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MINUTES - 11081994 - 1.37
_ CLAIM ' 1 • 3 7 y _BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA November 8, 1994 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 Sailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors i,,(Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all •Warnings". CLAIMANT: DOWELL, Shannon ATTORNEY: Elliott Friedman O EZca�►F- Date received ADDRESS: 6431 Fairmount Ave. , Ste. 9 BY DELIVERY TO CLERK ON nctobpr 18_ 1994 E1 Cerrito, CA 94530 BY MAIL POSTMARKED: October 17. 1994 J. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: 4?,X-.a, I R9 igll �puLylOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim Complies substantially with Sections 910 and 910.2. ( vrThis claim FAILS to comply substantially with Sections 910 and 910.2, and we art so notifying / claimant. The Board cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �� ' —`� By Deputy County Counsel I11. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) t ) 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. n Dated: NOV 8 199 PHIL BATCHELOR, Clerk, By XL , l ,ry �,Q�� _ . Oeputy Clerk . YARNING (Gov. code section 913) subject to certain exceptions, you have only six (6) months from the ate this notice ass personally served or leposited 1n the mail to file a court action on this claim. See Government Code Section 945.6. lay may seek the advice.of an attorney Of your choice in connection with this outer. If you want to consult In attorney, you should do so iowdistely. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I as now, and at all times herein mentioned, have been a citizen of the tnited Stotts, Over age 28; and that today I deposited to the Mited States Postal Service in flartinez, :alifornia, Postage fully prepaid a certified copy Of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. Mod: NOV 9 1994 BY: PHIL BATCHELOR by Vf, . �_ aJ Deputy Clerk :C: tounty Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF r_ SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2041 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ October 20, 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Elliott Friedman 6431 Fairmount Ave. Suite 9 E1 Cerrito, CA 94530 RE: CLAIM OF: Shannon Dowell 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: [x] 1 . The claim fails to state the name and post office address of the claimant. [x] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [x] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [x] 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. [x] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 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: October `s\,. 1994 at Martinez, California. CC: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) m Vb Ee X 1 �co; 1 bN 41 r, `t4 O O u 1r � Gp fir. � o m m . 2 � � � s d u. i i LAW OFFICES OF ELLIOTT FRIEDMAN ELLIOTT FRIEDMAN 6431 FAIRMOUNT AVENUE, SUITE 9 P.O. BOX 337 MARTIN FRIEDMAN EL CERRITO, CALIFORNIA 94530 HOMER, ALASKA 99603 FAX (510) 528-0655 TELEPHONE (510) 528-1616 (907) 235-8085 October 14, 1994 FRECEIVEDCounty of Contra Costa 4 Board of Supervisors 651 Pine Street Martinez, CA 94553 CLERKCON RACOSTACOISORS Re : Our Client : Shannon Dowell Accident of : October 6, 1994 Accident Location: 2nd Floor Contra Costa County Courthouse Dear Sir or Madam: Please be advised that I represent Shannon Dowell, who was injured in the 2nd Floor Ladies Bathroom of the Countra Costa County Courthouse, Martinez, California, on October 6, 1994 . Would you kindly provide me with the name of the insurance carrier with whom you have placed your liability insurance coverage at your earliest convenience so that I may contact them and minimize further inconvenience to you. You may provide that information on the enclosure accompanying this letter. I have diaried this matter for ten (10) days to receive your response. Please feel free to call if you have an questions . Very truly yo , ELLIOTT FRIEDMAN EF/jb ,T' INSURANCE INFORMATION INSURED PARTY (S) : NAME OF INSURANCE COMPANY: ADDRESS: PHONE NO. : POLICY NO. : DATED: Name: Title: ' CLAIM f. 37 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 Claim Against the County. or District governed Dy) BOARD ACTION the Board of Supervisors. Routing Endorsements. ) NOTICE TO CLAIMANT And Board Action, All Section references are to The copy of this document Bailed 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 r.f ^' 611 Section 913 and 915.4. Please note al l eMarnings". CLAIMANT: FORDIANI, Richard ATTORNEY: Robert W. Shapiro COUNTY COU4sEL MARTINF-ZOALIF. Date received ADDRESS: 1331 North California Blvd. , 6th FL DY DELIVERY TO CLERK ON October 19, 1994 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand Delivered via: County Counsel 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. , ll ATCHELOR. Clerk DATED:_ �q: �eputy 4 11. 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 tate claim (Section 911.3). ( ) Other: Dated: ►G7—zo c t{ Br:��- �.....� - 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. WRD ORDER: By unanimous vote of the Supervisors present (V) This Claim is rejected in full. ( ) Other: !"certify that this is a true and correct copy of the Boards Order entered in its minutes for this date. Dated: NOV sm PHIL BATCHELOR, Clerk, ByOA-A,,' c« Deputy Clerk YARNING (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 aril 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 srtter. If you want to consult On attorney. you should do so iamediately. *For additional Narnino see reverse side of this notice. AFFIDAVIT OF MAILING declare under penalty of perjury.that I as now, and at all times herein oentioned. have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinet. California, postage fully prepaid a certified copy of this Bard Order and Notice to Clainant, addressed to She claimant as shown above. - n Dated: NOV 91994_ IT PHIL BATCHELOR by �,6ta.Qom/ Deputy Clerk tC: County counsel County Administrator - CONFIDENTIAL COUNTY COUNSEL'S OFFICE ...�. CONTRA COSTA COUNTY RECEIVE® MARTINEZ, CALIFORNIA K OCT 1 .91994 MEMORANDUM , CLER CONTRA COS A SUPERVISORS Date: October 18, 1994 TO: Jeanne Maglio, Clerk of the Board of Supervisors FROM: Victor J. Westman, County Counsel -����--�, By: Gregory C. Harvey, Deputy County Couns1 R$: Fordiani Claim Please treat the attached letter as a claim against the Fire District. cc: Risk Management (with attachments) °Ore„cog" CONTRA COSTA COUNTY o FIRE PROTECTION DISTRICT FIRE CHIEF BOARD OF FIRE COMMISSIONERS Allen Little Edward B. Haynes Darrell W. Harguth 2010 Geary Road Robert H. Chapman Pleasant Hill,California 94523-4694 TELEPHONE (510) 930-5500 Q FAX (510) 930-5592 October 13 , 19_� � � :+ la t'Z2 I .::�ci. MARTNEZ OkLI F. Victor J. Westman, County Counsel Office of County Counsel 651 Pine Street, 9th Floor Martinez, CA 94553 --0116 Subject: Enclosed Claim Against the Fire District Dear Vic : I'1Pas�N :r.Avi:ew J�11-:—Richard TordJ lf:di ".s . c:l:aim ..a.nd provide legal ass . t:annce and guidance you deem ,Necessary. You may contact Assistant Chief Mike Argo when giving directions or for further il1format.ion. Tkz��nk you in advance for your assistance in this matter. Sincerea..y, Allen Little Fire Chief AL/vl cc : A,/C Argo Enclosure AL/WESAMAN. LTR Serving the communities of Clayton,Concord,Lafayette,Martinez,Pleasant Hill, Walnut Creek,and some unincorporated County areas King, Shapiro, Mittelman & Buchman Robert W.Shapiro,P.C. Attorneys At Law Oakland Office Mark R.Mittelman,P.C. 1999 Harrison Street Robert A.Buchman,P.C. David S.Stromberg Suite 1600 B Joan D.B.Edelsohn " ��'►;� Oakland,CA 94612 Christopher R. Aker �••j� Jonathan E.Bates 1 San Francisco Office Ann Marie De Die "' -' Arthur E.Fisher 1592 Union Street L.Leianne Joe 1331 North California Boulevard,Sixth Floor Suite 167 Debra E.Keller Walnut Creek, California 94596 Robin M.Pearson Telephone 510 935-7755 Facsimile 510 San Francisco,CA 94123 Leanne Schlegel P ) 935-1553 Peter M.Sproul David S.Wallace Please Reply To Of Counsel WALNUT CREEK Donald S.Honigman October 7, 1994 Donald Tenconi Retired from the Firm George King CERTIFIED MAIL -- RETURN RECEIPT REQUESTED Contra Costa Fire Protection District 2010 Geary Road Pleasant Hill, CA 94523 Re : Claim against Contra Costa Fire Protection District Dear Sir or Madam: This office represents Richard Fordiani, who purchased real property and improvements commonly described as the Lake Alhambra Retirement Residence, 825 East 18th Street, Antioch, California ( "Lake Alhambra" ) in August, 1992 . We are advised by your office that the Contra Costa Fire Protection District ( "the fire protection district" ) does not maintain any claim form or procedure for the submission of claims . Accordingly, by this letter, Richard Fordiani submits a claim for fraud and negligence against the fire protection district . Pursuant to Government Code §910 (f) , you are hereby advised that the amount of Richard Fordiani' s claim provides the superior court with jurisdiction over the claim. Lake Alhambra was constructed in 1988 for senior citizen housing, and was to include the minimum fire-resistive measures detailed in a letter from the fire protection district (then known as the Riverview Fire Protection District) noting 34 required fire safety items, including one-hour fire resistive construction for exit corridors, tenant separation walls, floor-ceiling assemblies, ceiling-roof assemblies, and exterior walls . A copy of that letter, signed on behalf of the fire protection district by Kevin McCarthy and dated December 10, 1987, is enclosed. Investigation of the as-built conditions at the Lake Alhambra facility has revealed that the requisite one-hour fire-resistive construction noted above was omitted. Also omitted was, inter alia, necessary draft stopping and fire blocking, and combustion air ducting. These conditions violated the applicable building and fire codes, as the fire protection district has acknowledged, and has 28687.1 Contra Costa Fire Protection District Page 2 October 7, 1994 threatened the health and safety of the aged and nonambulatory residents of Lake Alhambra. Indeed, after inspections of the facility by Larry Thude and Assistant Fire Chief Mike Argo, the fire protection district issued a Notice of Violations of Fire Safety Regulations, and formally withheld Lake Alhambra' s fire safety clearance. Copies of the Notice of Violations of Fire Safety Regulations and the written notice of the withholding of the fire safety clearance, dated April 15, 1994 and signed by Larry Thude, are enclosed. The acknowledged defective conditions were permitted to exist before Richard Fordiani' s discovery of them because the fire protection district apparently conducted no inspections of the original construction of the Lake Alhambra property. The City of Antioch, whose chief building inspector has also acknowledged the fire-safety deficiencies, likewise apparently never inspected for compliance with the fire safety specifications for the senior citizen facility. After consultation with the fire protection district' s inspectors and assistant fire chief concerning these acknowledged deficiencies, and learning of and discussing the great cost to repair them and bring the facility up to code, Richard Fordiani was forced to relinquish the Lake Alhambra property to its original developer, Sal Siino, who was responsible for the deficiencies . Inexplicably, however, once Mr. Fordiani lost the property, the fire protection district apparently chose not to require Mr. Siino to conduct the repairs necessary for the Lake Alhambra facility to comply with the applicable building and fire codes, even though the fire protection district had insisted that Mr. Fordiani make such repairs . Thus, for example, the required one-hour fire-resistive construction in floor-ceiling and ceiling-floor assemblies throughout the senior citizen facility do not meet the building code requirements, yet compliance with the fire safety measures provided by the code and the fire protection district' s original specifications for the facility (and the costly repairs necessary to achieve compliance) have apparently been ignored by the fire protection district now that Mr. Siino controls the property. Consequently, the fire protection district is liable to claimant Richard Fordiani for its negligent and fraudulent approval of Lake Alhambra' s occupancy given the developer' s omission of specified fire-resistive construction, in violation of mandatory duties prescribed by law and the applicable building codes, and for its patently inconsistent and discriminatory handling of the acknowledged deficiencies at the Lake Alhambra property. Apart from the obvious danger at the facility which the fire protection district continues to permit to exist, the fire protection district is liable for the damages Richard Fordiani suffered through the 28687.1 Contra Costa Fire Protection District Page 3 October 7, 1994 loss of the Lake Alhambra property, given the fire protection district' s negligence and fraud in the original approval of Lake Alhambra' s occupancy, and given the fire protection district' s demands on Mr. Fordiani and its subsequent favored treatment of Sal Siino. As a result of the fire protection district' s conduct, Mr. Fordiani lost all sums invested in the purchase and operation of Lake Alhambra, together with all future income and profits which would have been realized from the property, but for the deficient conditions, the costs associated with those deficiencies, and the discriminatory treatment received by Mr. Fordiani . Finally, the address of the claimant, Richard R. Fordiani, is 1660 Olympic Boulevard, Walnut Creek, CA 94596 . However, please be advised that all notices and other communications are to be directed to the undersigned. Thank you for your attention to this matter. We anticipate your prompt response . P truly yours, SHAPIRO, MI ELMAN & BUCHMAN rt W. Shapiro nkb enclosures CC : Client (w/o enclosures) 28687.1 , y kivervie-1v FILE COPY , FIRE PROTECTION DISTRICT j( 4 A"'"`r"" December 10, 1987 AMU.-4 Iw■rAt:/A 04A cArwrf.+trurA: ' IOWA=L lfOP�/f ACE Builders, Inc. 50 Bliss Avenue Pittsburg, CA 94565 ATTN: Anthony Siino SUBJECT: Senior Housing Facility East 18th Street a Olive Lane (NE) Antioch, CA Dear Mr. Siino: We bave reviewed construction• plaas for the subject project. :• The. plans.included•Sheets•A-1 `through'A-15,-:S-1 through,5-21,' E-1 +--r through.'E-6,:;P-1 .through P-5 .and'M-1:through'M-3, dated _ October l4, 1987. • Our review••:is=to insure complianceKwith ;. - -m{n;*�*+� codn<•requiremeats related to fire•aad.Iife=safety-.asrsgt '�• .. t forth'in Contra;Cost&-..County Ordinance 86-,76, the Unifoxe..lie., ` Code*and the"State.Fire Marshal•.s:&equlations:,"In:orderrto these requiremeants,; the following will'be.,aecessary: 2: The required :.fire,flow" Or: a rY•',t .,�+. :. Y .�•• ..s, . .- ,f -.the:Project:�tully�protected•�.�':•�' "' -Y•- ";;� 'with':anuappraved.:-autc=tic:fire-:sprinkler- system, 2,500.-WM.'r. Th&:required lire.flow:shall-be-delivered��': #rom�not�mora:thaw• threeM }>'firs hydranti.. idual t .owiaq::�t simuttaneous�ly,Nbile-maintaif ounds"raiaq ZO pes f pressure. in,the--main; =`:,: ' '. ... M�• 1rw r, '+. s."' L10.301(c}�; 1. • 7' .� t :k ,t.v Z. s i7. 4.. •+ •1 :: M. 1i r. ••fit.Y• a: ..,. ..a. •7+�:• •'nf ';.'��i:'tr.. � �•�• 2• Provide:two (2}• hydrants:of the'.East Ba '- each 'x .,'.Y=.r. eoL - '. Y type, ;s' incorporating onl.,(i)•,'4-112""and .two. (2) 2-,1/2" . - �indepeadeatli valved out-lets. The':locations sshrnns•ot�r:the ' G: .:above-referea�:ed plans'are acceptab _ - 1.e. y *.spy a7'a:" ii�•,, L + .'••. .'Yt:' :l': .F .y:• a301(c) ,VFC1 3. Submit,two .(2):sets of fire hydrantand,undesQrociiui : piping the -Fire District for review,and:approval prior�ta..instaliation (2.206 .W.10.301(e). 4. . Provide.an approved.aute®atic fire sprinkler system which.,' t is design& and installed in accordance with the requirements of H.F.P.A. Standard #13. E10.301(b) 10.3,01(e) IJFC1 .: .,:,r. 4. 4 y _`• iSWWEST FOURMSTREET—ANiiC10tCMOORM1A9009-10" i'EI,8447 wIS)737-1301 ` A� 13uii,der S X12-8 6 1987 lar to r + er P �cembe sprr cl to -gage Sets of fireroval Prior t3FG� compor eview and app 10.301te) submit t1wo riot for r [2.206 Q er sYst�` 5• the Fire Dist fixe sprigire i Hata` all Of the DiStcict.aca� ar o S.Q `jtheaDA`� - . C 6. Provide Fire valves (p ai tF•D•c.) from [10.301te).:. cortr°l t Counec e of 018 Del up+DrvS�i q Water,flow bui,ldta ceatral statiab1Q 1Of p de t�,on of >all. Dyed is cap tors the �l ;1 '• g °vide a ppm�wblc which 110.310 $prin)cl� ayatv,Ivel• : ta+s psi outr°l. sYs sYstesa c - auttic appy i ppr°va cordawet = ,�ds #12--Xr ' �+Cl ^. I Frov d�` tall edx. t ,`t S. . 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'•�„e+ ;N.a•� .D,y1jYY't''.'� vr! ^f' : 1` „�� W+ti•`f�:+♦k:•�• . :::•'�.�...i.�,''�"�•4i:�M"':% '+•' '�:•nrC:^}'r`ti.-(�� ''r!,•- K.��� r .1•.�.•. � `��..�'" �.�j�1�i � re+�..-••d r.7k5_tea` ;} •2�i" ;'�,.�T'� .r ':�.�:��•• A w..tj y'W'�.�. ice' •'.�,�,� Via.►. `�r�► -. .,;,;.'•.," • •ti:e:."tL� .�t-..'�.y ,�e.y .4� �••�. •,Rl• •�` t 'Si�//,jr +1.�t1i7\ir �� .J 4 =.�.,�j�• fYr.�}jAfe.5... .I:�i !,^ ."•.T-:+"' �,�.�`y��a►. ,. M1. •Y` ! •�,�..ir al's- .vµ .. - •' `i QVC'.' ..' J n a; i :4 •f'-�' ,1sW'�, - 'i'•.} •y '. r•.yam yJ7�jti�er::a., -� _ ` Y. a.. �'.{�. �..h',�f..:•<» ^^.1 'x.�•'.41,, :�•,i.1 �t:•". i1 � Y,�" .a .••.e` '`':a•,i,,.� r_. •fir•x_ �;- �: �;�.:��� � i3 ��R:�"• -��;;'�•*^�_`�;� , ,,.,;. `��:• M� ��• costa . '���. - . - ' - �� "•t:•��°dt�;�yi:'n.'�,�� %tiny; �� �,,� � r 7' +t• T. �"� , . ' ti'.�. �'f" a..r` .k t .i, , �' ....,r;wr'4�:4;p/W�; Y�t; ,.Sri +. +�•. =' -. t a�y� ��ia�r.F.rr,;N„ i ` ,�..:..; ,.:.j., .s• t'8�i.� r p K' ��' rx+' �.. +��, + �, +,r, :•� t .S'r ': '�',�, + „n? � ;. _.. � .i ,� 'x�•��+' r. Sari` �; .��..,..�+ ,moi,e. <ra .�Y•n+r..r 1 '• .� ,� � . l' .d.' i',� Y t*: ♦_ ,�.-.�';''"'�'•,�,, '• ;,y T���C�}�" .?';.i+ �Rw; ; .,t;;? •�7��'� - „�rr'Y: inf'�'i','.�C' ir�aiS�-•`` �+,.{.�^�'• �'�r�+ .T•.� *�� a�''s+•�r"` �. '�+'i"' k`lf •�, ,7 +;f`y`.���.�'��,�����:�iy�.-Ra` •4;5,,,�.�ii.�,%y��' ,i'* ��.t+t*,'-° i � R� .+tj�..r;lE• :a• ` ►. ..ars,. �. �r '•�.'3�+�.r�y�'••~ e!."_ A St 7 ' v'-i •�•' .1. 1. A ACE Builders, Inc. AS12-10 December 10, 1987 Page 3 13, Automatic closers, if provided for the fire-resistive assemblies referenced in Requirement #12, shall be actuated by a State Fire Marshal listed smoke detector and shall close Autanatically in the .event of a power failure. (4306(e) T-24, CACj 14. Provide a one-hour fire-resistive Occup ' between Roans 14 and 15 and Room 21. E separation (503(0) T-24,' CACI = 4 • 15. Provide Ona-hour fire-resistive assemblies at the doorways between. the following*rooms:,' a. 115 `and 421 " b. 117 and #12 x� ` C. 119 and 120 q; r'•ti::r�.t•. i i s5 amp t !'r:�yn4• e . #26 and '#2: .-+- .• . .�'.• ::. i.:r..,.,fie;.�`•co.:r, j�'..^.,• .`�.. er #29 and, .{••' 'C�,. ':+ir s%.•' 130 aad.t2}wg� •. :� .M1 ,: ' .' � �': `' l�1�J��z t�. �'�.,.���::�.--..Y:� . ). •'7. #31-aad:t :,t•♦ .rt �,�s• .•� s:f-!'-;11'- •;��'..'••.r�.,,•x.�Y•K.�". .•� 1-.{.n•jM.� !:•'L''. T har,{•t. .� . :. yyy,t:,<• r''/ ..r+ �' ��tlr••• Qf" !! i �b4 '::i��'.� s . ;36:and'135•fes �,. ,f. ✓-qw'•a f ,. '.`. .r,Y t. �7tii�: : +'T !H t ;'' R 1 x. t 'and 139;, 140 .and .139 .. ;r.• 'M:3`,,i �. ?1 .. ,�y .•r'*. '>Y» -�."-.':�` �. 'maxis?' ',.4►�.�.ds'" ° •.., :,. t•- :� . :t >t'S: -j 'L_i .•` 1202(b} Z k.C. .j• ' �. .. . 1A` ,!i,�-i' -21 oOcupant load.:of DiaiaQ shall ' ' -' T s 'the 7 :Room;, ,,beslk�atmataeat✓j ':1' r .� ' •y_ '-= the DiPostedna 'C' -J=at#.o1� `33eA= t}le:matitl` "'_ ''_ .rr(+��3�' 7��/!``•�,,,, '���:�:' 4 allow �* �jY' J_.' .� lits Y•'�"f ?M ab e '• �]:a• ` "�^".•a y+♦'. ..' '�. �!`+�` -will be de ,the.Fire'District=based:ttpoaith+Q�`* atotal.square�footaget�: `�•• revised3 T .:.. 3�OCiR♦:a3 :;� "< " a.,:r:., ,.. ' .Toj:.♦?'it Y" 1� :�:� •:.i!-.' t .. Y" �5�.+: -�'`-"1rT � `.;<'.!'yY•:- � A .;�:"'_t 13342 c) T.-2t." ��w�'/,��j ,, :w,"%:• `, Y'- :' All .exit:dcears'servi ng s'thej tvt f�n i r �.,._ nq.ahalls sililiq.• ,fat ``fir ,y-F,' y.-. ,,-;;�,�Y ;•�`Y' yy�,� direction of e .i•..ti.a,,.e1*.,{ N.1'� :�'r! ( tt (f L'•• nk, j� % •• esY 1 M.L23304 ` ': '.k•1*, � 2 • 4. •,! .`• ;..� ^r sk.�i,,e�l/:•��.,y i�#xz yC,a�• � --��'''�«�.Y�'�M14hi. h..!�' �v'�l t.ti�:�„•�{,Y...�JQ„i`;,z; - .. 18. •"All CXit.d4or8. Shal,1.-be: :�OpeOabZE.'...�ZQ1Q:�3Zerf.�l$f. 'M�'�h4itt::1: :�%y�`i• �Y. t�trt:•:drl••�:�,^ of aakey, `know ,.�ti•:,;;. .:.; ;,� : etre use or..any +- :;:.�;, - }.:. j2-3304y{c) 24 ,�; �. -fit , ..i^. - �C. � i :w !ei".,:• < .�. .'�•,,''-�A � "' it .. r v .' ::' "r .. ' T-,.. ' • j: �{� �J`tat.:.:•' ,i :.i'.�� - "��. � 1 -yta.-;r. :J,. L �Y7"�:,r�' � ••ip,� ..��,. "- ��• � •F.:• _]4'i'�.a!'%!�....�.A".y,t•}. .:'•`: "f. .'k`it' '.�:-;. b•. .f•; •c•.J�-�-�.;r�, :.rc._ `»!, �.: -t._`.y"'i•" ft"at'1'A.-�- �♦�'�'.:''j.JT• .:�.,,. •1�� f: .`�' �y•'. �.7S'. tr ••j,P..._: ... '' � 'is .,'• '%•:•i,y%� - s'..•t"'fin' 1• ..%t`�-+.'�' ..1[. :.'•tiTM rip::'•':. G:•'.'4"..•:- n'�t j :�ltt i';?•. :� V. 7 _ ,J .r. �+.:••,,�; `i, }•.».y: ?fit'•:ti;:F!-.:�""�.�.i-e�'?:'�•- }`•,c•'.�„','' Cr�:,:.+'�f"` ':i :::�t=o+.:;•<� . . - �'.{.L��M„��•�y� �,.�,' ..t y+t�a •.4 l'Vl1 w�i� .' if^ ..�-�1•.�,y:. �;.-!•' '.: �r ..' tv'„�ti„��.,-t,. ''}f� .�,,.. ;• 4"fit ...�.-:.' �.,i :'. Y:�": •�:'��, yr,y�}r{ �' •('• }%� "..[tet t+ \tib. - • �- - ` . ;�-,A.W`-,'�'[-•-'• .?�. ` ,�`' ` %;` e.+.•...t.. +t Nit., y; .Ay,..:;C,�.f.r.4:: 4J M'`��.ti.••: ACE Builders, Inc. As12-10 December 10, 1987 Page 4 t- 19. Provide construction plans which show details of the one-hour fire-resistive construction for the exit corridors, tenant separation walls, floor-ceiling assembly, ceiling-roof assembly and exterior walls. :•_; 12.206 UFC and 2-1202(b) 3305(8) T-24, CAC] 20. Provide a one-hour fire-rated separation between the. Dayrooms and the exit corridors. on each floor and between the Dining Room and the exit corridor. ' (3305(a)' & 2-3305(h) T-24 CACI 21. Provide approved self-closers for all doors which open ' y ,=r. •� i.gto a exit corri90 _� ( ) •-V14.�• I.h rraR2. j2-3305 T-24 '� y '' a y� Y' �t '!'.• ' �•'�•-. �{' •may aI• 22. Provide handrails on each side of both'stairways. Handrails shall extend 12: inches:-beyond the:top and bottom stair nosing and shall be',returned ortezxcinatae is .: _;! -t ' -* :h. :: newel posts or-safety tezminala." 40 (2-3306(.7 j Tilt `�CA '�C - tI.L � . r �.eait•. h�F': �..•'» +•:' ;s„'a's-ice c," 23. Provide an approved emergency lighting•systcsa; exit': '�t`� illurminates.all - wh �s?►,iw= .;,,i ` �; :', '•, • exit:pathways.,and:whic2z:recehves Jpower=4. . -. ti=' from storage batteries ar:an ton- i J: St ta..esaerQeat-y•3tr 4,,: . ,.:�. The system shall..be.capable.of."activatinQ`automat. 1� ' ,�' '� r. �y in the event-of-4 Power.failure indlshall:Jx`.intaled •'' `=' t: : - inir=• .�. '"COrdMO Mith the -regvireuwntt;Qty` �iXr2-51 '�fi- +t �`��;'=r7«_;`�?+ � �xai►�;:� CAC and tha�-Electrical..Cade. �"� L 313 b?kT 14� 24.• Provide=app •:. :• a: . . •. ...,.... ::�,. ��,..� �. *..., � .�,• . . , } --..,, `, ,� }.,.,.:. roved, illuuainated exit. signs'installcd at all �•.. ": � `� c.. �r. � -. required exits and.where otherwise necessasy''ia�order.tQ4 _ { ' `���: •= r s.�: =` `clearly indicate the direction of egress. =signs:are:to be illuminated r. .gr•at Ma••l:=l time imes`i'�and• a�haf`X�:Fz ,y4Q' T �' •.{i,a:-.:7�^•',i��^?, �tli..ti-.�;.{r..•.�},'��{..+;.Ci.r :...'•L''.�.i-��:",�•�i'.SS.• ::`•'M , Power f011owbi: 'yy �r ' .�.::. -'•`^.: r.: •C: .,, VF •`•. f�♦r •��- '1 wZ'y,.t. `•`` • ` -i 's e.a M,ie a. During normal'onditions,'tLe signseCeive . _ :.�. ":t' t� a".c °= : •'r electriCal• .from =aVaildblenCirCllit'' «-. ' c �`- '{" st'ouae" %rr�"!"+`� pOwter. :any- .' ''" 's _' '!ir, ",tf�`�-� s-. ' `,. :��•. •b. • In theevent' of: a power failure; power.Xhallr automatically provided.by means.of-storage ,. batteries;.or, an. on-sate- emergency !Tqf�fiy�tpr `r:�y a. •.s.' hti i� s ;;.` 2-3314 c ,-&.2 331 24* �) .�- � .•; :.*, f�.• ' 'a: •.:a J'- ,'• '•,•a;..». �.;�:i. 'J�r•a�-:' ���`"" .�.!;.T.f.',:':ra..." -Oat" j� ••i: .'t'�' - J.25.• Provide approved',panic.hardware-for , all'r+equiz�ed.°.e�rit. x " doors serving the Dining•:Room.:'- This•,requir applicable to'the main lobby`doors which are'.a:compotieat; ; of the Dining Room exiting`system. ;(2-3318(a)} -24 -.CAC). yrs:; �.+++w.�..r,w.+�. .r+ wws.....,14.MM.1.ybw......,w-......w.... �... —..-. ..._._ ...__....1 . ACE Builders, Inc. ' AS12-10 December 10, 1987 Page 5 i 26. Provide approved fire dampers, with a minimum one-hour f fire-resistive rating, at the following locations: a. In all ducts which penetrate the two-hour area separation wall at each point of penetration. b. In all ducts which penetrate the roof-ceiling. assembly and/or floor-ceiling assembly at each point of penetration. c. In all ducts which penetrate the ceiling or walls of the exit corridor at each point of penetration. All fire dampers shall meet the requirements of U.B.C. _ Standard 43-7 and shall be readily accessible for required servicing. 4306(i) T-24, CAC) - •r �, :. � = 27!'. pod kzaOveuisltsAa f_ire exti tam so as a to s +aa g. ns kitaban (Room #13) Tha.system shall-ba,, na Asa • �'' � ' .. _..� r ': , that a1l.cook: ng surfaces,:deep fat. UPS: . '.i 1: 'r". _ t � :•�� .�, ' and grills are protected.. •Pratect3aayshallc�else:bis�,::••-" . . _• provided,far'the. eaclosed.plenum ,space. '�,• : ' �'{'r• T•',�L tthla.'#e;hood` 1�' a -KA 6A ' 'abava tt:a>t3ltarac�alad{tare e�chsust~-ducts ses�.ngth�s`"`': �+�^'. ` ► ti, 1� heitg l •N: • 1..1.a'ti.Ft.•� •.'FS•+Mii��.�ii�ti��iMiiiZt Nr\iN�»���•' �•A•' �'• • { ••. Standard 49b.:and•the:`Nachan3cal'Cade. !� Vin` `°'• ;mss• ,w. ;�• z•; :�• 1S.f _� 314(a).,--&,`10.314(b)�UFC1 tUu, ''•�' [�-��/.y� ;w :•o.if•. ta' '•'�' .'i�{• 'e•�.;�,! s r.. - T rlS. ,mac I�" +..'• "'1'Ci.,� ; 1-•• " ` y�'T: t�-w .e+ :`' ,.f '• .��`•~«'i.•�t;:t'a�=,f•- ,:y`r'A. ;�•w:_ �..:.':' �ti *'v •,`.. ".:ti-�''•''`'k .:,;s•. •�:»�:�Y•�.1,;.'�•�.';•��:i�.r\�7�'�� �(•, 28. '.:Subaait two (2) setsof';fire.extinguishing system- pi Arkor ko the Fire--District for review and approval:Brio to-{ 'Ltd .P .' ...'Str...Z•+�•=t:".r'' installation. nstallation.ti:.+•:''9';t..fi:1`�"iri-'�:'•.'t.=r�4a.+r1.�._..•...•....�t•�y4:`'•�~..t..a'�.. rX.�:•-.l..�.t`l•._:;'•)h:4ii-`•.r •»n; •_%M'�a.•d...•�C•n:4<:::'-f�':=�T�•�.t.Cra�t':;:'•+.r:y�'''s L a` - s M_s , or-, t29. Provide one':(S).!,40:.lid. *�.`i aiy1Q i_r `;;�• f,r•� o�;•._•, � M. L'ti-�1: .- ..;i t. •,Si 4'r r i�.. •C F;,;•y.,1.. '._I10 314(d):-UF4-=•,•�.,. .,. 30.:`Provide ra I**im ,,,.;2A:108C rated=firs'extingttlshsrs:+lacatawd ' >% , .•`. ? •.; :- _ .;s. :.within a.y.T" S-foot,travel.' distance o -:anyiat~'ca'e ': •. •!yt,, 1. >d:•1,•:' '�yy.+1•r` ,►:y. f yaa.fu`.;;i ti.;t'.:r � '�;'.• .i; floor '+floor• .. _;�=2 ,c '= - . 7i '+ F:•:t-. ""`•ka,•,•r`. -•K i;.`fj.,N:. ..•r"+'r:, +y` ittK. - '-� to y �: .V•1;t.:•sy '-•`; 'rat-.t,. :'a. ' ~ .•;►' •' A•• •. /. .,,: •.':L ': � i1':' .:.b'' :'-:is '-„,t•�.a,,��� .Lflh:-.� .r►%y--.' _�;_ M1�`�ti� ;•.^�•.. { iE*ji$hl`rs'ChAll33?e.mounted•101A�, {�, �: -w�.:• o.; , +fx ti+=_ ai:i i' •,. ''w cabinets te:such%thiLti!tba..top'af.''the eZ�Ql2ishQe�i+a more"thaa�five;(.5).feet abovefloor'.level. ^''_'rr'•• `�•t�.- , ;« Vii+ ” ..a�: µ yiv wv+�'« :;. r:• _..;. :-�_,.w.r�.:' . :�- %• ;;, �.. [20:301(a} ;UFCl;• .. ��;.*f�•:•:,;_ ,;.;��,ti . is •Y..a',t.��.'. '"r' •aj'.Y t�Y- .,%tn`•::: ,r}a .t>' f;.•a r -., k';• tc _:i,• ': `' -f ;L i.. :i� ••��;, acr� •I� .. yM,'jai ,�•• •rt' _� ;r�a.. .rte ;J"• �` yT �syry:.�•.•... ^ /„ •Y' 1 J I ... .. a.' ^; -, r :ri, • •ala 2r•�,`, '. +.r '%. .. '- • • .CE Builders, Inc_ S12-10 )ecember 10, 1987 'age 6 31. Provide illuminated addressing located on tht building in such a mauner as to be plainly visible from the street or tr road fronting the property. [10.208 UPC] �. ' � '♦i f1�j 32. Locate trash enclosures such that commercial dumpsters are not stored or placed within five (5) feet of combustible walls, openings or roof eave lines.'c (11.201(d) UFC] 33 The owner/operator shall apply to the Fire District • �-for .,- ,,.� -". •�=:.1:. an "Apartment_Inspection Certificate". _ _ [4.101 .Vr C� -^ � ; 5, •t'i "ff1j��c�'•, 34. Contact the" Fire District (miaimum 48-hour notice _7�— ) for fi :the- required) 1•.. i,'�...•l'•. Via'..•..��'.'t:�. •.' � '1' ��d r ed nal;inspection of�the:buildinq;Prior occu17IIIICY.• �• �/'; .,!'�' syl�:M..{ ��;a;:. ;r�.�`�"-�sy�•�l+s�,YJ��,i`''�' '`'f��'��.?..'�� .t:•�ro{�, il�'�-•`R„�„A�- .. ; '_ _• �..:• .`^.•Ir+•�[•'L$....:�• '�'}%"_•:�'-[2�C1(a �V.0 4r r " •'- f•• �• l� ,'P.n -r^f�...l• �:,L •' .it ;�;..'•*� '�':.'w'.��`.i•�.Y• J?` ' � �3_('''"!i•.�i r��� ,s�� .��J. .r:.;•}• +s+t• a• �.. F ,..-:; '' .��•.s•..-' �••`'. :�iKY�'.t�nS4�" +��^ � .��,�?�':71 P;R t ii.�' fV + �.4.' �.. it review •sa;aoti tc:beaoaatri�a:asti. � • , "' Ltagrity:of:the•faeility .ogatinQ� :Quire�ients.br!-the..•Antioch:Building.; Ai ng;Depa=UaeQt andl.0 _,•if„ :t=4 'haviaQ'respoasiMII Tr,Fiaal7ire:;Dlstrict+ecce-tang subject.tofield inspects ► - oa�and�•necessary�tests- J1. - rm hive :=r Queationz.' ardiaQ .rOV Qp��aSe::COil s undersigned•at',;(415) '?57-1303:"I., '• -_ ��':3��• 'i ��]•'.�f�! ^ � t �• �` �.�n..;*lpE3.: �'t:•J�,� 1...•fr:f'1 t �1••rl.�.:•4 Tt lop '�,.•:�{.•�� izz-rr.E'?ti�.� a'Y•e`.A' •� �yfj?•�..;.,�. f', .. �;'.'! !, '••...•. •l :w .�,; _.s ,f,,,.s Pyre• .:.:.•-. .,v w: ..rc: a• f: �;? iC�;`r•.t.£ tY�'i ��~�:i i C�'�!L'' -• 'i. ,�r�,=_ ri. iC:: ;es-. `S''':�. •vv•. .. ',r ...t.wj�4� { �;1 _ i :�, -��..:, 4� �1, �1... •..t�rye^ f� � •� � � •�A:ap^fi;:r•..^yt,.�.j.�,,,! �� ��yM..'1 ':. Y�4,��%��i��� ;�� I.r•�,''' .wT?"1'�a`.J�. i��,� }Ty+ - •I. �r�14�'.'��"''~•C<M�'..7�c..���tiP M���''.,'11N��� •�. "�_ i13•��"i'T� '�• r..5=�;'�' .� _^�h`I�f 1" � "�.� f, Building -Dept,�LToria:Chilco��?�L, �..Vic �r:Eagiariq,: i r } f ,:�^�.'r�'p;;. u- �1,-+ .. <•`^�•.�-. ,;A,ssoci/v �^ =>=.J:�?u, . :,.A, w.: *;. ...."�r1,- i. r.•. .. r• C.Y. •'�� � J'+ ti. Ysr r•Ef�ti.? '�.. '.:}�� -G.'f. 't.�G`.•. -JoharL'lli�.;r#sf:r� '.i ;.•:s` '•Dicjc:5il ileas(P87=0308) `-f�F fr" f-t;1 �; ' :E'.15M.,,-`� � `.pro qct •F i.. `.. y ^+ �.��rl'' `/ '.a: •J.tI. 7'tiSi t7tr r, _'; %4 "ai t,,' .... . �. .n iiy i• �� ter' � + f.\ L: L.. .• �•r .y list• _r.�l c y^..cit{.'fw� `:. .1';fiz`;i....�.'}i S: :�'7.�?'%9 !. :�.::• •�+.a t.•::LiZ:.Fq cr •. t�' •�V . -. �G /•;t r„i. 7 ,y • y i. Y r .,•/ .! _ • .{C•• 1 >" r ~Y�•� • :'l ^;k:. aI',J?t d!;y_ , '.+-� �.ai-• f•iy., •"� A. +.vi " •.`.- a` r1, `+t: Y. as+•, 1 1 �y ',' �. 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C� aL +.•rat;�'� i F.h14Y j•RC�r' +%f �1 �+ �f . our' rsvi4w' t .tbs, building4ildi:DaP'� tw-,N—gs�iss' � ��• �'� i a tiOch :and/or:' Qs:t2u: tY tte as t t., x �uits ��St3 :mac ► - car �'�ot'`:CD - .�• ,�f= Fa3.. r � the C= ��}.ib•�i��baslw'g�tY,�•�-:���'�,'=`'�."_ ' `y ,M}�• -.�.<�:•.�;-�•t����;."��,-,:- •=k.':• `'•� r ,�.`:: subi th tag {�t ari Ol, :« r Jam i.-'i �' • i ii i ! : v• . ..�"^r!•;:r4;r- `.3TC �,-t�`cai�?Sj`:: '.(xµ- � '. by 'anLYS �. j wt-••.• ,�.,.,, t' 2".,, •'T 4 dY' YM Y. 'r- �T �yv, .�rF . ty t.. '•Li� N•�j. .":.<+'r"• 'y`.Y�1A}.�;[� :� 'k:>l' fi�' �f�'a"�xi>�rti�l`�u',.J�i�v J,r• ,w `C� r:. Y i��t,� deed (1153 T5?-13 ,,• :sfi '" ri1Y: ,a�r`t` _ ;'`` .,'�T ' ; � = i Nr .. ir;�e'�f•"�4��',. 'Oe;;•..�j4:'a -irr 4.Yi j"y'�' ♦ C.,yq'.+ltiX.• a., a f. �.!a,- �.•!h N\...�' ••�':•.`: Y •� � �•� \ it ' 7• ="r��'��''f'• !:a• :��. 'a�ii1.. :`;ta'ti =,;�.`''r,,T`fr{,L.,,^'?�,�,,'..!r'-a:='- 'r �[,'�fi e�•, �.;?'•�,. Ys r.•-y.• p:Vii.,yr f ' ', ::P'.•i.13'."tY..'. .•-tis. •. �•�... •;��'; :Ss-....�7�h•;:•':r�+ti'.: 'w.: Ing: ':. ',j '•+x.•. :�.+�.~�-`a � . '�ai/{7^'.1�..�. N.• '�. .-' .f.'.` 9u ^�,+�•y•�..:s,<. �t �'�''.ay.yam +5_iw`:••�,.�`_ • t' my Lr,.we;.'j+i„ �' .t- . v 'y'-"f•.•w r,•. ` 'k': :- •` y..i• at . `' 1:�V-;`:+l`- } '• ' ice yM ..� ASS-7 AL: t. Bldq F �y /Gary -ice �71.yMinq; cc-. o a»y^/ 3 •'` a, t'• r� '~•''An: - .a .✓'.�•.�. 1'I\ • �yi.► Yom`_ ,y„ •�• I V`O• .�.. �. .. •'a~•:• '�'f••; S� fro e��' e $ ©� ,... Fil 58¢� " _VAX O'S �,�i`•'!J .. �,�y,�;o,r,eKiAT�:sem •` ,_..�; �sao f4:)U APR-15-'94 FRI 17:13 ID:KENSINGTON PLACE TEL NO:510 -943-6705 #151 P02 V e r v iew FIRE PROTECTION DISTRICT Chief April 15, 1994 Fire Corn kstoq; ALLEN LITTLE ROBERTBA ALDPiDCG HORACE A.ENEA State of California SIC LANSTROM BOB LEVVIS Department of Social Services W7A8E1H RIMBAULT Community Care LicensingNCER,W ' JOE EDWARD SP[Jr. 5850 Shellmound Street, Suite 315 TOVAR. Emeryville, CA 94608.1963 ATTN: Rose Arellano, Licensing Evaluator SUBJECT: Lake Alhambra Retirement Residence Fac. No. 071441058 825 East 18th Street Antioch, CA Dear Ms. Arellano: We have reviewed your Fire Safety Inspection Request (Form 850) , dated April 4, 1994, for the subject facility. Your request for Fire Safety Clearance was in reference to information concerning building deficiencies as noted in a report dated March 28, 1994, which was recently submitted to your office by the facility operator. Based on information the Fire District has learned from architectural and engineering reports provided by various professional consultants and from on-site inspections conducted to assess these reports, the Fire District must, at this time, withhold fire safety clearance, pending compliance by the facility operator with the Notice of Violation of Fire Safety Regulations, dated April 15, 1994. In the interim, during which time the facility operator, has been allowed to review the various construction deficiencies involved for purposes of establishing a written plan of correction for our review, the Fire District stands ready to assist in every possible way to minimize any adverse impact on the residents. If you have any further questions please contact me at (510) 757-1303, Ext. 23. Sincerely, ALLEN LITTLE Fire Chief By: LARRY UDE Supe)Vising Fire Inspector AL:LT:lr cc: Gary Baysmore, Licensing Supervisor - DSS, Comm. Care Licensing Joe Garcia, Chief - State Fire Marshal's Office, Coastal Region Gary Rayner, Chief Building Official - City of Antioch Richard Fordiani, Parkford Management Company Mike Argo, Assistant Fire Chief Richard Costa, Chief Fire Inspector Steven Bailey, Fire Inspector 1 soo WEST FOURTH STREET—ANTIOCH,CALIFORNIA 94509-1099—TELEPHONE(SIGI 7S7-1303—fAX(510)754-8832 APR-15-'94 FRI 17:14 ID:KENSINGTON PLACE TEL NO:510 -943-6705 13151 P03 klvervi6v FIRE PROTECTION DISTRICT cels+ April 15, 1994 Fire G,mmisslurrors: ALLEN LITTLE ROBERT SALORIOCF HORACE A.ENEA SIC LANSTROM 809 1MIS EL17ABFTH RIMRAULT Parkford Management Company, Inc. EuwARUSPENC(R.I,. 1660 Olympic Boulevard, Suite 211 IOETOVAR,Jr. Walnut Creek, CA 94596 ATTN: Richard R. Fordiani SUBJECT: Lake Alhambra Retirement Residence NOTICE DSS Fac. No. 071441058 Violations of fire 825 East 18th Street Safety Regulations Antioch, CA Dear Mr. Fordiani: On April 7, 1994, and on April 14, 1994, inspections relative to fire and life safety were conducted at the subject facility. These inspections by the Fire District were performed with your concurrence to assist the District in processing a Fire Safety Inspection Request (form 850) , dated--April 4, 1994, which we recently received for the subject facility. This request for Fire Safety Clearance was initiated in reference to information concerning building deficiencies as noted in a report dated March 28, 1994, which you recently submitted to the local State Department of Social Services, Community Care Licensing office. In order to comply with the California Fire Code, Contra Costa County Ordinance 89-74, and Title 19 & Title 24, California Code of Regulations, the following corrections must be made: 1. Provide approved one-hour fire-resistive construction in accordance with requirements of Section 1202 of Part 2, Title 24, C.C.R. Compliance with this requirement includes, at a minimum, corrections which address the following existing conditions: a. Attachment of 5/8" gypsum wallboard directly to the bottom chord of the attic truss assembly and the bottom chord of the floor-ceiling truss assembly. b. The lack of fire blocking on the top side of party walls between each residential dwelling unit and at adjoining corridors. 2. Provide approved one-hour fire-resistive construction in accordance with requirements of Section 1209 of Part 2, Title 24, C.C.R. Compliance with this requirement includes, at a minimum, corrections which address the following existing conditions: a. The lack of 5/8" gypsum wallboard on the attic side of the elevator shaft. 1500 WEST FOURTH STREET—ANTIOCI I,CALI(ORNIA 94509.1099—TELEPHONE(510)757.1303—FAX(S10)754-8852 APR-15-'94 FRI 17: 14 ID:KENSINGTON PLACE TEL NO:510 -943-6705 #151 PO4 Parkford Management Company, Inc. April 15, 1994 Page 2 3. Provide approved one-hour fire-resistive construction in accordance with requirements of Section 1205(a) of Part 2, Title 24, C.C.R. Compliance with this requirement includes, at a minimum, corrections which address the following existing conditions: a. Water heater ventilation provided by light-gauge ducting materials venting into the• attic space. b. The absence of combustion air vents on laundry rooms equipped with gas-fired dryers located off a corridor. You are hereby notified• to make the above-listed corrections. You are further requested to prepare and submit a written plan of correction for review by the Fire District by May 15, 1994. Based on information the Fire District has learned from architectural and engineering reports provided by various professional consultants and from on-site inspections conducted to assess these reports, the Fire District must, during this interim period, withhold fire safety clearance for the subject facility. An appropriate notification letter will be issued to the local State Department of Social Services, Community Care Licensing office. During the time you have been allowed to review the various construction deficiencies involved with your consultants for purposes of establishing the required written plan of correction for our review, the Fire District stands ready to assist you in every possible way to minimize any adverse impact on the residents. If you have any further questions please contact me at (510) 757-1303, Ext. 23. Sincerely, ALLEN LITTLE Fire Chief By: Y E Supe sing Fire Inspector AL:LT.lr cc: Gary Baysmore, Licensing Supervisor - DSS, Comm. Care Licensing Joe Garcia, Chief - State Fire Marshal's Office, Coastal Region Gary Rayner, Chief Building Official - City of Antioch Richard Fordiani, Parkford Management Company Mike Argo, Assistant Fire Chief Richard Costa, Chief Fire Inspector Steven Bailey, Fire Inspector 1 . 3 � > CLAIM [ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 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: $511.00 Section 913 and 915.4. Please note all !Wa'rnfinpi"; I1f CLAIMANT: HERNANDEZ, Grace and Justin L tr 0 C T ATTORNEY: COUNTYCOUNSEL Date received MARTINEZC2ALIF. ADDRESS: 4350 San Pablo Dam Road #5 BY DELIVERY TO CLERK ON October 21, 1994 E1 Sobrante, CA 94803 BY MAIL POSTMARKED: October 20, 1994 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. y}- pNIL gATCMELOR, Clerk DATED: ��LX-B-Y�.� .02 ' - �l 9 B1: plputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (V lThis claim complies substantially with Sections 910 and 910.2. r ( ) 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: 0 L( BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) I ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BDARD/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 mutes for this date. Dated: NOV 8 1994 PHIL BATCHELOR, Clerk, By Deputy Clerk YARNING (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 iawdistely. *For additional warning see reverse side of this notice. AFFIDAVIT OF NAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, ever age 18;.and that today I deposited 1n 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 claimiant as shown above. . Dated: Nov 44 1LQB BY: PHIL BATCHELOR by Deputy Clerk cc; County Counsel County Administrator 29 USA N ,� a' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form RE: Claim By ) Reserved for Clerk's filing stamp [-7RE—CEIVED Against the County of Contra Costa ) or ) -fi 211994 District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur. (Include city and county) AAn6 r4nAf, C05A (�17 3. How did the damage or injury occur? (Give full details; use extra per if -ff required) 1 W05 u/a/ki' a/an �/,� roa®( w 4h had # UN2 Sear 0�C7tr1 r-+ 3 Ui't713. /Ve neve /liO hGY � �- .. rn JYL� -/A e 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? p �' (over) i 5. wnat are the names of county or district officers, servants or employees causing the da.-^age 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. i,4�41-Yl� w ��lav ��f f� 1,�6 d1 , , � s�-r 0"keolk 7• How was the amount claimed above computed? , (Include the estimated amount of any prospective injury or damage.) 29 ri -,,er3 8. Names and addresses of witnesses, doctors and hospitals. J& ----------------------------------------..�...._______-______�. ---- ---------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT �p j r ` F Gov. Code Sec. 910:2 provides: ' O "The claim must be signed by the claimant SEND NOTICES TO,:, :.(Attorne ,)-;�=�=- , or some -person,on his behalf." Name and Address-df Attorney 2 j= man t Clai 's Drvyi'ilg`n'ature ell A dress -Q4 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, 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. din r�� _ ,� �- t � 1 - �. `� - --------.--_..-.-- --�� -ter �_�- -_ ��._-�-- -�"`'l ---s'��----��----�-- - -- -- .' °� �-- APPROVED OMB NO.0938-0279 DCTDRS ' HOSP �F PINOLE 2 3 PATIENTCONTROLNO. colpm 151 APPIANY bozo -5667 131 5 FED.TAX N0. 84'STATEMENT COVERS PERIOD. 7 COV D. 8 N-C D. 9 C-1 D. 10 P I NOL E _1 CA 94564 17 FROM THROUGH —7'24-513no915-37206591 09119410911941 TNAM 12PATIENE 13 PATIENT ADDRESS 0 SAN PABLO DAM R # EL SOBRANTE CA 94.803 ADMISSIONCON 1 ION CODES 14 81RTHDATE 15 SEX 16 MS 17 DATE.r. IS-HR_ •I9 TYPE ,20 SAC'+21 D HR 22 STAT 23 MEDICAL RECORD 1 . . 24 26 2e 30 31 05131993 91194 E E , d i it0000957O 32 OCCURRENCE. zn n 34 OCCURRENCE, > 36 OCCURRENCESPAN 37 CODE DATE +� CODE" "' DATE'=" °":R. ��-'% >CODE' '°FROM ='?- THROUGH °;° �.9 _._-�, — A a5. B...... .......__. ._ - -- B b c 39 VALUE CODES f E 41 VALUE CODES Bs ACE Y ME RNAN D'E Z coD.a AMOUNT ,�: . , •r �s ..n.. J CODE AMOUNT 350 SAN P:ABLO DAM R.D #5 a 45 091 L a -L SDBR�ANTE CA 948.03 b b c c _ e_. . d d 42 REV.CD. 43 DESCRIPTION 44 HCPCS/RATES 45 SERV,DATE 46 SERV.UNITS 47 TOTAL CHARGES 48 NON-COVERED CHARGES 49 10450 EMERGENCY ROOM 1 128 00 1 2 z: ...._......... 3 3 4 4 5 5 7 7 - 8 E 8 9 9 10 10 11 11 12 12 13 _ m.. 13 14 14 15 15 16 16 x 17 17 —----..-_. _... . _ ._.. -. __ _- _ M—_ _ —_ _ ____ _ -18 18 19 19 20 20 — .._ _, _.. a._ A._....,� . ..aA------- -----,....... 21 21 22 22 230001 TOTAL 12,8 :00 W 23 50 PAYER 51 PROVIDER NO. ®9 54 PRIOR PAYMENTS 55 EST.AMOUNT DUE 56 A PR':IVATE PAY Y ,_ , c 57 G1lr. 0�1pQi 58 INSURED'S NAME 59 BREL 60 CERT.-SSN-HIC.-ID NO. 61 GROUP NAME 62 INSURANCE GROUP NO. A ERNANDEZ GRACE Y7 18' 450471984A e _ _ _ .. _.__ _- C c 63 TREATMENT AUTHORIZATION CODES 64 ESC 65 EMPLOYER NAME 66 EMPLOYER LOCATION . . . A 1 EYE CENTER NO CALIFOR EL -CERRITO CA 94530 A B A� sr - rt, C C 0 ER D) G.CODES 76 ADM.DIAG.CD. 77 E-CODE 78 67 PRIN.DIAG.CD. 66 CODE 7aC0oE - 7z coOE 7a cooE 920 79P.C. 80 CODEINCIPALPROCEDDDRTE OTHRPR EDURE o a o [THER'PHYS.'[D TTENDINGPHYS.ID' GA2OAQ586.Lt $OEC'}�E1R' a :CODE .a .DATE 9 - b OTHER PROCEDURE `_^, • ' - CODE DATE r r - r ='°�.. '' CbDE .° DATE' r3OTHERPHYS,IDa b a 84 REMARKSGLrBO 09/16J:94 SV65 PT3 FC 70- 000 ' J y.) a b66201 PRIVATE' PAY P 92 0 ' ` b c 4350 SAN' PABL 0 DAM. OVIDER REPRESENTATIVE / 86 DATE � d SOBRANTECA 9 17' . _ UB-92 HCFA-1450 -OCR/ORIGINAL ICERTIFY THE CERTIFICATIONS ON THE REVERSE APPLY TO THIS BIL AND ARE MADE A PART HEREOF. UNIFORM BILL: NOTICE: ANYONE WHO MISREPRESENTS OR FALSIFIES ESSENTIAL - INFORMATION REQUESTED BY THIS FORM MAY UPON CONVICTION BE SUBJECT TO FINE AND IMPRISONMENT UNDER FEDERAL AND OR STATE LAW. Certifications relevant to the Bill and Information Shown on the Face 9. For CHAMPUS purposes: Hereof: Signatures on the face hereof 'incorporate the following This is to certify that: certifications or verifications where pertinent;to this Bill: 1. If third party benefits are indicated as being assigned or in (a) the information submitted as -a part of this claim is true, participation status, on the face thereof,]appropriate assignments accurate and complete, and, the services shown this form by the insured/beneficiary and signature of patient or parent or were medically indicated and necessary for the health of the legal guardian covering authorization to release information are on patient; file. Determinations as to the release of medical and financial (b) the patient has represented that by. a -reported residential information should be guided by the particular terms of the release address outside a military treatment center catchment area he forms that were executed by the patient or the patient's legal or she does not live within the catchment area of a U.S. military representative. The hospital agrees to save harmless, indemnify or U.S. Public Health Service medical facility, or if the patient and defend any insurer who makes payment in reliance upon this resides within a catchment area of such a facility, a copy of a certification, from and against any claim to the insurance proceeds Non-Availability Statement (DD Form 1251) is on file, or the when in fact no valid assignment of benefits to the hospital was physician has certified to a medical emergency in any instance made. where a copy of a Non-Availability Statement is not on file; 2. If patient occupied a private room or required private nursing for (c) the patient or the patient's parent or guardian has responded medical necessity, any required certifications are on file. directly to the provider's request to identify all health insurance 3. Physician's certifications and re-certifications, if required by coverages, and that all such coverages are identified on the contract or Federal regulations, are on file. face of the claim except those that are exclusively supplemental payments to CHAMPUS-determined benefits; 4. For Christian Science Sanitoriums, verifications and if necessary (d) the amount billed to CHAMPUS has been billed after all such re-verifications of the patient's need for sanitorium services are on coverages have been billed and aid, excluding Medicaid, and file. g p g the amount billed to CHAMPUS is that remaining claimed 5. Signature of patient or his representative on certifications, against CHAMPUS benefits; authorization to release information, and payment request, as required by Federal law and regulations(42 USC 1935f, 42 CFR (e) the beneficiary's cost share has not been waived by consent or failure to exercise generally accepted billing and collection ' 424.36, 10 USC 1071 thru 1086, 32 CFR 199) and, any other applicable contract regulations, is on file. efforts;and; 6. This claim, to the best of my knowledge, is correct and complete ( any hospital-based physician under contract,the cost of whose and is in conformance with the Civil Rights Act of 1964 as services are allocated in the charges included in this bill, is not amended. Records adequately disclosing services will be an employee or member of they Uniformed Services. For w . purposes of this certification, an employee of the Uniformed maintained and necessary information ' ill be furnished to such governmental agencies as required by applicable law. Services is an employee, appointed in civil.service (refer to 5 USC 2105), including part-time or intermittent but excluding 7. For Medicare purposes: contract surgeons or other personnel employed by the If the patient has indicated that other health insurance or a state Uniformed Services through personal service contracts. medical assistance agency will pay partl of his medical expenses Similarly, member of the Uniformed Services does not apply to and he wants information about his claim released to them upon reserve members of the Uniformed Services not on active duty. their request, necessary authorization is on file. The patient's (g) based on the Consolidated Omnibus Budget Reconciliation Act signature on the provider's request to bills Medicare authorizes any of 1986, all providers participating in'Medicare must-also holder of medical and other information to release to Medicare participate in CHAMPUS for inpatient hospital services medical and non-medical information; including- employmentprovided pursuant to admissions to;faospitals occurring on-or status, and whether the person has'',employer group health after January 1, 1987. - insurance, liability, no-fault, workers' compensation, or other (h) if CHAMPUS benefits are to be paid in a participating status, I insurance which is responsible to pay for the services for which agree to submit this claim to the appropriate CHAMPUS claims this Medicare claim is made. processor as a participating provider. I agree to accept the 8. For Medicaid purposes: CHAMPUS-determined reasonable charge as the total charge This is to certify that the foregoing information is true, accurate, for'the medical services or supplies listed orf the:claim farm. I' and complete. will accept the CHAMPUS-determined reasonable charge even if it is less than the billed amount, and also agree to accept-the I understand that payment and satisfaction of this claim will be amount paid by CHAMPUS, combined with the cost-share from Federal and State funds, and that any false claims, amount and deductible amount, if any, paid by or on behalf of statements, or documents, or concealment of a material fact, the patient as,full payment for the listed medical services or may be prosecuted under applicable Federal or State Laws. supplies. I will make no attempt to collect from the patient (or his or her parent or guardian) amounts over the CHAMPUS- determined reasonable charge. CHAMPUS will make any benefits payable directly to me, if I submit this claim as a participating provider. ESTIMATED CONTRACT BENEFITS z o �o { z mN Fo Nw Lu %0v U o "- T F'w Q LU `� w 1.. QL1 ).' U¢ g� CA W s., P4 O-: 2 a- _ 1 F- 2 U F mw d I� wm i F- L) 5 J �.' U F-a Ltd 1-� a uwi •t w� . o 0.r W� cc z a + ,y at P O w a ?� sn 1!� W Q 0 z m LUgz "�. Ga ►n C9 W p I W Z CO oz Zto a G' w O a L?� <7, tJ.! M Q Z I o N iy- z cra 4, M 4JJ0 ~ a w o W Z x W 1! <J LU Ln U) LIQ ca r4 z z. W `+ tit LJd Q 5 a zOw 2! Q �# $Le1) WW M GK, trt L!S fR N O m 04 � uj U.U) p C, c) ?.4 in C ; v7 a L#d: w + co a „'Cf qp zr'4 _q; Co" ` v w 0. Z W Q W a Q Ui t��� ao-88 0 Q w LUJ Uj v w LjJ tfy tLl z m N Q, mi �. W MAi r� Ww W a U v Ldt tom ' {�` N .� to C�d'T LU C) � z Q O X.O _ Z'•A. a w; U. V r4' W' W UJ N W co d ?� Jn Z Q MO+ til 'Ln W L11 Co- ttowQ � 0NV°� 1otW +t$ Q. •L. cc Ix 0 '� LJ co {J .J V) UJ ui f Z� ttJ S _ d 00 W CC Zin Q —Z W t w M1 to v' �+ r Z N LL fA m ,"� Q w Q.l� G? <$ LL W Z "' z 441 id! Q C < J tJ V Y ti° 0 1 4 Gt1 Z $ =f" 5 o CCR ti lid Q V 14� coa' E °� c p Ltd 4 Q a u t0 er W w °' td! tfD Gt3 LU .-i z 0 btr U O v? W CA z o a o dlfl WZ uj � 0 crt :iO p 0, v al Ud w Nk LU a Eri u v 0 z z ltd a Q ' w cLU U L i- h• ,. • e=is . .a, lid w "�a o w tia N =a? U- �qN� a 7 atUl LU 'o°Ce IJsi tXl wFgQ m, r iw azoom P+d a tid C (+'i CC uj V i LL M O' .J c':: 01-4 ce p $ we Cp rr a C) ox uj � s m lJ o4w; z 4 o a �+ C 'D > N J a UJ 4 0 w cr. o k lel o D V? umj 0 N V1 # t`3 0 `` iT tT v7 a. Y tJ co # 0P4 ui l/0 161 4h 4 yP Ct N n rN cry ..d Vf LU w iT 0% 1-4 r4 as {7 CIA CA DOCTORS HOSP OF. PINOLE_ x,151 -APP-IAN WAY- PINOLE £A 94564 95-3720659 17` JUSTIN A HERNANDEZ PT# 00284566 .— FlC 70 ADMITTED' 0911"I.f94 D'ISC"HARGEO 09/11/94 i CHARGE# DESCRIPTION` ` QTY: DATE CHARGE � 6100522 27502 ER VI-SIT LTU 1 '09111 1280,00 OI HO SPI fAL /MEDICAL FACILITY.. '. VISA AMERICAN EXPRESS MASTERCARD DOCTORS HOSPITAL OF PINOt:E ___- AMTonTE $ CRED2151 APPIAN WAY,... cARo'No rw - .. .m NUMBER 00284566 PATIENT PLEASE MAKE SURE THIS ADDRESS SHOWS ON RETURN ENVELOPE NAME HERNANDEZ JUST A G. „a nN IN R''” HERNANOEZ GRAGE Y t3t]C,TI RS NQSPkItTAI: GF{s PINt3LE N E 4350 SAN PABLG DAM,, 2=1'51 APP IA.N WA:Y` o9 s� EL `508RANTE" GA .v.48o3 PINOLE CA 94564 ` R l INITIAL OUT 10911;1194 Q..;C?9111=194} ; ,9116194'ci 70 b 1 I -DISCHARGED DATE OF,PRE TYPE OF BILL j,PATI11 ENT TYPE { ADMtTTED r VL STMT ' STMT.DATE NO tlF ElN CLASS .PAGE ST MTS 1 PLEASE RETURN TOP PORTION WITH YOUR PAYMENT i AM9 NT OF IF PAYMENT HAS BEEN'MADEPLEASE DISREGARD PAYMENT °c X1113194 ;09J111`�4 E,100'S'22 ,Z?5LI2 ' I~Et' YfI'SIT LTD.: 1. t 1 " p , ., PATIENT NUMBER PATIENT NAME IDATE INSURANCE BILLED f 002845667 HERNANDEZ- J.i1.5TI,N :A 5.128.{313' � IRS�Cg53720'b5.,91.? �, T IS ACCOUNT IS' DUE ANO,'P'AYA8l,E UPON RECE,IPsT.. c 0009 DOCTORS HOSPI,T=AL '4:F..:�P,INOL '215'1 ARPI AN- NAV, NM-7882(72!87) 510-724`5000. . PlNOLEfI CA:.,..945b4 l . ) } 1 i TOTAL CHARGE'S _... TOTAL DUE 128000, CLAIM s ' 3 7 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 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 Sailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors --the IV below), given pursuant to Government Code Amount: $15,000.00 �G(S -' ;Section 913 and 915.4. Please note all Wgrningso. CLAIMANT:HILLIARD, Geneva OCT i fG COUNTY COUNSSL ATTORNEY: MARTINEZ CALIF. Date received ADDRESS: 1632 North Jade 4402 BY DELIVERY TO CLERK ON OrtohPr 18_ 1994 Richmond, CA 94801 BY MAIL POSTMARKED: October 17. 1994 1. FROM: Clerk of the Board of Supervisors TO: .County Counsel Attached is a copy of the above-noted claim. Q IL eATCNELOR Clerk p \ DATED: P e-P�i. X94 5L dq: Deputy ' fit', , CA�e xJ1n 0,M J ]1. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓r 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 910.6). ( ) 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: - oZ0 ' 4 `� BY: � - 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). ]V. 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: NOV 8 199 PHIL BATCHELOR. Clerk, By � a a_1,0,E,� ,p Deputy Clerk i YARNING (Gov. Code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or UPOsited in the sail to file a Court action on this claim. See Government Code Section 945.6. reu may seek the advice of an attorney Of your choice in connection with this utter. If you want to consult in attorney, you should do so immediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF }AILING i declare under penalty Of perjury that I ON now, and At all times herein mentioned. We been a Citisen of the Mited States, ever age 28; and that today I deposited to the United States Postal Service in Martinez. ;41ifornia. postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to the claimant AS shown above. fated: NOV 9 19% BY: PHIL BATCHELOR by � , �A���� Deputy Clerk .C: Lounty Counsel County Administrator CCN 11 l k k i, Vi (-6 40 CO ,.tini . ni • N s RE,*- �. _ nS=OPTD, CALIF.. CC7 1. IOF '11E BOARD OCTOBER- , I r, . y9y.•.. 1 PETIONJ Tt CUIRTTI S PL ERvTS R-S 2 C,,:MI A_ 'nrT- A ID T F' ' Sf S FOR 1)A1,1AGES. 3 DSF. '.D7T'IT'S LINDA LUCCA LAS- DT LTI S HC>USTTTF AL?':''TTOPzllY. 4 PLAIT`TIFF., GEN VA. HILT,T 00 16,2 1 i I01I5 CAT,!F.. 5 DAT'' {. F :CTDEW 1O/13 Ia91[- 6 DT;FA11TDX* T. C"ALr.RD, LAW IL7NFC`'C i,TEPT ALSO PLAT--ITT-77S 7n R- M�,'1 i i�'S STI (_ij TDE-21rtJ'�f��',� ST:=J!,,]I'E!:TS 8 r n n- rTnTT mT i T-'1 iT 1Pr r f rr ^ -- - l 9 1.,sT'TO T��7Iry �T:T .�`i s.JIS OF � {�.T Tr(iCt..L±S ' �D 3:�:r,0;l '�?� LIS'T'---ID D 10 _ OP F'i:.AUJD l:JlTw 4.7T.'�..'.'w.�-i+�1fiJ1,'TS 11 P- "BIT:SIVE BETijiVIOR 2 -DISTURBANCE OF VENTU1-iE'.- 123 D :ET'D CTEM PEF00O[,T RECEIVE® 13 Lr iur ?T�1':2'G�Yyj �J"=1A ��8,r Ul/l 18 994 :5 ..T Or' CITE-7AT.'�R (Rri.PUT.r'�i:i: 14 bi�N GLIENIP HOM ;CID E 1 - -- -- -�----- CLERKBOARDC STACO.ISO S 5 CONTRA.COSTA CO. 16 PLAIA_.ITT. FF _ LTS.F CJl T'JST; C": G .S ST "y ': :'� 70 TI- 11 ?U-1:ULCHAS �k� r�\ r � .. ,gym- r19 '7r. r l.-L'_ , .0 _! r_i _� r 1' 4_ �� I l 5 V V tiJdollars 20 li-FT 1i•-;]7 fllT j r SA 21 - D _ r �,Fi_T';±' -�i8 _,F ( �C -jT ! CI; r.I.i.!U FF DEPRE1ssir ; 22 -rLAIT' ^IFF CLAI 'iSm '1'1 TiTTAL C:R �ET,T n T: I ABCjV �C.:_TOxj 23 W"'D O TIILR U1"rJ �t n r D C T �.'�. ..,�� COF.,D ITI 31B 24 25 T 1.F-:,;k �r Ti _ _ V 2403 , / 27 ,f yod 28P - CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 Claim Against the County. or District governed by) BOARD ACTION the Board of Supervisors, Routine Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document sailed 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: $10,000,000.00 Section 913 and'915.4. Please note all oilarnings". CLAIMANT: SWAN M. Douglas ATTORNEY: COUNT`! MAFITINEZCALVF. ate received ADDRESS: 1771 Broadway St. , #323 BY DELIVERY TO CLERK ON October 20, 1994 Concord, CA 94520 BY MAIL POSTMARKED: Hand Delivered J. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p�IL eATCMELDR, Clerk t".e� 0 � p DATED: Y%020 / 4 9� ! : Deputy, 1I. FROM:: County Counsel TO: Clerk of the Board of Supervisors (tirI 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 1S 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: 7a '"Z-o BY: Deputy County Counsel 111. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). JV. 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. 9� p Voted: NOV 8 aaoaT PHIL BATCHELOR, Clerk, By 11 , a�. Deputy Clerk YARNING (6ov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice as personally served or deposited in the mail to file a court action on this claim. see Government Code Section 945.6. row may Seek the advice of an attorney of your choice in connection With this *atter. If you want to consult in attorney, you should do so tamediately. *For additional Karnino see reverse side of this notice. AFFIDAVIT OF NAILING I detlare under penalty of perjury that I as now, and at all times herein mentioned, have been a Citizen of the ynited States, over age 28; and that today i deposited to the united States Postal Service in Martinet, elifornia, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to the tlaiwant as shown above. NOV Dated: BY: PHIL BATCHELOR by - Otputy Clerk :C: County Counsel County Administrator Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury ..o 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 6911.2.) 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 orm. RE: Claim B {� , '�Dz9l,� A4 ; Reserved for Clerk's filing stamp R1-7 t ��� JAAJ' �' ) RECEIVED ) ) Against the C.Qunty .of Contra Costa ) 2 0 1994 District) CLERK BOARD OF SUPERVISORS Fill in name CONTRA COSTA CO. ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 4 . off and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) TOL-44A, lggl Y- 2. Where did the damage or injury occur? (Include city and Bounty) 3. How did the damage or injury oofur?� (.G/live ful details; use extra paper if required) �-�(,4,,.1�]jb&)T-1, ;�M�1� l Al � � 4\) (sZ� L I C �'C6 1'�A4L66b ,LJ AiTALJ � 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What are the names of county or dis ict officers, servants or employees causicig the damage or injury? O 7 V 64) 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. AttacD two estimates for auto damage. CWS 0 dznvu• 7AJI� &-'N)(4 0 �iC� l ?/l OSC �� 0-^-Jn� tM.C--AJ r 4--J) ID&,KJ f 6�4 AAr,-.r, < 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) )o.T C'rJ"r1e "AL- l'A�• r C�7Uyu �"{` 6. Names and addresses of witnesses, doctors and hospitals. T6 � 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910. provides: q X90 0 S "The clmust igned by the claimant SEND NOTICES TO: ° (Attorne ) orb a son n his behalf." Name and Address of-A,ttorney:;" .:H�"-31 �c, la is Signature 9 6 4y�ow& -r 3�3 71 Address nom- �rl-t Telephone No. Telephone No. �:? ) /n d —T U 7 NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($1090009 or by both such imprisonment and fine. CLAIM 1- -37 • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA November 8, 1994 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 veiled to you is your notice of California Government Codes. 1 the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $7,500`9`000.00 Section 913 and 915.6. Please note all •Narnings". : .� i. CLAIMANT: SINGLETON, Ronald, Mary Katerine and Nicole ATTORNEY: Larry D. Schwartz OCT gin;:,') 9777 Wilshire Blvd. Date received C06113TYCOUN,;:-=L ADDRESS: Suite 1006 BY DELIVERY TO CLERK ON October 1 y`-Rh9�9'4'RL► ° Beverly Hills, CA 90212 BY PAiL POSTMARKED: October 14.1994 J. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above noted claim. DATED: �%(� I-P,�ec� �7, P 19 �qll �putylOR. Clerk (I'LL ]1. 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 I 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 Tate claim (Section 911.3). ( ) Other: Dated: y BY: Deputy County Counsel 311. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) I ) 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 sNnutes for this date. Dated: NOV 8 1 I PHIL BATCHELOR, Clerk, By_ �J ���A � Deputy Clerk YARNING (Gov. Code section 913) Subject t0 certain exceptions, you have only six (6) months from the date this notice Ms personally served or deposited In the mail to file a court action on this claim. See Goverment Code Section 945.6. rau may seek the advice of an attorney of your choice in connection With this utter. If you want to consult On attorney, you should do so is nediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the United States, over age 28; and that today i deposited to the United States Postal Service in Martinez. California, postage fully prepaid a certified copy Of this Bard Order and Notice to Claimant. addressed to the claimant as shown above. Dated: NOV 4% BY: P141L BATCHELOR by �,Ni a• � Deputy Clerk J - CC: Lounty Counsel County Administrator C aim Io: BOARD OF SOP�v�2� A ORIGINAL A. Claims relating to Causes of action for death or for injury ..o 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 asst be presented not later than one year after the aeerual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its orrice in Roan 106, County Administration Building, 651 Rine Street, Martinez, CA 94553. i 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. B. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. n: Claim By ) Reserved for Clerk's filing stamp RONALD R. SINGLETON 14ARY KATHERINE SINGLETON ITICO.LE SINGLETON, a minor RECEIVED Against the County o Contra 'Costa ) or ) i 7 X94 District) CLERK BOARD OF SUPERVISORS F i l tri namee ) CONTRA COSTA Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sun of 7 ,50 0, 00 0 w and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) accident: 4-29-94 ; 11: 45 p.m. death: 4-30-94 ; 1 : 30 a.m. 2. Where did the damage or injury occur? (Include city and county) Bethel Island Rd. , approx. 265 ft. north of E. Cypress Rd. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Vehicle in which claimants' decedent, RONALD LOUIS. SINGLETON, made sharp turn from E. Cypress Rd. at point where road turns and becomes Bethel Island Rd. Driver lost control of vehicle and it began to roll over and struck utility pole. Claimants' decedent sustained fatal injuries as a result of this accident. .�_ ----------------- --------�-------w-.._---.y_ _ 4. Wnat particular act or omission on the part of county or district offioers, servants or employees caused the injury or damage? Full extent still under investigation. Preliminary investigation reveals known dangerous roadway condition with lack of adequate warning, lack of adequate bighting, negligent design and maintenance of roadway. (over) 5. .,khiat are the names Of county or cistrlet orrieere, aCr-ranw vc- Q14 ,LUYaca %xi1Aoi116 the damage or injury? Still under investigation. Department of Public Works appears to be the county agency in charge of the roadway in question. 6. What damage or injuries do you claim resulted? (Give N11 extent of injuries or damages claimed. Attach two estimates for auto damage. Death of 19 year old male son and brother of claimants. 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Loss of society, comfort and support of son and brother of claimants, as well as burial expenses and expenses incurred by decedent' s heirs for care prior to and subsequent to death. 8. Names and addresses of Witnesses, doctors and hospitals. Erin Dale Bridges, 408 Bluerock Dr. , Antioch, CA 94509; Dawn Horne, 2736 Carob St., Antioch, CA 94509; Jaclyn Bloom, 2317 Chidkie St. , Antioch, CA 94509; Stephenie Biggs, P.O. Box 607, Bethel Island, CA 94511; P. Kliber, CHP. 9. List the expenditures you made on account of this acccc nt or injury: DATE ITEMUNT 4-30-94 ambulance fees $14,000 4-30-94 hospital charges $ 1,600 5-94 burial expenses $10 ,500 e � e • e � * r a e � � * * � � e * � w � � e a e � � e � 1t � f a► � * e e e � • e e Gov. code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTIM TO. (Attorney) or bysome person prrhis behalf." Name and Address of Attorney Larry D. Schwartz imam's S gnature 9777 Wilshire Blvd. , Ste. 1006 Larr CD. Schwartz Beverly Hills, CA 90212 Attorney at Law Address Telephone- No. 310/278-1214 Telephone No. eaee ■ trt i� eaair � f "�'iF' � e * NOTICE Section 72 of the penal Code provides: "Every perscn 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. LARRY D. SCHWARTZ ATTORNEY AT LAW 9777 WILSHIRE BOULEVARD, SUITE 1006 BEVERLY HILLS, CALIFORNIA 90212 October 14, 1994 (213) 278-1214 IN REPLY REFER TO: Clerk of Board of Supervisors of Contra Costa County 651 Pine St. , Rrm. 106 Martinez , CA 94553 Re: Claim of Singleton, et al. vs. Contra Costa County To Whom It ,May Concern: Enclosed for filing please find original and three copies of Claim form regarding the above-referenced matter. Please return a conformed copy to our office in the enclosed .envelope. Very truly yours, ; Jacqueline Orienter for Larry D. Schwartz Encls. ods Qo� (Now Q�gj0�4 00 40�o Qo4mm Z 708 84.5 061 m LL rn s E F 5" 9 9 & GO L `�0 7 9 U S s v AdO,0 33SS3dabtf d. W iR a Eliw .Y a7 3 Z (Yu! CIS ) Co do Cc r-qt n n n O Tt0 OA' Y/'6 Q O O 0�r ® w W w &o.9•Lco S irk .' CO d (A `❑ El 1:1 GE 0 � #S! � � ♦ �. �. o t o o X0 E,3 �' c rn � 1 .' L w _ >E�T 6✓ ®p fa C 4J U w W w � N« 1tlO)`,a ! > c o 0 2. o 2- cl 2 t!J >5 J z x oW[mmc. O 4 6S1 fj O rn ; y z i O ❑ i LL OL 1 an' rn �yo«w w LL `7 0"a-1, W O « N j){ O I R Z V' i wt N Elf— Q d Y air 1 O ® Y OrdC5 LL 09 U Av 00 ui o € o4 M. Q o m s cui � c a m o g 9e310-8-M-eo9sot e i 137 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November.,V,, 1994 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 Goverment Code %mount: $500,000.00 Section 913 and 915.4. Please note all •warnings". CLAIMANT: SARRACINO, Mary ATTOANEY: Gagen, McCoy, McMahon & Armstrong U.i? 2 k � r� c/o William E. Gagen, Jr. Date received COUNTYCoj_ijg3SL ADDRESS: 279 Front Street BY DELIVERY TO CLERK ON October 21, M*INEzcAi�c P.O. Box 218 Danville, CA 94526 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IV eATCMELORClerk Q /� DATED:_ e-(�e.�� o� `{ . I �l 9 eT: Deputy . yQi . ( e 11. FROM: County Counsel 70: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying I 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: /0 — Ly —4' y BY: puty 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 (J ) 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. NOV 81994 � r Dated: PHIL BATCHELOR, Clerk, By �1 l q n .D Q A,� , Deputy Clerk YARNING (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 wail to file a court action on this claim. See 6overnment Code Section 94S.6. You may seek the advice of an attorney of your choice in connection Kith 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 %AILING I declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited 1n the United States Postal Service in Martinez, California. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to =he Claimant as shown above. (► � Dated: NOV 9 1994 BY: PHIL BATCHELOR by, Deputy Clerk CC: County Counsel County Administrator _ s r Clam -o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims .relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to personal property or growing crops and which accrue on or after January .l, 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 Ponta RE': Claim By ) Reserved for Clerk's filing stamp MARY SARRACINO ) RECEIVED [�i ) . Against the County of Contra Costa ) OCT 2 1 1994 or ) KB 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 $ 50 0, 000. 00 and in support of this claim represents as follows:. 1. When did the damage or injury occur? (Give exact date and hour) May 3, 1994 at 10: 17 a.m. 2. Where did the damage or-injury occur? (Include city and county) ~M 3555 Clayton Road, Room 215 , Concord, CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) Assae Kawano Carr, mother of Mary Sarracino, had a history of mental illness evidenced; by numerous suicide attempts. On March 28 , 1994 and April 23 , 1994 Drs. J. . Champlin and M. Hernandez prescribed medication while Assae Carr was confined to Merrithew Hospital . Assae Carr was found ��'a8'-an -3-,--3 --f kava-pr�scrrhed-,by-the dr s . 4. What particular act or omission on the part of county or district officers, servants or emplo ees caus the injur or d e? Drs. Champlin anY Hernandez knew oy Mrs arr' s history of mental 'illness and her propensity to overdose on medication. Mrs. Carr was a patient of Drs . Champlin and Hernandez, staff doctors at Merrithew Hospital. At the time of her death, Mrs. Carr had 4 prescriptions of medication as follows : (see attached list) c r,' �. wnat are the names of county or district officers, servants or employees causing the damage or injury? Merrithew Memorial Hospital and Health Center, Dr. J. Champlin and Dr. M. Hernandez 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Assae Kawano Carr died on May 3 , '1994 due 'to an overdose of prescribed medications. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Estimate $. Names and addresses of witnesses, doctors and hospitals. Mary and Manuel Sarracino 1022 Palisade Court Martinez, CA 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Funeral Expenses Approximtely $5 ,300 Gov. Code Sec. 910:2 provides: "The claim must signed by the claimant SEND NOTICES TO: (Attorney) or by some son on his beha ." Name and Address of Attorney WILLIAM E. GAGEN, JR. - - ---- 0, Gagen, McCoy, McMahon & Armstrong Claimant's Si t, r 279 Front Street 1022 Palisade Court P. O. Box 218 Danville, CA 94526 Address Martinez , CA Telephone No. �-- 0� O S Telephone No. (510) 228-7080 N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or. officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. Claim to: Board of Supervisors of Contra Costa County Page 2. 4. continued: 1 . Amitriptyline, 50 mg (60 tablets) prescribed by Dr. J. Champlin 4/23/94; 2. Amitriptyline, 50 mg (60 tablets) prescribed by Dr. M. Hernandez 3/28/94; 3. Perphenazine, 2 mg .(30 tablets) prescribed by Dr. M. Hernandez 3/28/94; 4 . Diphenhydramine, 25 mg (30 tablets) prescribed by Dr. J. Champlin 4/23/94, CLAIM 1 3 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 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: $Unknown Section 913 and 91S.4. Please note all *warnings",. CLAIMANT: ROWE, Russell Glen ATTORNEY: Joseph Scanlon COUNTY',®UNC-2L Date received MARTINEZCALIF. ADDRESS: 1220 Oakland Blvd., `Ste. 200 BY DELIVERY TO CLERK ON Orrtnbpr 17, 1994 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claim. DATED (% B �x-ei� l'7. l `1 g iq�l �puLyIOR, Clerk ]I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( tom This claim complies substantially with Sections 910 and 910.2. r ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 1S 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/7�4 a/ 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 Boards Order entered in its.ninutes for this dates. �l Dated: N 0 V 8 Im PHIL BATCHELOR, Clerk, Byy. i tQ Deputy Clerk YARNING (Gov. code section 913) subject to certain exceptions, you have only six (6) months from tht date this notice Ms personally served or Wsited in the mail to file A court action On this claim. See Government Code section 945.6. Ow any seek the advice of an attorney of your choice in connection with this matter. If you want to consult n attornty, you Should do so immediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I an now, and at all times herein mentioned, Mve been a citi=en of the Inited States, over age 18; and that today I deposited in the United States Postal Service in Martinez, alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimante addressed to he tlaiannt as Shown above. gated: NOV 919% BY: PHIL BATCHELOR by �� , Q�� Deputy Clerk C: County Counsel County Administrator 1 In the Matter of the Claim of RECEIVED 2 RUSSELL GLEN ROWE, Claimant, 1 �Q� 3 V. off 17 M4 4 COUNTY OF CONTRA COSTA, CALIFORNIA CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 5 6 7 JOSEPH SCANLON hereby presents this claim on behalf of 8 RUSSELL GLEN ROWE to the COUNTY OF CONTRA COSTA, CALIFORNIA 9 pursuant to Section 910 of the California Government Code. 10 The name and address of claimant is: RUSSELL GLEN 11 ROWE, 4250 San Pablo Dam Road, Apartment 17, El Sobrante, 12 California 94808. 13 The post office address to which RUSSELL GLEN ROWE 14 desires notice of this claim to be sent is as follows: LAW 15 OFFICES OF JOSEPH SCANLON, 1220 Oakland Boulevard, Suite 200, 16 Walnut Creek, California 94596. 17 On April 18, 1994, claimant received personal injuries 18 when he was involved in a motor vehicle accident on San Pablo 19 Dam Road, approximately 348 feet east of its intersection with 20 La Colina Road, in an unincorporated section of Contra Costa 21 County, Bay Judicial District, in an area commonly known as "El 22 Sobrante" . 23 The aforementioned public entity is herewith charged 24 with negligent ownership, maintenance, control, use, management, 25 and entrustment of the public street at said location, commonly 26 known as San Pablo Dam Road, in that said entity caused and 27 allowed a dangerous condition to exist, to-wit: persons exiting 28 their driveways on San Pablo Dam Road in the vicinity of the LAW OFFICES OF JOSEPH SCANLON accident, and who first look to their left (believed to be west) 1220 OAKLAND BLVD.,STE.200 WALNUT CREEK,CA 96596 (510)937-4950 I to view oncoming traffic eastbound on San Pablo Dam Road, would 2 encounter several obstructions to their view which did, on the 3 date of the subject accident, prevent the motorist with whom 4 claimant collided from seeing claimant before he (the motorist) 5 exited his driveway at or near 4192 San Pablo Dam Road, and 6 entered said road. Said entity was specifically negligent in 7 allowing automobiles and other vehicles to park along the side 8 of San Pablo Dam Road (believed to be the south side) along 9 which said motorist had to look in order to check for oncoming 10 traffic eastbound on San Pablo Dam Road. 11 It is believed, and based thereon it is alleged, that 12 said motorist's view of claimant was obscured when he checked 13 for traffic before entering San Pablo Dam Road on 14 April 18, 1994, just prior to the subject accident. There were 15 cars parked to said motorist's left along the edge of San Pablo 16 Dam Road as he checked for oncoming traffic before entering San 17 Pablo Dam Road. As a result of the vision obscurements caused 18 by those parked vehicles, said motorist was not enabled to see 19 claimant and thus pulled out in front of him, thinking that the 20 way was clear. As a proximate result of a combination of these 21 circumstances, including said entity's negligence, claimant was 22 unable to avoid colliding with said motorist's vehicle, causing 23 severe bodily injuries to claimant. 24 So far as is known to Joseph Scanlon as of the date of 25 serving this claim, RUSSELL GLEN ROWE has incurred damages in a 26 27 28 LAW OFFICES OF JOSEPH SCANLON 2 1220 OAKLAND BLVD.,STE.200 WALNUT CREEK,CA 90.596 (510)937-4950 1 sufficient amount so that jurisdiction over this matter would 2 lie in Superior Court. 3 4 DATED: October 17, 1994. 5 OSEP SCP&LON 6 Attorney for Claimant RUSSEL GLEN ROWE 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 LAW OFFICES OF JOSEPH SCANLON 3 1220 OAKLAND BLVD.,STE.200 WALNUT CREEK,CA 94590 (510)937-4950 1 , 37 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November18, 1994 Clain, 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 wailed to you is your notice of California Government Codes. ) the action taken on your claims by the Board of Supervisors )(Paragraph IV below). given pursuant to Goverment Code Amount: $579.00 + Tax .Section 913 and 915.4. Please note all •warnings". CLAIMANT: SNYDER, Brian S. COUNTY r_,0L1N L ATTORNEY: MAF1T1Nr=Z CZ1F. Date received ADDRESS: 3019 De Anza Dr. BY DELIVERY TO CLERK ON OctebPr 2.0. 1_994 Richmond, CA 94503 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. J. FROM: Clerk Of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gaIL eATCMELOR. Clerk l DATED: ,�o4( _ _2./7 /C79 s Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 1,1" 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 16 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: ID— BYDeputy County Counsel Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claims was returned as untimely with notice to claimant (Section 911.3). JV. BOARD ORDER: By unanimous vote of the Supervisors present ( v) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:_ . NOV " 8 1994 PHIL BATCHELOR Clerk B ) a ' /�nim • • y- � .v-��X • Deputy Clerk . YARNING (Gov. code section 913) kibject to certain exceptions, you have only six (6) months from the date this notice as personally served or leposited in the mail to file a .court action on this claim. See Goverment Code Section 945.6. lou may seek the advice of an attorney of your choice in connection gith this matter. If you want U consult kin 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 as now, and at all times herein mentioned, have been a citizen of the tnited States, over age 18; and that today i deposited 1n the United States Postal Service in Martinez, :alifornis. postage fully prepaid a certified copy of this Board Order and Notice to Claimant. addressed to the Claimant as shown above. Dated: NOV 9 1994 BY: PHIL BATCHELOR by�s P', JJA Deputy clerk :C: County Counsel County Administrator y Y yJ Qac d C�l , cs ✓ JS M t�r" Clam 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, 19877 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 form RE: Claim By ) Reserved for Clerk's filing stamp Br\'avi S, Snyder RECEIVED Against the County of Contra Costa ) or ) ?� District) Via Fill in name ) CLE, � NTpAOCOS A CO. The The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ -S57 / t?Taxc and in support of this claim represents as follows: 1. When did the damage or injury occur? *(Give exact date and hour) J���n 2 I°I q�{ I ; 30 2. Where did the damage or injury occur? (Include city and count C,�-7 KtaHmand� Inierseci�h �� Park ��-fra� pmoli IJf_P Pr. y d, i 3. How did the damage or injury occur? (Give full details; use extra paper if required)CoNn -` for waS �ai4+ivig wGi+e livt� om 5freef i0hile ed to trq iC .While 0verg a 5 S ra �d a►n hn loss 101ack s�p� rr y wa � y y � .. -- to�birn truck=-------- ----------------------- - ----------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? C"VI WG 5 h D pro erl Usiv1 Okl '-I tS5 5 ra ivy e- v,1`f►M01t Ca,n/Sin a W hi+f_ mk•5t -t D 0 CC Ar, d 5. wnat are the names of county or district officers, servants or employees causing I he damage or injury,? ��I�►oWfl -------------------------------- What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach- two estimates for auto damage. /VeK) -( 9q3 Gloss blgck, irvw-V hqs , wk4e_ ov-r'spra y ovI -►� � O od J wiv,dshi eldJ roc,l cr,,,\d do&- ki _ bc-�k __��s�tn�er_ C�v+�__JoPrf✓?rr'S Sides 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) TaQ oP .ps�iMakc sJ 2 'VX ` -------------------------- ---- ------ -- ---_-------_---------- 8. Names and addresses, of witnesses, doctors and hospitals. Mar Sn yd2r 4ggq• Me�dowbnok Py. elchmor�o( Bri Sy� der 301 q 7e. A-nzix D r. Richv�i 0 V1 �as 5 eM 2r� .9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT _ VQ '� 6q Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: rte,, or b some person on his behalf." .Name and Address of Attorney' Clai s Signature �r Dp Address Telephone No. Telephone No.LSlo ''a-42�3 N O T I C E Section 72 of the Penal Code provides: - "Every person who, with. intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent. claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000),' 6r' 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. t: 60508 Estimate Report NAME DATE / �WORK PHONE HOME PHONE�� 3 i= ADDRESS CITY STATE ZIP YEARUt MAKE MODEL I.D.NO. PAINT CODE ��// PROD.DATE J� TRIM MILE=AGE LICENSE NO. DATE OF LOSS WRITTEN BY�1���W` ',CO. FILE NO. CLAIM NO. P.O.NO ADJUSTER LIC.NO PHONE Deductible/Betterment MVist. ¢ pAaxAft rmat�cbt Nct4 w�� t �►4 Secaj U� xRt+ik .x ,- . µ a 01 1011 3 hA 5 7 - n RAMP. o M3 a 13 y 4 15 r� ON 17 MEN 19 � ,arp x'" ` It I a 4 x i a04WWe 21a s �S`A{ wtfifi rf^f 23 u 25 ❑ DIRECT MAIL ❑ NEWSPAPERS �❑ TEL.DIRECTORY ❑ CUST. REFERRAL ❑ RETURN CUST. ❑ OTHER I hereby authorize the above work and acknowledge receipt of copy. ITOTALS PARTS Prices subject to invoice $ Signed X Date LABOR hrs.@ $ Shop Supplies $ PAINT hrs. $ ® L. T® PAINUNI Nllulm Paint Supplies $ Towing/Storage $ 1410 Stradella Court Sublet/Miscellaneous $ Walnut Creek, CA 94596 EPA/Waste Disposal Charge $ Phone (510) 934-6400 CAD#41917998 $ SUBTOTAL $ FAX # (510) 934-6405 $ B.A.R. #AM129416 TAX............ - ....._. ................. .. $ TOTAL $ 1989 I/D/E/A inc.,One I/D/E/A Way,Caldwell,11 83605-6902•CALL TOLL FREE 1-800-635-9261 Form No,238444.1002Ecustom K& 0 9 100 03AI3338 *H03'elso3 RINIO. p LEE'S.BODY SHOP p Body and Fender Repair and Painting l 1405 STRADELLA,COURT, WALNUT CREEK, CALIFO,6tNIA 94596 PHONE: (510)'934-7681 • FAX:(510)934-407* CONSUMER NO. 16805-. OWNER l SV) ADDRESS+ C) Cy h ! DATE MAKE YEAR ODEL COLOR. IDENTIFICAT)ON NO: 'P" MILEAGE LICENSE NO. �D r9 3 .� ON OF CAR dtEl' kEgS u rece�r�a P/(FiT5 fROPtTOFCAR KEY NRS w PARTS Pi2Ql17©FCAFi. K&1' HR3 ' ±AA1°5 Bumper Headlight Headlr ht Bumper Brid. Parking Light P in L' ht Bumper Guard Fender,Front def`Front Grill Fender MIdg. Fe rtler Mkt . n Grill Guard Wheel,Front Iieb1.From' -, Gravel ShieldHub"&Drum 8 Dru Knuckle DoorFronf4- 7:7--' ro "- Knuckle Sup. Door GI s Ooor Glass Lc fir Cont.Arm Ve ss t Gloss Op.Cant.Arm r M(d • Cross Members Door Handle_ Handle, Front End Center Post Center.Post Tie Rod Door,'Rear Door.`Rear. . Shock Absorbers Door Glass Door Glass Crank Case Vent Glass Vent Glass Steering Wheel Doer MId . 09or Mkt Horn Ring Door Handle r Handle Horn Rocker Panel Rocker Panel Windshield Rocker Mk . Rocker Mid Cowl Floor Floor Quarter Panel" Quarter Panel wa.Q ; -- _. r P np Quarter MkIp.. Quarter M109. Rad.Support Fender,Rear Fender,Rear Rad.Core Fender Mkt . Fender Mld .• Fad.Hose Fender Skirt Fender Skirt Bathe;Sider Funder Shield Fonder Shield BaOle,Upper Tail L' ht Tail Light Baffle,Lower Back-Up Light Bade-Up Light Fan Blade Wheel,Rear Wheel,Rear Fan Beft Hub 8 Drum Hub b Drum Hood Paint Material Paint Material Hood Hinges Hood Mld . REAR OF CAR Ornament Rear Window j Name Plate Bumper Look Plate,Lr. Bumper,Brkt. Lock Plate,Up. Bumper Guard Motor MIS. Gravel Shield Lower Panel Floor MISE.•ITEMS Trunk Lid Top Trunk Hinge Frame Trunk Handle LABORHRS.@ 'IDENTIFICATION• PARTS Springs License Light KEY Seats Tail Pipe PAINTING Tires Gas Tank N NEW TOWING R REPAIR Tubes OH OVERHAUL Hub Caps I A ALIGN TAX 1, .• P `PAINT S SL161-FT TOTA , o 'The above is an estimate basrT; -,our inspection and does not cover additional pars orlabor.which may tu- ,d after work has begun.Occasionally, .e,k is opened up,we discover worn,broken or parts not evident in trs,1—t inspection.Quotations on parts and ire; :umenl and subject to change. ESTIMATED BY �t 'j WORK AUTHORIZED BY ESTIMATE —^TIMw LEE'S BODY SHOP Body and Fender Repair and Painting 1405 STRADELLA COURT, WALNUT CREEK, CALIFORNIA 94596 PHONE: (510)934-7681 • FAX:(510)934-4074 CONSUMER NO. 16805 OWNER ADDRESS DATE 19 MAKE YEAR MODEL COLOR IDENTIFICATION NO. MILEAGE LICENSE NO. ..:;...... .:.::.:.::::::� ..:::..........:::::::::. ;:::: ':: ilii:: s:FFOddFOF.CAR;>::;;:.KEY:.;HRS;::... ARTa........ ::::FRONT F:GAt :>:»:_:K£y,::P iS.... PARTS...............FR01iT:OP:GAR;:;:;;::fS�%? :�3£t3:..:• sere. ::::::: ............................................................ Bumper Headlight Headlight Bumper Brkt. Parking Light 0airking Light Bumper Guard Fender,Front Fender,Front Grill Fender MId . Fender MId . Grill Guard Wheel,Front Wheel,Front Gravel Shield Hub&Drum Hub&Drum Knuckle Door Front Door Front Knuckle Sup. Door Glass Door Glass Lr.Cont.Arm Vent Glass Vent Glass Up.Cont.Arm Door Mk . Door MId . Cross Member Door Handle Door Handle Front End Center Post Center Post Tie Rod Door,Rear Door,Rear Shock Absorbers Door Glass Door Glass Crank Case Vent Glass Vent Glass Steering Wheel Door Mkd . Door Midg. Horn Ring Door Handle Door Handle Horn Rocker Panel Rocker Panel Windshield Rocker Midg. Rocker MId . Cowl Floor Floor Quarter Panel Quarter Panel Water Pump Quarter MId . Quarter Midg. Rad.Support Fender,Rear Fender,Rear Rad.Core Fender Mktg. Fender MId . Rad.Hose Fender Skirt Fender Skirt Baffle,Side Fender Shield Fender Shield Baffle,Upper Tail Light Tail Light Baffle,Lower Back-Up Light Back-Up Light Fan Blade Wheel,Rear Wheel,Rear Fan Bek Hub 8 Drum Hub d Drum Hood Paint Material Paint Material Hood Hinges Hood MId . REAR OF CAR Ornament Rear Window Name Plate Bumper Lock Plate,Lr. Bumper Brit. Lock Plate,Up. Bumper Guard Motor Mis. Gravel Shield Lower Panel Floor M ISC. ITEMS Trunk Lid Top Trunk Hinge Frame Trunk Handle LABOR HRS.@ IDENTIFICATION PARTS Springs License Light KEY PAINTING Seats Tail Pipe Tires Gas Tank N NEW TOWING R REPAIR Tubes OH OVERHAUL Hub Caps A ALIGN TAX P PAINT S SUBLET TOTAL The above is an estimate based on our inspection and does not cover additional pars or labor which may be required after work has begun.Occasionally,when work is opQned up,we discover worn,broken or damaged parts not evident in the first inspection.Quotations on parts and labor are current and subject to change. ESTIMATED BY WORK AUTHORIZED BY ESTIMATE ^ 1 . 37 CLAIM _BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 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 1V below). given pursuant to Government Code Amount: $45,716.09 Section 913 and 015.4. Please note all i n •. ,. , CLAIMANT: XU Ya Lig{ �l ti C` 7 O G T 2 1994 ATTORNEY: Timothy Jaress Law Office OouNTvcouNss4 c/o Timothy Jaress, esq. Date received &I Rr►►vezOAUF. ADDRESS: 1426 Fillmore St. , Ste. 213 BY DELIVERY TO CLERK ON October 25, 1994 San Francisco, CA 94115 October 22, 1994 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED:_ 99 41 gall MputyloR. Clerk NJ ( �J 11. FROM: County Counsel 70: 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 , elaiaant. The Board cannot act for IS 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). I ) Other: Dated: l o — ui-9q BYputy County Counsel 111. FROM: Clerk of the Board 70: 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. . t Other: I certify that this is A true and correct copy of the Board's Order entered in its minutes for this date. Dated: NO Y 819% PHIL BATCHELOR, Clerk, By " a e � . Deputy Clerk YARNING (Gov. code section 913) Object to certain exceptions, you Rave only six (6) months from the date this notice was personally served or leaosited in the mail sn file a court action on this claim. See Government Code Section 945.6. ou may seek the advice of an attorney of your choice in connection With this matter. If you want t0 consult n attorney. you should do so immediately. *For additional warning tee reverse side of this notice. AFFIDAVIT OF MAILING declare under penalty of perjury that I an now, and at all times herein mentioned. Ave been a citizen of the sited States, over age 18; and that today I deposited to the United States Postal Service in Martinez, alifornia. postage fully prepaid a certified copy Of this Board Order end Notice to Claimant, addressed to he tlaiimnt as shown above. NOV ' 9 19N �I ated: By: ►MIL BATCHELOR by �, , l,NA,A .Q Q a Otputy Clerk t: County Counsel County Administrator y M rA l Y -rA ., NQQ V ta � O Cd A low vrA , W N d U r WO U LL O U 4 � r N • l C a:- to: BOAP1) OF S'.JPERVISORS OF CONTRA COSTA COUM INSTRUCTIONS TO CLADOWT A. Clai.=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 wfiich 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 accusal 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 Co=ty, the name of the Distriot 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 Seo. 72 at the end of this fO:w. RE: Claim By } Reserved for Clerk's filing stamp YA LI XU ) _ RECEIVE AgainsE the County of tra Costa ) or ) OCT .2 51994 District) vr� Fi in name ) CLERK 130A R OF SUP Co fSORS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum Of $ 4 5 . 7 i h .n g and in support of this claim represents as follows 1. When did the damage or injury occur? '(Give exact date and hour) On May 1, 1994 Sunday at 8: 35 p.m. 2. Where did the damage or injury occur? (Include olty and county) San Pablo Dam Road, Unincorporated county of Contra Costa 3.. Now did the damage or injury occur? (Give full details; use extra paper if required) Claimant was injured when her auto struck a concrete drain on the shoulder of San Pablo .Dam Road in Unincorporated Contra Costa County, State of California. Claimant alleges that the concrete drain was negligently designed, constructed & maintained. and provided insufficiant . 4. What particular act or omission on the part of county or district officers, 0"Va_l_,_ servants or employees caused the injury or damage? Same as answer line #3 �. wnaL are the r?.ves of county or district ofxicers, servants or employees causing or in,jure,? Unincorporated, county of Contra Costa --rrrw.-------..r ---r.---- What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Head, neck and -back injuries rw•w�.r�+.rsr.rr4•�..�wrr�rr...��r� w�.rti�.�r��..r�+r•�.r�.���. 7. Now was the amount claimed above oomputed? (Include the estimated amount of any prospective injury or damage.) property damage $101-71fi .09 Personal injury. $35,000 .00 Tota)_ $45 , 716 .09 Mir++.rrrrrrrrrrrr...rrrr+�..rr.rww.w rrrrrwr..ww S. Names and addresses of witnesses, doctors and ho�p� t�l . American Medical Response West, P.O. Box remont, CA 94537-7780 Tri-City Imaging 2191 Mowry Ave. , Suite 500 H, Fremont, CA 94538 East Bay Neurological Medical Group, Inc. , 2191 Mowry Ave. , #500G Fremont, CA 94538 9. List the expenditures you made an aocount of this aoeident or injury: DATE ITEM AMW . N/A e e e e e e d e e . * * * a e e e -e e.a e r e e a e s +� • * e !t a �► R * e a u a► e Gov. Code Sec. 910:2 provides: f1he claim must be signed by the claimant SEND NOTICES TO: (Attorney) orlx some mson on his behalf." Name ang Address of Attorney Timothy Jaress LAW Office f 1426 Fillmor St. , Ste 213 Claimants Signature Timothy Jaress ,esc San Francisco, CA 94115 684 48th Ave 303 , San Francisco, CA 94121 Telephone No. (415) 346-355 2 Telephone No. (415) 387-1604 iiFpItA # iA -Ir V V NOTICE Section 72 of the Penal Code providesa - - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, oity 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 loth such iTprisonvvent and fine. Tf1T.^.1 G i'i? AMENDED 377 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 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: $150,000.00 Section 913 and 915.6. please note all OMa min CLAIMANT: PENDLETON, Jane OCT ATTORNEY: James Dalbon COUNTY COUNSEL Date received MARTiNezCgLIF. ADDRESS: 543 41st Ave. BY DELIVERY TO CLERK ON October 21, 1994 San Francisco, CA 94121 BY WAIL POSTMARKED: Hand Delivered via: County Counsel 1. FROM: Clerk of the Board of Supervisors '70: County Counsel Attached is a copy of the above-noted claim. IL ATCMELDR. Clerk 9 pp DATED: (► .o�� c . / / 9 �q: Deputy JI. FROM: County Counsel TO: Clerk of the Board of Supervisors ( vrThis claim complies substantially with Sections 910 and 910.2. r ( ) 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 claire nt's right to apply for leave to present a late claim (Section 911.3). Other: Dated: �f 2,4 I Cis( BY: 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. . t ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: lOV 1"8 0'_� ' PHIL BATCHELOR, clerk, ly \J Deputy Clerk YARNING (6ov. code section 913) subject to certain exceptions, you have only six (6) months from the date this notice was personally served or leposited in the mail to file a court action on this claim. See Government Code Section 965.6. ray may Seek the advice of an attorney of your choice in connection with this waiter. If you wantto consult kn attorney, you should do so immediately. *For additional warnino see reverse side of this notice. AFFIDAVIT OF NAILING I declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the inited States. over age 18: and that today i deposited in the united States Postal Service in Martinez, :alifornia. postage fully prepaid a certified copy of this Board Ober and Notice to Claimant, addressed to the claimant as shown above. )Ited: NOV 9 IM By: PHIL BATCHELOR byDeputy Clerk .C: t0unty Counsel County Administrator C t; C v� f o J � d � cn d. d �, N CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: October 7, 1994 TO: Jeanne Maglio, Clerk of the Board of Supervisors FROM: victor J. Westman, County Counsel By: Brandon Baum, Deputy County Counsel VV RE: Claim of Jane Pendleton Please treat this letter as an amended claim. E EIVED 110 OF SUPEIMSORS COSTA CO. James Dal Bon Attorney At Law 543 41 st Ave. San Francisco, CA 94121 QrT I i; ls;9 (415) 221-1271 MARTINEZ C,WLIF. October 17th, 1994 Victor Westman County Counsel Contra Costa County P.O. Box 69 Martinez, CA 94553 Re: Jane Pendleton vs. Contra Costa County Sheriff ' s Department Dear Mr. Westman Esq. , On October 7th, 1994 your office received a government claim form for personal injuries from Jane Pendleton. The claim was rejected on the basis of sufficiency. The rejection letter was sent to the plaintiff on the same day and requested more specificity on dates of occurrence. The note also requested that the claim be signed by the plaintiff or her representative. This letter is to correct any insufficiencies contained in the original government claim form submitted by the plaintiff. Additionally, I hope to open up settlement negotiations between the plaintiff and Contra Costa County. I am confident that this dispute can be negotiated without filing a suit in civil court. First, in response to question number three in your Notice of Insufficiency of a Claim (See photocopy attached) , plaintiff filed her complaint with the Americans with Disabilities Act on May 6th, 1994 with the Equal Opportunity Employment Commission. The plaintiff ' s pay was reduced by 5% on June 13th, 1994 by Tom Lambert. On July 1st, 1994, Lisa Ward, the plaintiff 's supervisor apparently publicly blamed the plaintiff for the excess overtime amongst the dispatchers. The matter is allegedly being investigated by the sheriff ' s department. Secondly in response to question number six, I have included a copy of the original claim signed by myself on behalf of the client. Please call me at your convenience to commence settlement negotiations. .RECEIVED Anes cerely,,W4OCT 21 CLERK BOARDOFS PERVISORDal Bon S CONTRA COSTA CO. Clam: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp .Tana Panril ai-nn ) RECEIVED Against the County of Contra Costa ) or ) OCT 2 1 1994 District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 1r;n _ 000. 00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) May 1994 and continuing 2. Where did the damage or injury occur? (Include city and county) 40 Glacier dr. Contra Costa County . Martinez, CA 94553 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEE ATTACHED 4. What particular act or omission on the part of county or district officers, se-rvants or employees caused the injury or damage? SEE ATTACHED �OVC^� WnaL are tne names of county or district officers, servants or employees causing the tan;age or injury? Assistant Sheriff Rodger .Davis, Captain Simmons, Lt. Lambert. Tom' Young, Gloria Sutter, Lisa Ward and Joanne Earle. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. SEE ATTACHED ..r..._...»..—_.._.___--____..__ ..�_.�»__�..._,,_ _ 7. --------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) SEE -ATTACHED 8. Names and addresses of witnesses, doctors and hospitals. SEE ATTACHED 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.-2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some -half." Name and Address of Attorney ,person on his be James Dalbon (Claimant's Signature) 543 41st Ave. San Francisco, CA 427 Sage Ct. 94121 (Address) Benicia, -CA 94510 Telephone No. (415 221 -2479 Telephone No. ( 707) 745-8620 V T-V 9 1 1 1 T V NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance orfor 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, voucheri 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 impriso-runpent and fine. 3. For information on how the damage or injury occurred, please refer to #4 section below. 4. May 1994 - Disabled people in the office are blamed for excess overtime by the supervisor on duty. Two weeks after filing an Americans with Disabilities claim against Contra Costa County my salary was cut by 5% for a period of six months following a minor complaint that occurred two months prior. June 1994 - The Sheriff ' s Department notified me that they will not accept my disability restrictions and have ordered me to have my doctor prescribe a release for me to work shift work again. Without the release I am told I will not be allowed to work my assigned shift. The department could have accomodated my disability but the lieutenant said he was unwilling to do so. Based on past practice I have had the seniority to work dayshift for over five years. During a conversation with Assistant Sheriff Rodger Davis I was told that the department could not make an exception for me or they would have to make exceptions for everyone else. In his letter of 21 June he explained that the department could no longer accommodate my medical restriction. When asked what this meant he replied they no longer would have a position for me. Written up by Supervisor Ward for wearing cologne. This was retaliation against me having filed an ADA claim against the county. July 1994 - I am informed and believe I was publicly criticized and blamed for the excess overtime. Approximatley one week later I met with bureau manager Gloria Sutter to discuss this incident. She stated there was nothing she could do to rectify it and that she was dealing with it. August 1994 - I met with Gloria again to express concerns regarding treatment being received from co-workers. It was explained that the July incident was still being investigated and other employees were probably angry with me because I don't work overtime. She asked if I wished her to bring everyone in and ask them to be nice to Jane: I responded that would only make things worse and she agreed. After I left her office she brought each employee in, spoke with them, and then called me back in to explain that the concensus of the room was that it was my problem. Supervisor pulled me off the floor to criticize me for not answering a 911 line on the fourth. ring. I was on a non- emergency line at the time. Five other dispatchers were on duty at the time, not all were on emergency lines. Nobody else was talked to regarding this incident. September 1994 - Administration informed me they won' t accommodate me. 6 & 7. Defamation $25,000.00 Invasion of privacy 25, 000.00 False light 25, 000.00 Intentional infliction emotional distress 25, 000.00 Negligent infliction emotional distress 25, 000.00 Tortious violation of public policy 25, 000.00 $ 150, 000.00 8. Dr. Lantz Dr. Sankary 2160 Appian Way #200 Doctors Hospital Pinole, CA 94564 2151 Appian Way Pinole, CA 94564 Dr. Nino-Murcia (deceased) 795 San Antonio Rd. Palo Alto, CA 94303 OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR. COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2041 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ October 7, 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Jane Pendleton c/o James Dalbon 543 41St Avenue San Francisco, CA 94121 RE: CLAIM OF: Jane Pendleton 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. [X] 3 . The claim fails to state the exact date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. Please be as precise as possible regarding the dates of occurrence, including the date your pay was allegedly cut and the date you file your ADA claim. 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. U 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. [X] 6 . The claim is not signed by the claimant or by some person on is behalf. (1 7 . Other: VICTOR J. WESTMAN, County Counsel By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence code §§ 641, 664) I declare that my business address is the County Counsel's office of contra Costa County, 651 Pine street, Martinez, California 94553; 1 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: October 7, 1994 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) Pro" Amended I -37 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November- 8 1994 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 wiled to you is your notice of California Government Code's. 1 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 91S.4. Please note all •mornings". CLAIMANT: SESSION, Dwight ATTORNEY: G T 2 4 1e��r Date received cor�T-Y COUNSEL ADDRESS: 1073 Shoreview Ct. BY DELIVERY TO CLERK ON October 24,mTWZCAL1F. Bay Point, CA 94565 BY MAIL POSTMARKED: October 21 , 1994 2. FROM: Clerk Of the Board of Supervisors -10: County Counsel Attached is a copy of the above-noted claim. /�, ;4 � � q`� pp Il ATCMELOR. Clerk DATED:— (�'/(� d-�.�¢.t� dq: �puty_ 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( If 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: /0--Ly BY: ( Deputy County Counsel Ill. 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. WU ORDER: By unanimous vote of the Supervisors present {XThis Claim is reftcttd in full. j ) J)"er: I certify that this is a true and correct COPY Of the Board's order entered in its Minutes for this date. Dated: N®v 8 PHIL BATCHELDR, Clerk, By ja,d 0�®� . Deputy Clerk YARNING (Gov. code section 913) subject to certain exceptions, you have O"ly six (6) months from the date this notice was personally served or faaosited in the mail to file a court action on this claim. See Government Code Section 945.6. 'Du may seek the advice of an attorney of your choice in connection Kith this utter. if you want to consult IT' attorney, you should do So Immediately. *For additional warning see reverse side of this notice. AFFIDAVIT OF MAILING f Declare under penalty of perjury that I an now, and at ali times herein mentioned, have been a citizen of the inited States, over age 18; and that today I deposited to the United States Postal Service in wrtinei, Alifornia. postage fully prepaid a certified Copy of this Board order and Notice to Claiunt, addressed to ;he t?aimsnt as shown above. Med: NOV 9 IT: PHIL BATCHELOR by ;r� n n ��5[-�.�Otputy Clem .C: tognty Counsel County Administrator I PF. � t 1� i {o. � Q 7 > W c LL �i O LL 1 Mr. Dwight. Session 2 5535 Giant Highway 3 Richmond,Ca. 94806 4 5 6 7 8 9 DWIGHT SESSION ) 10 ) 11 Plaintiff 1 12 ) 13 V. ) 14 ) 15 County of Contra Costa, ) 16 Contra Costa County Public Defenders ) 17 Office and ) 18 Evangiline Brown ) 19 ) 20 Defendant(s) ) 21 ) 22 23 24 25 26 27 The undersigned claimant makes claim against tree County of Contra 28 Costa or the above-named District in the sum of $500 , 000. 00 and 29 in support of this claim represents as follows : 30 --------------------------------------------------------------- 31 1 . When did damage or injury occur? (Give exact date and hour) 32 33- August 16, 1994 and thereafter. 34 35 2 . Where did damage or injury occur? ( Include city and county) 36 37 Martinez, California. Contra Costa County. 38 39 3 . How did the damage or injury occur? (Give full details ; use 40 extra paper if required) . 41 42 Mal-intent, Malpractive, Malfeasance by breach of 43 duties by Public Defender. 44 45 46 4. What particular act or omission on the part of county or 47 district officers, servants or employees caused the injury or 48 damage? 49 A. Failure to consolidate cases as she represented she 50 had. 51 B. Disclosure of information prejudicial to client by 52 Public Defender 1 1 2 3 5. What are the names of county . or district officers, servants or- o employees causing the damage or injury? 5 6 Evangeline Brown 7 8 6 . What damage or injury do you claim resulted? (Give Full extent 9 of injuries or damage claimed. Attach two estimates for auto, 10 damage. 11 Loss of Freedom, Loss of rights , Violation of all due 12 process , Delay in Release from custody. 13 14 7 . How was the amount claimed above computed? ( Include the 15 estimated amount of ant prospective injury or damage. ) 16 17 $500.000.00 General Damages, Stress Aggravation, 18 Mental Stress 19 20, 8 . Names and addresses of witnesses , doctors and hospitals. 21 22 Not currently Ascertained 23 24 9 . List the expenditures you made on account of this injury: 25 Date Item Amount 26 27 Not Currently Ascertained 28 Gov. Code Sec. 910. 2 provides: 29 "The claim must be signed by 30 the claimant or by some other 31 perso onis behal . 32 � t 33 SEND NOTICE TO DWIGHT SESSION 34 1073 Shoreview Ct. Dw' t Session 35 Bay Point Ca. 94565 36 37 38 NAME AND ADDRESS OF CLAIMANT 39 MR. DWIGHT SESSION 40 West County Detention Facility (C1 (ynt' s Signature ) 41 5535 Giant Highway 42 Richmond, Ca. 94806 43 44 45 46 47 48 49 50 51 52 2 1 2 3 4 5 NOTICE 6 7 erection 72 of the Penal Code provides: 8 9 "Every person who, with the intent to defraud, presents fol- 10 allowance or for payment to ant state board or officer, or to any 11 county, city or district board or officer, authorized to allow or 12 pay the same if genuine, any false or fraudulent claim, bill , 13 account, voucher, or writing, is punishable either by 14 imprisonment in the county jail for a period of not more then one 15 ( 1 ) year, by fine of not exceeding one ( 1 ) thousand ($1, 000 ) , or 16 by both such imprisonment and fine, or by imprisonment in the 17 state prison, by fine of not exceeding ten( 10 ) thousand dollars 18 ( $10 , 000 , or by both imprisonment and fine. 3 Mr. Dwight Session 5535 Giant Highway Richmond,Calif . 94806 October 3 , 1994 Board of Supervisors (Clerk) County Administration Building Room 106 651 Pine street Martinez, Calif 94553 RE: Dwight session 90 Day Letter. County Clerk; Please be advised that it is my intention to file a Civil Action for legal Malpractice against Ms. Enavgiline Brown and the Contra Costa County Public_ Defenders Office, for Negligence and Malfeasance in the handling of my legal matters in Delta Judicial District Municipal Court Docket Number, 04- 886697 , 04088547-9, 04-087375-2 Warnt. and 91216-2 . The filing of this action of damages will occur within ninety ( 90 ) day' s of the date of this letter. Please tender this matter to your professional errors and omission insurance carriers so that settlement negotiations can be initiated. RESPECTFULLY SUBMITTED MR. DWIGHT SESSION i } OFFICE OF COUNTY COUNSEL DEPUTIES. CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY `• VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHESI TELEPHONE (510) 646-2041 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ October 24 , 1994 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Dwight Session West County Detention Facility 5535 Giant Highway Richmond, CA 94806 RE: CLAIM OF: Dwight Session 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. [X] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. Please elaborate in greater detail regarding the "failure to consolidate cases as she represented she had", as well as the "disclosure of information prejudicial to client. " We need this information to evaluate the claim. [] 4 . The claim fails to state the name (s) of the public employee (s) causing the injury, damage, or loss, if known. [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less 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. [X] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 7 . Other: VICTOR J. WESTMAN, County Counsel By: � a -�---- Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code §§ 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: October 24, 1994 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE H 910, 910.2, 920.4, 910.8) S46 bd LU _ ujco, CO � w N o o LU o c O .q cc z oo m 0 � tr chi !; fN LC]LA N O O 4 Q ro _� to co 5 o `Z 4> 0 0 L I CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 8, 1994 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 Wiled to you is your notice of California Government Codes. 1 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 •w ings,:�<- CLAIMANT: SESSION, Dwight ATTORNEY: west County Detention Facility Date received COUNTY MARTINEZCALIF. EZC CALIF. ADDRESS: 5535 Giant Highway BY DELIVERY TO CLERK ON nrtnher 7.1 1994 Richmond, CA 94806 BY MAIL POSTMARKED: Hand mel iverec3 via: Risk MgMt. J. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppM ll eATCMELOR, Clerk DATED: A .� a/. 199 a1: Dtputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. , (%4 This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Bard 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). t ) other: Dated: Ol �f�y BY: Deputy County Counsel 111. FROM: Clerk of the Board 70: 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. t 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 Deputy Clerk YARNING (Gov. code section 913) 6ubjeCt to certain exceptions, you have only six (6) months from the date this notice was personally served or Ileposited in the mail to file a court action on this claim. See 6overnment Code Section 945.6. rou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult in attorney, you Should do so iwaediately. *For additional warning see reverse side ofthis notice. AFFIDAVIT of MAILING i declare under penalty of perjury that I amu now, and At all times herein mentioned, have been a citizen of the Ih+ited States, over age 18; and that today i deposited 1n 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 tlaixiant as shown above. Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: tounty.Counsel County Administrator r � t F - , tX1 , �a � � � v . ; a ,a cr 0 Go ,0 oll v cY+ qq 3�p s i ` CONFIDENTIAL COUNTY COUNSEL'S OFFICE CONTRA' COSTA COUNTY MARTINEZ, CALIFORNIA MEMORANDUM Date: October 7, 1994 TO: Jeanne Maglio, Clerk of the Board of Supervisors FROM: Victor J. Westman, County Counsel By: Brandon Baum, Deputy County Counsel "631 RE: Claim of Dwight Session(s) Please treat this letter as a claim. I believe we have already received an identical claim from this individual . RECEIVED OCT 2104 CLERKOBOARD NTRA COSTARS �.. .�a, -6 OC r NY. Dwight Session 0,`2 1994 553: Giant Highway Ri.chmond,Calif . 94806 MARTINEZ BRANCH UFFICF. OF THE PUBLIC DEFENDER October 3 , 1994 �.....� �u�G�TFrA (;;jg COUNTY PUBLIC DEFENDERS OFFICE 610 COURT STREET MARTINEZ,CA. 9455' OCT F'• ttyf6a COUNTY RE. Dwight Session 90 Day Letter. Dear Sir; Please be advised that it is my intention to file a Civil Action for legal Malpractice against Ms. Evang,il ine Brown and the Contra Costa County Pub3 is Defenders Office, for Negligence and Misfeasance in the handling of my legal matters in Delta Judicial District Municipal Court Docket Numbers,04-886697,04-088547-9,04- 087375-2 War, and 91216-2. The filing if this action for damages will occur within ninety ( 90) day's of the: date of this letter. Please tender this: matter to your professional errors and omissions insurance carrier so that settlement negotiations can be initiated. RESPECTFULLY ;�SIBMITTEL� CEI OCT 2 1 X994 �` UPERVISORS CLERK BOARD OF CONTRA COSTA CO- I Mr. Dwight Session 2 5.535 Giant Highway 3 Richmond,Ca. 94806 4 5 6 7 8 9 Dwight Session ) 10 ) 11 Plaintiff ) 12 ) 13 V. ) 14 ) 15 County of Contra Costa, ) 16 Contra County Public Defenders Office ) 17 and ) 18 Evangiline Brown ) 19 ) 20 Defendant ) 21 ) 22 23 24 25 26 27 The undersigned claimant makes claim against the County of Contra 28 Costa or the above-named District in the sum of : 500. 000.00 and 29 in support of this claim represents as follows: 30 -------------------------------------------------------------- 31 1 . When did damage or injury occur? (Give exact date and hour) 32 33 August 16,1994 and thereafter. 34 35 2. Where did damage or injury occur? ( Include city and county) 36 37 Martinez, Ca. Contra Costa County. 38 39 3 . How did the damage or injury occur? (Give full details; use 40 extra paper if required) . 41 42 Mal-intent, Malpractice, Malfeasance by breach of duties 43 by Public Defender. 44 45 4. What particular act or omission on the part of county or 46 district officers, servants or employees caused the injury or 47 damage? 48 49 A. Failure to consolidate cases as she represented she 50 had. 51 B. Disclosure of information prejudicial to client by 52 public Defender. 53 54 5. What are the names of county or district officers , servants or 1 employees causing the damage or injury? 2 3 Evangiline Brown 4 5 6 . What damage or injury do you claim resulted? (Give Full extent 6 of injuries or damage claimed. Attach two estimates for auto 7 damage. 8 Loss of freedom, Loss of rights, Violation of all due 9 process, Delay in release from custody. 10 11 7 . How was the amount claimed above computed? ( Include the 12 estimated amount of ant prospective injury or damage. ) 13 14 $500.000.00 General Damages, Stress Aggravation, Mental 15 stress. 16 17 18 8 . Names and addresses of witnesses, doctors and hospitals. 19 20 Not currently Ascertained 21 22 9. List the expenditures you made on account of this injury: 23 Date Item Amount 24 25 Not Currently Ascertained 26 27 Gov. Code Sec. 910.2 provides: 28 "The claim must be signed by 29 the claimant or by some other 30 person on his behalf. 31 32 SEND NOTICE TO :ATTORNEY 33 34 35 NAME AND ADDRESS OF CLAIMANT 36 Mr. Dwight Session 37 West County Detention Facility (Claimant' s Signature) 38 5535 Giant Highway 39 Richmond, Ca. 94806 40 41 42 43 44 45 NOTICE 46 47 Section 72 of the Penal Code provides: 48 49 "Every person who, with the intent to defraud, presents for 50 allowance or for payment to ant state board or officer, or to any 51 county, city or district board or officer, authorized to allow or 52 pay the same if genuine, any false or fraudulent claim, bill, 53 account, voucher, or writing, is punishable either by 54 imprisonment in the county jail for a period of not more then one 1 ( 1 ) year, by fine of not exceeding one ( 1 ) thousand ( $1 ,000 ) , or 2 by both such imprisonment and fine , or by imprisonment in the 3 state prison, by fine of not exceeding ten( 10 ) thousand dollars 4 ($10 ,000 , or by both imprisonment and fine.