO, j i 0 LAFAYETTE SAN JOSE SACRAMENTO 961 B Moraga Road 1250 Aviation Avenue P.O. Box 60376 Lafayette, CA 94549 Suite 200-Q Sacramento,CA 95860-0376 (510)946-1063 San Jose, CA 95110 (916)978-9790 FAX:(510)284-2931 (408)995-6630 FAX:(916)978-9681 FAX:(408)280-5700 • CLAIM BOARD'iOF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OCTOBER 19,1993 And as the Governing Board of -Cont- 0dsta-:.CotMtfflo_6d:Control District Claim Against the County, or Districtlgoverned by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $2,300.00 Section 913 and 915.4. Please note all 'Warnings". CL A I MANT MAMONI,Phil ATTORNEY: Date received ADDRESS: 2865 Lane DRive BY DELIVERY TO CLERK 0 Se tPmhPr 17. 1993 goncord, CA 94518 BY MAIL POSTMARKED: September 16,1993 i I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 20,1993 (dIL DELOR, Clerk ATCH: eputy II. FROM: County Counsel i TO: Clerk of the Board of Supervisors ( 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: i Dated: 2 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). i 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: s �4. �Qy PHIL BATCHELOR, Clerk, By �AADeputy Clerk T 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 94S.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 immedii;tely. *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:" OCT 2 0 199 '1, BY: PHIL BATCHELOR by , , Deputy Clerk CC: County Counsel County Administrator II Clair.: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claiu.s 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 yearl after the accrual of the cause of act-ion. (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 ag irzt, 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 ) RECEIVE® Against the County 1of Contra Costa ) SEP710 or ) C!_ERK gOARD OF SUPERVISORS 6 _oar District) Co�a�Ra cGs�A 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 $ ,„�p 0. ' b and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hoax) - ---------------- --- ------------------------------ 2. Where did the damage or injury occur? (Include city and county) . d/-d 012 el 3. How did the damage or injury occur? (Give full details; use extra paper if - �•� --�_ opo( I r�Q j�� ..,w�..� ,�u/.��r�'�, ,,�,►�,------- -- ----- ----------------------------------- 4. What particular act or omission 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 damage or injury? ------------ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7.' How was the amounti claimed above computed? (Include the estimated amount of any prospective injuryjor damage.) 8. Names and addresses of witnesses, doctors and hospitals. ---------------------- ----- -�..�w 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: (Attorne ) or by some person on his behalf." Name and Address of Attorney 4 Cl is Signature . A _.. v Address - T ..Ya. 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 claim, 'bill ui _;1voucher,'or.. writing, is punishable either by imprisonment in the county jail for aperiod -of .not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. i 1 ROTO- R001FJP COAST; _. TO 195 MASON CIRCLE-CONCORD,CALIFORNIA 94520 sss-s.i o0 C ,AST PROPOSAL AND CONTRACT 0 ATE 3y� /n 19 -L- TO: i r JOB NAME: �I WE PROPOSE TO FURNISH ALL MATERIALS AND PERFORM ALL'LABOR NECESSARY TO COMPLETE THE FOLLOWING: yIif 10 ✓Ri -cove, ; it 04' - c� .sv � ! ?�[/"�. � !i y2_ II� �il.L'��. --ii 7 at-5 �' i Ow C,� r•rr�- ,c. � ,v . . / I / 1 ✓ it v .� AY t"7 GAYY M147rY '' i V) .30 /Fzl- /! G i7f O' A_y e� f/17C!eS J-,c /Lf fi ci /e -I/i f/ 'I II ALL OF THE ABOVE WORK TO BE COM- PLETED IN A SUBSTANTIAL AND WORK- d o MANLIKE MANNER FOR THE SUM OF: 72 "-' TERMS PAYMENT IN FULL TO BE MADE UPON COMPLETION OF JOB.IF NOT PAID IN FULL WITHIN 30 DAYS AFTER DATE OF STATEMENT A FINANCE CHARGE WILL BE ADDED TO YOUR ACCOUNT.SUCH FINANCE CHARGE IS COMPUTED BY A PERIODIC RATE OF 1%%PER MONTH WHICH IS AN ANNUAL RATE OF 18%.APPLIED TO THE PREVIOUS BALANCE AFTER DEDUCTING CURRENT PAYMENTS AND/OR CREDITS, CONDITIONS: It is understood and agreed that we'shall not be held liable for any loss,damage or delays occasioned by fire,strikes,.or material stolen after delivery upon premises,lockouts,acts of God, or the public enemy,accidents,boycotts,material shortages,disturbed labor conditions,delayed delivery of materials from Seller's suppliers,force majeure,inclement weather,floods,freight embargoes,causes incident to national emergencies,war,or other causes beyond the reasonable control of Seller,whether of like or different character,or other causes beyond his control. Prices quoted in this contract are based upon present prices and upon condition that the proposal will be accepted within thirty days.Also general conditions which are standard for specialty contractors in the construction industry.Not responsible for lawns,trees,flowers,fences,etc. NOTICE TO OWNER Contractors are required by law to be licensed and regulated by the Contractors' State License Board. Any questions concerning a contractor may be referred to the registrar of the board whose address is: Contractors'State License Board, 1020 N Street Sacramento,California 95814. "Under the Mechanics'Lien Law,any contractolr,subcontactor,laborer,materialman or a modification thereof,in the office of the county recorder of the county where the or other person who helps to improve your propertin such y and is not paid for his labor,services prooffcerty is Sa dsituated and bond hall been anng that a amount not lesas than fifty percent(50%)of ayment bond be recorded econtract or material,has a right to enforce his claim against your property. "Under the law, you may protect yourself against such claims by filing, before price and shall,in addition to any conditions for the performance of the contract,be conditioned for the payment in full of the claims of all persons furnishing labor,services, commencing such work or improvement,an originallcontracT for The work of improvement - i equipment or materials for the work described in said contract. Any alteration or deviationifrom the above specifications.involving extra cost of material or labor will only be executed upon written orders for same, and will become an extra charge over the sum mentioned in this contract All agreements must be made in writing. . y.7 SUBMITTED G BY ��7 y.F" ACCEPTED LICENSE NO 3c2.3 53 2 i DATE` --..y•,.-��vwy�&-7'�gY'.""�,,,#r�,:,,w'4t4�;�'tsNt�a`l.w4P`�+,',�7ti}e'er ��.r:;3t7 �`,.11'u':�I"Y�agazh>}-af••i1,fii':S'f�r�iwvt7a.J:yr.-t..tir}c"E.,,gjsyt�, ...t7 t '., sJ•�fiSj,+9"'df:Mr'�A"„�r'Ltrh '�p fa�;iM?v''jtirr�rai: BLACK & BLACK Work Order �� Making a Splashe Al mow. ate j , � r i Al i a at�ir 'a Olub pip nv” B x s Telephone zi Work�� 01� b0 Description � ., ar �� er La Total _ /t-= LA ow y u � � ,...ry I_"irJE' it` LAc-c-�(Ni-1, NSa. 1.6 S \ri0 2k -woo_ i 1 -76 -2-00 o iso 3s� 1� - GUSToM(AL IU— P to VI 0 E: I 3' Subtotal ax , I hate read this contract and accept it in it's entirety De11VeIy 1-800-655-9009 417 Harding Ave, Livermore, CA 94550 TOTAL p g LI%ITED WARRANTY- AB work performed by Black&Black,should the pool be new and in good condition,is guaranteed to be free of defect in installation asdescribed in product brochures published by the manufacturer of the pool.Conditions not covered by warranty include damage resulting fromaccidents,actsof God,unstable sod conditions,setd ng,alterations,misuse,abuse or any condition covered by the product warranty;all warranties y are for a period of one year following the completion d,i a original job order. 1 s TgRMSANDCONDIfIONS- Hereafter Black&B1ackshaBbezefered to as'Installer",ardownerororganizationrepresentedbysigneeshaBbe known DepOSlt a , as"Owner". Permit rmitc�.d 1 ahor Rnln Owner shall obtain and pay for all-permits and pay any assessments required by public bodies.Owner agrees'. m � to payrany costes arising governmentorlaborunion uIeswhichaddiocostofinstallaanincludingmwementofmaterials,water,utilities,orother regulatedactiOn,IIHItt{Ps,Unlessottierw�sespectfied Owner will provide allwater,gas orelectrlcutWtiesandpayaBmstsarising from hookupand DePOSlt , use of such.Installer.shall not be responsible for any electrical workor services whatsoever lipnipnCC Owner is responsible for any aent or, ccid nialfiuiction'of.poot Owner agrees to procure any n fecesearY liability'or fire insurance;�with course of construction The insurance policy shall name "�x+ry in asadditional insured and shall protect the interesffi of the,Owner and Installer:Owner agrees to protect and defend Installer from any and all Balance . . claims arising from use or failure of pool. F tra Work and Chanons•If Owner or any public body or,inspector directs any:modificationor sddWon to aworkshallbedeterininedinadvanceandthecostshallbeaddedtothecontractpriceinaddihon theworlccoveiedbythiscontract thechargeforthatextr to Installers usual fee for overhead and profit Owner shall make payments for all extra work as that work progresses.Installer shall do no extra work without prior authorization,signed by both parties,.(Directive or Repatr Work If minor items or corrective or repair work remain to be accomplished by Installer after the project is ready,Installer shall perform the work expeditiously and Owner shall not withhold any payment pending completion of that work. payment;Final payment by Owner shall bead ue upon completion of.project.If full payment is not recfeved upon 2npletion,a sum of 10 percent of total plus 24%annual interest will be added to the total owed. (:oveming t Awe This agreement shall be cor�attued in accordance with,and govemedby,the lawsofthe,StateofCalifomia.';�jotnorahnn •iave•ThisdocumeiitandalidocumentslncorporatedbyreEerencecmatitutetheparties: entire agreement.No other agreements exist between ilie parties. �n CLAIM BOARD'bF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OCTOBER 19,1993 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements. ) NOTICE TO CLAIMANT 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: Unspecified Amount Section 913 and 915.4. Please note all 'Warnings". CLAIMANT:MARKS, Daniel Timothy ATTORNEY:Hinton & Alfert Date received 1646 No. California Blvd. ADDRESS• Ste. 600 BY DELIVERY TO CLERK ON September 17,1993 • Walnut Creek, California 93612 BY MAIL POSTMARKED: Hand Delivered I i 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of theabove-noted claim. QH B DATED: September 20,1993 �aIl Deputy OR, Clerk �QJ I1. FROM: County Counsel I TO: Clerk of the Board of Supervisors (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: tt4�be4,1 l! 3 BY. C,. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as unt',Imely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (✓� This Claim is rejected in'Ifull. j ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ,�c( ,Q �PHIL BATCHFLOR, Clerk, By ,�f, �QQp,� , Deputy Clerk J 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 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.-----, - Dated: OCT 20 10 ,. �� BY: PHIL BATCHELOR by �z ,�J Deputy Clerk If Ct: County Counsel County Administrator I� RECEIVED 1 PETER J. HINTON t PETER W. ALFERT. 2 HINTON & ALFERT SEP 17M 1646 No. California Blvd. , Suite 600 3 Walnut Creek, California 94596-4113 CLERK BOARD OF SUPERVISORS Telephone: (510) 932-6006 CONTRA COSTA CO. 4 Facsimile: (510) 932-3412 5 Attorneys for Claimant Daniel Timothy Marks 6 7 8 In The Matter of: ) CLAIM AGAINST THE COUNTY OF CONTRA COSTA 9 DANIEL TIMOTHY MARKS ) (Calif. Gov. Code §910) 10 Claimant. ) 11 12 The above named Claimant acting by and through attorneys 13 HINTON & ALFERT, hereby makes the following claim against: 14 CLERK, BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 15 651 Pine Street Martinez, California 94553 16 NAME OF CLAIMANT: DANIEL TIMOTHY MARKS 17 ADDRESS OF c/o HINTON & ALFERT 18 CLAIMANT 1646 No. California Blvd. , Suite 600 Walnut Creek, California 94612 19 20 DATE OF INCIDENT: March 18, 1993 21 LOCATION OF Dougherty Road, one quarter mile north of INCIDENT Old Ranch Road in the County of Contra Costa. 22 AMOUNT OF CLAIM An unspecified amount within the 23 jurisdictional limits of the Superior Court. 24 NATURE OF Claimant suffered injuries, including but not INJURIES AND limited to a shattered pelvis consisting of 25 DAMAGES at least 13 fractures, fractures of his L3-L4 disks and related nerve injuries which have 26 confined him to a wheelchair. Claimant seeks general and economic damages for personal 27 injury and emotional distress arising from a automobile accident which occurred on 28 property owned and maintained by the County 1 a I of Contra Costa. Said damages include, but are not limited to, medical expenses, past 2 and future, lost wages, loss of earning capacity and incidental expenses. 3 NAME OF PUBLIC Public employees, agents, and/or personnel of 4 EMPLOYEES CAUSING the County of Contra Costa, presently CLAIMANT'S unidentified, who were involved with the 5 INJURIES AND design, construction and maintenance of the DAMAGES roadway known as Dougherty Road in the 6 vicinity of claimant's accident. 7 CIRCUMSTANCES See Attachment A. GIVING RISE 8 TO THIS CLAIM 9 . Dated: September 17, 1993 HINTON & ALFERT 10 11 12 By P HINTON 13 A o eys for Claimant 14 This will acknowledge receipt of the above claim on this 15 day of September, 1993 . 16 COUNTY OF CONTRA COSTA 17 18 By 19 Title: 20 21 22 23 24 25 26 27 28 2 1 ATTACHMENT A 2 This claim arises from a vehicular accident which occurred 3 on March 18, . 1993, on Dougherty Road, approximately one quarter 4 mile north of Old Ranch Road, in the County of Contra Costa. The 5 accident occurred when the vehicle which Daniel Timothy Marks was 6 driving travelled from the surfaced portion of the roadway onto 7 the adjacent shoulder and attempted to return to the surfaced 8 roadway at which time it rolled over causing major damage to the 9 automobile and major injuries to claimant. 10 Claimant is informed and believes that the geometry of the 11 1 curve, the surface of the road, the drop off at the edge of the 12 road and theicomposition of the shoulder as well as the absence 13 of adequate warnings in that area created a trap for persons 14 using the roadway and constituted a' dangerous and defective 15 condition of public property, all of which were created by 16 negligent acts and omissions by the County of Contra Costa, its 17 agents, employees, predecessors in interest, and special 18 districts, as to which each such individual and entity had actual 19 or constructive notice. 20 As a proximate result of the foregoing negligent acts and 21 omissions, the County of Contra Costa, its agents, employees, 22 predecessors, in interest, and special districts, claimant, 23 himself using due care, was caused multiple and serious injuries. 24 25 26 27 28 3 1 M 1 ^l� i M r M kIvo .r -19 4 V t ` 1' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OCTOBER 19,1993 Claim Against the County, or Districtjgoverned by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: Unspecified Amount Section 913 and 915.4. Please note all •Warnings". CLAIMANT: PELAYO,Norma ATTORNEYHinton & Alfert Date received ADDRESS: 1646 No. California Blvd. , Ste. 600 BY DELIVERY TO CLERK ON September 17,1993 Walnut Creek, California 94612 Hand Delivered BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors �TO: County Counsel - Attached is a copy of the Above-noted claim. DATED: September 20.1993 (aIL deputy OR, Clerk Il. 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: 2-1 4 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 in its minutes for this date. Q /� Dated:CDEW",�qt, 12a PHIL BATCHELOR, Clerk, By �Q (� /QQ , 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 laction 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 ] 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 clai=rAAas OW_above. OCT 2 0 1993 r Dated: BY: PHIL BATCHELOR Dy a Deputy Clerk CC: County Counsel County Administrator x • • I PETER J. HINTON REC'EiVED PETER W. ALFERT 2 HINTON & ALFERT SEP ( 7 1646 No. California Blvd. , Suite 600 3 Walnut Creek, California 94596-4113 Telephone: (510) 932-6006 CLERK 90AEDOF5LURFRVI OR13. 4 Facsimile: (510) 932-3412 OOn��R;ar,OT�� ) . � .T_x-.�...... ..... 5 Attorneys for Claimant Norma Pelayo 6 7 8 In The Matter of: ) CLAIM AGAINST THE COUNTY OF CONTRA COSTA 9 NORMA PELAYO ) (Calif. Gov. Code §910) 10 Claimant. ) 11 12 The above named Claimant acting by and through attorneys 13 HINTON & ALFERT, hereby makes the following claim against: 14 CLERK, BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA 15 651 Pine Street Martinez, California 94553 16 NAME OF CLAIMANT: NORMA PELAYO 17 ADDRESS OF c/o HINTON & ALFERT 18 CLAIMANT 1646 No. California Blvd. , Suite 600 Walnut Creek, California 94612 19 20 DATE OF INCIDENT: March 18, 1993 21 LOCATION OF Dougherty Road, one quarter mile north of INCIDENT Old Ranch Road in the County of Contra Costa. 22 AMOUNT OF CLAIM An unspecified amount within the 23 jurisdictional limits of the Superior Court. 24 NATURE OF Claimant's fiance, Daniel Timothy Marks, with INJURIES AND whom she has lived for several years in a 25 DAMAGES common law relationship, suffered injuries, including but not limited to a shattered 26 pelvis consisting of at least 13 fractures, fractures of his L3-L4 disks and related 27 nerve injuries which have confined him to a wheelchair. Claimant seeks general damages 28 for loss of consortium arising from a 1 1 automobile accident which occurred on property owned and maintained by the County 2 of Contra Costa. 3 NAME OF PUBLIC Public employees, agents, and/or personnel of EMPLOYEES CAUSING the County of Contra Costa, presently 4 CLAIMANT'S unidentified, who were involved with the INJURIES AND design, construction and maintenance of the 5 DAMAGES roadway known as Dougherty Road in the vicinity of claimant's fiance's accident. 6 CIRCUMSTANCES See Attachment A. 7 GIVING RISE TO THIS CLAIM 8 9 Dated: September 17, 1993 HINTON ,&','ALFERT rl 10 11 By 12 P J. HINTON At rneys for Claimant 13 This will acknowledge receipt of the above claim on this 14 day of September, 1993 . 15 COUNTY OF CONTRA COSTA 16 17 18 By Title: 19 20 21 22 23 24 25 26 27 28 2 ATTACHMENT A 2 This claim arises from a vehicular accident which occurred 3 on March 18, 1993, on Dougherty Road, approximately one quarter 4 mile north of Old Ranch Road, in the County of Contra Costa. The 5 accident occurred when the vehicle which Daniel Timothy Marks was 6 driving travelled from the surfaced portion of the roadway onto 7 the adjacent shoulder and attempted to return to the surfaced 8 roadway at which time it rolled over causing major damage to the 9 automobile and major injuries to claimant's fiance, Daniel 10 Timothy Marks. 11 Claimant is informed and believes that the geometry of the 12 curve, the surface of the road, the drop off at the edge of the 13 road and the composition of the shoulder as well as the absence 14 of adequate warnings in that area created a trap for persons is using the roadway and constituted a dangerous and defective 16 condition of public property, all of which were created by 17 negligent acts and omissions by the County of Contra Costa, its is agents, employees, predecessors in interest, and special 19 districts, as to which each such individual and entity had actual 20 or constructive notice. 21 As a proximate result of the foregoing negligent acts and 22 omissions, the County of Contra Costa, its agents, employees, 23 predecessors in interest, and special districts, claimant's 24 fiance, himself using due care, was caused multiple and serious 25 injuries. 26 27 28 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 7 Claim Against the County. or District 'governed by) BOARD ACTION the Board of Supervisors. Routing Endorsements. ) NOTICE TO CLAIMANT OCTOBER 19,1993 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: MORENO,Anthony Sr. , MORENO,Kathleen,I1OREN0; -James_,_=MORENO-,_Richard MORENO,Letasha,MORENO,Latanya,MORENO,Joseph, MORENO, Phillip ATTORNEY: Law Offices of Edward M. _Yias%rangeIIEs A Professional Corporation �te &eived ADDRESS: 3447 Mt. Diablo Boulevard BY DELIVERY TO CLERK ON September 20.1993 Lafayette, California 94549 BY MAIL POSTMARKED: September 17.1993 Cert. P 247 733 004 1. FROM: Clerk of the Board of Supervisors TO: _County Counsel Attached is a copy of the above-noted claim. QH g DATED: September 22,1993 IV Deputy OR. Clerk i 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (V/ This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply,isubstantially with Sections 91D 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: 122— 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 I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: pQ,,, q, q 3 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 IB; 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 2 O BY: PHIL BATCHELOR Dy Deputy Clerk LC: County Counsel County Administrator 1 1 EDWARD M. MASTRANGELO, ESQ. RECEIVED w LAW OFFICESIJOF EDWARD M. MASTRANGELO 2 A Professional Corporation SEP 2 X993 3447 Mt. Diablo Boulevard 3 Lafayette, CA 94549 CLERK BOARD OF SUPERVISORS ' 4 (510) 283-0600 CONTRA COSTA CO. 5 Attorney for Claimants, ANTHONY MORENO, SR. , KATHLEEN MORENO, 6 JAMES MORENO, RICHARD MORENO, LETASHA MORENO, LATANYA MORENO, JOSEPH MORENO, 7 PHILLIP MORENO 8 9 In the Matter of the Claims of: 10 ANTHONY MORENO, SR. , et al. 11 Claimants, 12 vs. 13 COUNTY OF CONTRA COSTA 14 15 16 TO COUNTY OF CONTRA COSTA: 17 The above Claimants hereby present this claim to the County 18 of Contra Costa pursuant to Section 910 of the California 19 Government Code. 20 1. The post office address to which Claimants desire 21 notice of this claim be sent is as follows: Law Offices of 22 Edward M. Mastrangelo, A Professional Corporation, 3447 Mt. 23 Diablo Boulevard, Lafayette, California 94549. 24 2 . Date and Circumstances of Occurrence: On or about 25 March 17, 1993, at approximately 3 :30 p.m. , decedent Antonio 26 Soto Moreno, a minor, was killed when he was struck by a Santa 27 -1- 28 i II 1 Fe Railway locomotive train on the Santa Fe tracks located 2 behind 475 Last Santa Fe in Pittsburg, California. Prior to 3 this accident, decedent was playing with his cousin Arthur 4 Torres, then age seven; his sister LaTanya Moreno; his brother 5 Joseph Moreno; and a friend named Donald Pacheco, then age five. 6 The children were playing under the Harbor Street underpass, 7 which is just below the Santa Fe tracks, when they decided to 8 climb up a graded sloped hill which leads up to the tracks to 9 continue plying. There was no fence, warning signs or other 10 barriers separating Harbor Street and the train tracks. 11 Decedent Antonio Soto Moreno was ahead of the other children and 12 when he reached the top of the hill, he proceeded to walk 13 northbound across the south tracks with the other children 14 following. iAt the same time, a Santa Fe locomotive approached 15 on the south tracks traveling westbound at a speed in excess of I 16 sixty miles per hour. The train struck the decedent, 17 decapitating him and killing him instantly. Claimants are 18 informed and believe and thereon allege that the area of Harbor 19 Street, which abuts the Santa Fe railroad track, is in the 20 County of Contra Costa, which is legally responsible for the 21 design, inspection, repair and maintenance of said real I 22 property. The County of Contra Costa knew, or in the exercise 23 of due care) should have known, that the lack of a fence, 24 warning signs or any barrier whatsoever separating the tracks 25 from public property created an unreasonable and foreseeable 26 risk of harm to persons such as the decedent. Said County of 27 -2- 28 I I' •. . III 1 Contra Costa, through its employees, failed to exercise I 2 reasonable care in the inspection, design, repair and 3 maintenance � of the abutting real property thereby causing the 4 death of the decedent as here and above set forth. 5 As a result of this incident, the Claimants have suffered 6 damages including, but not limited to funeral and burial 7 expenses, loss of financial support, loss of love, 8 companionship, comfort, affection, society, solace and moral 9 support. Claimants LaTanya Moreno, Joseph Moreno and Arthur 10 Torres were present at the scene of the accident and were aware I 11 that the accident caused injury and death to the decedent, and 12 as a result have suffered severe emotional distress and mental 1 13 shock. 14 3. Names of People, Employees Causing Injury: Employees 15 of the County of Contra Costa, whose identities are presently 16 unknown to IClaimant. 17 4. Amount Claimed: Undetermined at present, but in an 18 amount within the jurisdiction of the Superior Court of the 19 State of California. 20 DATED: td-ward-m. Aastrangelo, 21 Attorney for Claimants 22 23 24 25 26 27 _3_ 28 1 PROOF OF SERVICE BY MAIL (CCP g51013 (a) - 2015.5) 2 I am employed in the City of Lafayette, County of Contra 3 Costa, California. I am over the age of 18 years and not a party 4 to the within cause; my business address is 3447 Mt. Diablo Blvd. , 5 Lafayette, CA 94569. 6 I am readily familiar with this firm's practice for 7 collection and processing of correspondence for mailing with the 8 U. S. Postal Service. On September 17, 1993 , at the above- 9 referenced business location, I sealed envelopes enclosing a copy 10 of Government Code Claim (Section 910) on all parties in this 11 action, and placed them for collection and mailing following 12 ordinary business practices to be deposited with the U. S. Postal 13 Service on September 17, 1993 : I 14 Contra Costa County Clerk of the Board of Supervisors 15 651 Pine Street, Room 106 Martinez, California 94553 16 Attention: Shirley 17 I declare under penalty of perjury under the laws of the i8 State of California that the foregoing is true and correct. 19 Executed at Lafayette, California on September 17, 1993 . 20 21 ulie Bowker 22 23 24 25 26 27 28 'i LAW OFFICES OF EDWARD M. MASTRANGELO A PROFESSIONAL CORPORATION - EDWARD M.MASTRANGELO 3447 MT.DIABLO BOULEVARD TELEPHONE (510)283-0600 MARGARET BLODGETT LAFAYETTE, CALIFORNIA 94549 FACSIMILE (510)283-0791 NICHOLAS J.MASTRANGELO RECEIVED_ 3 September 17,, 1993 SEP 2 0 19M CLERK BOARD ORS COSTA CO IS Contra Costa County Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez, California 94553 Attention: Shirley RE: Claim of Anthony Moreno, Sr. , et al. Dear Shirley: Enclosed is the original and one photocopy of the Government Code Claim (pursuant to §910) to be filed in accordance with the above-referenced matter. Please return a date-stamped copy to this office in the attached envelope. Thank you for your cooperation. Ver/ truly yours, Edward WM. AMastran elo EMM/jab Enclosure i uT �Iwo .. ( C\ �G _ COD r tD -14- L.MRl l71I ��pppp z 4 V�-- l- r O WA L o � tUM coLO COLO N Ern — - - - �o° t oo°c > ss> o CO �.; 0 cv cc r U o as 4-- IE voi co Co U- to+j Et!? X01 o � NV co 4-Lu o LU<1 u LL o 1Ya �.LLIo` C Vco- ,� $� UU0) � � d LLJ o ca t -r 1 00 s co • O M �- iti 00 w w° 3W �� r • 1 a(o CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA OCTOBER 19,1993 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT 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: $519.90 Section 913 and 915.4. Please note all 'Warnings". CLAIMANT:AETNA CASUALTY and SURETY ATTORNEY:Jackie Hensley, Claims Adjuster Date received ADDRESS: P.O.Box 13089 BY DELIVERY TO CLERK ON SPS temher 1701C)C)'3 Sacramento, CA 94813 BY MAIL POSTMARKED:_Sge tPmhPr 14,1991 1. FROM: Clerk of the Board of Supervisors 1TO: County Counsel Attached is a copy of the above-noted claim. - QQHHIL BATCHELOR, Clerk DATED: October 20,1993 BY: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (V� This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to complysubstantially 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. ii The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 2 I f 3 BY: �° �r. Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. 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�c�� t,_e� )R )q PHIL BATCHELOR. Clerk, Sym{ �,a .l�p�,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 warning see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the.claimant_ as shown above. Dated OCT 2 0 _ BY: PHIL BATCHELOR by!�l , 11/n J 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 whichaccrue on or after January ll 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 mustbe presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claim 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. II * 4 RE: Claim By Reserved for Clerk's filing stamp anal. RECEIVED U r-:e Against the Coutity� of Contra Costa L nSEP L17 1993 or CLERICD OF F SUPERVISORS District) CONTRA COSTA CO. (Fill in name3 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ .:5/ and in support of this claim represents as follows: -—-------- ------ -_-_---_ 1. ------- 1. When did the damage or injury occur? (Give exact date and hour) 2. did the damage or injury occur? (Include city and county) 3. �"1�46�wdi;d ;e damage or injury occur? (Give full details; use extra paperlif required) a, L") ULtv 40 _,eg;4 CaAlo 040 d 4. What particular act or omission on the part of county or district officer 17ae-W Wk servants or employees caused the injury or damage? CA,4L"r -U0 Ni- hav4,1,0 l _&W OUA CtAA44A, (over) Wnat are the names of county or district officers, servants or employees causing the damge or injury? �nkn� n -------------------____.._r________------+._r_r_rr_r..r_+-___________________..________ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ?/v.!Cs +�='�••rwe...rw.rw____rr__r_rr_r_.w_r.�___.. 7. How was he amount claimed ab&e com6ted? (Include the estimated amount of any prospective injury"or damage ) �y $. Names and addresses_of witnesses,, ',doctors and hospitals*Av Y 30.50 1h )A L/0,Q ► ______________.._.._..____..____�..�_.._..�...�..:..._..__,._.n__r_.._'r__w._.r_..__wrr_r___ 9. List the expenditures you made on account of this' accident or injury: DATE ITEM AMOUNT q9 N 10-39.10 � LT) Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or b some person on his behalf." Name and Address of Attorney lga i. 0_0_.A Claimant's Si tore Vo 1:30<�9 96<&1 �Address Telephone No. Telephone No.�� G � � 1 'W'" ' NOTICE AUG 161993 Section 72 of the Penal Code provides: t',u z. cLi,;'a�rtLIrQRNIA CLAIM SERVICE CENTER "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 ($1,0013),. or by both such imprisonment and fine, or by imprisonment in the state prison, by a` fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 1 -wEli- ai r 4 - 1 1 .,1 a l„ '.5• ' .. _ ,t�._�i �� .ss+,-�.n.-vt.,-�.0 • ^OJT ,�,. � ��.: . t �^"� • �,, Vie^ ,��' ,.�^ �. � `,^• f �!,y�7+t°F' err a�w� �:_i }'s)�y.,Z�c 1•- r�7.t,,,�r3' � �.` �^ r m r �'�' 's�` v��#u.-x-`�i `~ i-'`'`-�'ia.d►�4� Z�' c... �`� � �`#�•A.l�'"-a..�R^A% n:' .pt, y. •� •r-''.k� ,'� � �.G L tii if E £�•ap�t4 �� - �,;`_ i- .�„. �„ 08/04/20 at 1 a .. w, 112600-OOOP545 V 1'4 in E3 U X%Q-We Ek T 7 U AFFRANA" NUTTEN ET 1UQA NASH! � 010 ) 94 7Q510 Q& 15101 0406564 YOTINATE QF aECOU Written Ey: NABH1 UV/04/93 lii ! L a.m. AdjusLar: ln5urnw APRON NEFF plaim, #92200729930--� Claimana: 2AFkPT WAY PAIVQ� P00y .4163 2T 34724365 VAWM�j Admee5: PAPNPT ORK90, CA Dqte pf Loss: 6122/9--, Vy: Typy of Los5: LAIBILIT'i' Other: 010 ) 131-31§k- Foiq? Of impact: 6 EEAR 1nopean 1131 PONT PANE 00TIS BUREINESS. Location: Field WOLNUTCREEK, uA 94596 Repair Facility: License 4 DO Q RED 4-2.2L-F! V1N: AS3XFqhD8LH159141 Licm 3AMN635 CA Prod. Date: 11/89 hilpage: QQ307 Automatic transmiesion Fower steering Paler bynkq-.'' Hody 5ide moldinge Air COP01,10ying Rear defagour Tilt One& 1ntqVqQyyp wayrs Am rQ10 F2 rndv,�; Driver wirb,;,, Suck,V Beaq.-' Clear acat pa int -----------------------------------7---------------------------7•i 1 PART LOB, PAINJ� No. REPLA&E DESCRIFTION OF DAMOPF QVIi' T -------------------------------------------------------7-7-7-777----------------- REAH BUMPER O/H Rear SuTper i ,o no 3. keplace REC Fascia w/o 5pprt qkg 1-1Q.12 TOW Add for Qe5r Coa�� Replace impact sLrip bright 1 7 r50 inc, 0. Replace EEC Faacie neinforaqman, 03Q) !no! REAR EODY A LAMFf 0 Replace V Tail lamp asny dha6cv 1 U.5 2* Repair DECK LID 1 QA CLEAR COAT t 11� R&I 2 NAMES 124 Replace EMELEM00GO 11 �o 10 H&LETTEE PH00.933-5131 1 TI,i �JT C-lir-11 PA q, File "Win OLDAM5.10JUNY kT.WE,LT.FNUR,2DCK LOTH QUED, LKSTR MATCH&EQ L1pjT.FRT.TRIM RIMO MISSIMOTHgg 3 TEIM. RIMAS CUP! SO4AP -1E NON PAY AW, Fart,-- Labor 4.3 hru q6. 00zhr Etcw) Faint 1. 1 hra W.D01hr 2 44.0 u Faint/Materisla 5. 1 hrw 20, 00/hr laqm'' W Q0 ------------------I--------- SUBTOTAL Tax on 5 453. pw mt 0,2000 ----------------------T---------------------- TOTAL COST OF PEFAIRB $ jP39.5- -------------- ................... NET COST OF REPAIRS lowq.m� HIS APPRWAL MOST BE FENMTH K TH ,>R ..."f FNRHY t:f, T5 MY RHAMS. Ng onnow. TOE 1B W11, T&S ESTIMATE NA2 SEEM F20SHEID 5AUP QN tot USE Of CrA5, FARTS KUPPLIED PY A 20URCE OTHER THAN THE MANUFACTURER OF ICUR NQTQR )EHfo,E, Vol WARHANT10�1 nPPLICAELE TO THEW HEFLACEMEMT PART2 ARE FROVIDED BY TEE MANUFACTURER 02 DISTHIBUTOR OF THE PARTS, RATHER THAN BY THY ORIGINAL MANUFACTURER OF YOUR Wmate Wed m WTOR WH ENINHO RME WyWAY) 4q; vp Shad fry fhe TQq DQR$7. Whose Datp 7/3], Fist A uf Kv WuNwp 1#005 Ell, Itc. r CLAIM FILE COPY CHECK NO. 439795607 Claim Number i] Policy Number Insured I r- LI (J,63 i 4'582,24—VI" 3472436.7PAA NEFF, A Date of Loss Agents Code Claimant Name and Address 2••-— WAY DRIVING DateofCheck ---93 Amount (JNE THOUSAND FORTY AND Dollar- SAFEST WAY DRIVING .%7'(,HOOL For FOR : LOSS OF USE 1133 TIONT LANE WALNUT CREEK CA 94596 e, C-5191(1-91) ___ �0� J M H G IYG ADVICE `� -[ET KI jR5 FL C ",,,,-[3 7 v 53225 �R- -'�L4 ce�-, 'rJ61 Unit Offit t Office oic R 4700 4 t It�6 ............... .... ,A", as Clamant, ' iharedM 401 i"41'i x,Vll"" 'N - �v -0- 5 wq"�— ", 74 2 cua Rut 14A 'giff, "014 ZO "g, U4to Ct�ectc C 5192 C1 9t) iD2 ed i, "'s ............ 7 a�....... ............ L 35A Ni Code, kM 403 -4 teTtelease "7' Claw 666, :S&l r IJUMERS","i 3 Cause comp,, ► 404- 405 099 ,11, 10991 I ULT /NO FA MED-A Close, CCL TAG Dollars Dollars CECCtN to- Cents R/F,�,',,' "Cents Type Sev. Add,` Close P/1", Dollars Cents PF 406 '�b 'S �4 407 3' i �caaaxAasaaaaa ODI U h. tom► ase `A -Go O kr c» ;r vy y by CL- ISM J 01. S0S3Hd r$ rn 00 FT m LO co rn wv 1 oa CT3 C O X E O m U C3 (O Cl-N