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HomeMy WebLinkAboutMINUTES - 02141995 - 1.17 CLAIM i� !DART) OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA t+ (� February 14, 1995 r 1 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: Unknown Section 913 and 915.4. Please note all •Warnings". CLAIMANT: Steve Ray/ Mrs. Charlie Ohlson , � 1� ATTORNEY: - JAN 17 1995 Date received COUNTY COUNSEL ADDRESS: 1337 N. Curson Ave. #10 BY DELIVERY TO CLERK ON January Ig1MTr rwALIF. Los Angeles, CA 90046 BY MAIL POSTMARKED: January 12, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHELOR, Clerk � l DATED: January 17. 1995 �d: Deputy , . 11. FROM: County Counsel TO: Clerk of the Board of Supervisors { ) 'This claim complies substantially with Sections 910 and 910.2. ( his 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). {y'"Other: f ItAeAL-_ 'R.OAU.. Dated: f /�" ! Jr— BY: Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 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. 14199 Dated: PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the Claimant as shown above. Dated: FEB 15 1 BY: PHIL BATCHELOR b &,,'0y.,1puty Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF .+ I; SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY `•tea- 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 January 18, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Steve Ray/Mrs . Charlie Ohlson 1137 N. Curson Ave. #10 Los Angeles, CA 90046 RE: CLAIM OF: Steve Ray/Mrs . Charlie Ohlson 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. [] 3 . The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [] 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: *,�� //�-� eputy 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: January 18, 1995 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) Claim to: BOARD OF SUPERVISORS OF CONTRA COMA COMUY INSTRUCTIONS TO CLAIKPM A. Claims relating to causes of action for death or for injury --o person or to per- sonal property or growing crops and Mich accrue on or before December 31, 19879 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, 19889 must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims mint 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 's 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, *epai°ate claims mst be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this eees • e • e • • • • aesss • eesef • • efaeesesaf • • ffeese RE: Claim By ) Reserved for Clerk's filing stamp Stere Ray / Mrs. Charlie Ohlson ) j RECEIVED Against the County of Contra Costa ) or ) JAN. 1 7 1995 Brcoksi.de flos ital District) (Filln name ) CLERK BOARD OF SUPERVISORS 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) August 12, 1994(2�0a.m,,) 2. Where did the damage or injury occur? (Include city and county) Where: Brookside Hospital. City; San Pablo County: Contra Costa 3. How did the damage or injury occur? (Give i1:11 detailgi use extra paper if required) See attached. sheets. A. What particular act or omission on the part of county er district officers, servants or employees caused the injury or damage? Neglect of patient. (over) 5. What are the names of ,county or district officers, servants our employees causing the damage or injury? Are as follows: 1. Brookside Hospital. 2. Dr. Robert Herrick(net:rologi.st) Dr. Robert 3. Hayder. (primary) and hospital nursing staff 'on duty the morning the doth cx`c axw_ b. What damage or injuries do you claim resulted? (Give lull extent of injuries or damages claimed. Attach two estimates for auto damage. Death of mother. (see attached sheets as required for 3.) Heath of mother. q. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) S. Names and addresses of Witnesses, doctors and hospitals. 1. Steve Ray -- 1337 N. Curscn ave. #10 . Los Angeles, Ca. 90046 2. Mrs. Charlie Ohlson -- 127 Baro Vista Ave. #309. Piedmont, Ca. 94611 3., Mrs. Rosemary Thanpscn =-840 Taper St. Vallejo, Ca 94595 9. List the expenditures you made on account of this accident or injury: WE IM 8/12/94 Fuller Funeral Herne $1800.00 R 8/16/94 Rollin Hills $1200.00 $3000.00 Gov. Code Sec. 910.2 provides: the SEND NOTICES TO: (Attornev) or aby csome �soneonignedhis �lf."claimant Name and Address of Attorney (Claimant's gna ure (Address) 1337 N. Corson Ave. #10. B Los Anc,,eles, Ca. 90046 Telephone No. Telephone No. 213/ 876-0420 or. 310/ 282-2950 2 0 T I C E Section 72 of the Penal Code provides: "Every person who, With intent to defraud, presents for alloWanee 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 waiting, 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. 3. CONSUMER COMPLAINT JULY 31, 1994 3: 30 p.m. Earlene Jackson was discovered in her apartment by her daughter, Charlie Ohlson and her son-in-law, Curtis Ohlson. When the para- medics arrived, it was discovered that Jackson had a stroke. Mrs. Ohlson instructed them to take her mother to Alta Bates Hospital in Berkeley. The paramedics told her by law they had to take her to the nearest hospital, which was Brookside. Mrs. Ohlson explained that she didn't know anything about Brookside and that Alta Bates was her mother's hospital. When the ambulance arrived at Brookside, Jackson was admitted to emergency. While she, her daughter and son- in-law waited for a doctor, Mr. Ohlson, a musician told his wife he had to make an important call regarding his profession. A doctor waiting on a patient, overheard Ohlson's discussion with his wife, and immediately left his patient. He approached Ohlson and started discussing music. He looked down at Jackson and said, "Man she's really in bad condition. " This comment was made without any examination on his part. At this point, Mrs. Ohlson said she had a bad feeling about the hospital. AUGUST 1, 1994 Mrs. Ohlson's brother, Steve Ray, arrived from Los Angeles immediately after hearing about his mother on the night of July 31st. At 10a.m. , Mr. Ray was introduced to Dr. Robert Hayden his mother's primary doctor. Hayden explained to Ray and Mrs. Ohlson, the condition of their mother, which he said wasn't good. He told them he didn't see any way she would possibly make it through the (98hr. ) period it usually takes for a stroke victim to make it through the danger period. In short, he said, "Your mother will die. " Hayden continued, "Even if she survived, you wouldn't want her to live, at least not like that. I was up against a situation similar to this with my own mother, and I told the doctors to let her die. Hearing this, Ohlson removed herself immediately running to the woman's room in tears. Ray asked if there was anything that could save his mother, such as time, and was told no by doctor Hayden. Ray asked Hayden if he were sure that his mother would die, this time the doctor could not confirm what he had just said. When Ohlson returned, doctor Hayden told them their mother's neurologist would be a Dr. Robert Herrick. Hayden told them that Dr. Herrick tends to talk down to patients and their families not really explaining to the what they need to know. After their meeting with doctor Hayden, Ray went upstairs to intensive Care to be with his mother who was unconscious. At this point, Jackson was not on any type of life support. While he was in his mother's room, Ray noticed a syringe on the floor, there was no one around at the time, so he returned his attention to his mother. AUGUST 2, 1994 Ray returned to visit his mother and noticed the syringe had not been removed. This time Ray confronted his mother's nurse as she stepped in, and she replied, "Oh, now how'd that get there. "Like his sister, Ray began to have a bad feeling about the hospital. AUGUST 4, 1994 When Ray visited his mother it was about ila.m. When he stepped into her room, there next her bed was a (6) foot ladder. Not feeling comfortable about the location of the ladder which was in falling distance of his mother's face, Ray asked her nurse if it were necessary for the ladder to be there. The nurse told him a technician was working on the room's air conditioning and that he'd be finish in a moment. After spending time with his mother, Ray left with plans to return that evening. When Ray returned, with his other sister, Rosemary Thompson, the ladder was still in his mother's room near her bed. With no nurse in sight to inquire the whereabouts of a technician, Ray and Thompson took it upon themselves to move the ladder into the hallway away from their mother. AUGUST 5, 1994 At this point, both doctor, Herrick and Hayden didn't feel Jackson had shown any improvement. All of Jackson's children inquired every day regarding their mother's condition. At one point, Hayden told Ray his mother would need a by-pass procedure for a cloth. A moment later Hayden returned and said no he was wrong about the procedure and left. He returned again telling Ray about another procedure then left returning again explaining he was wrong again. At this point Ray was afraid for his mother's life. When Jackson made it through what determined to be the 'danger period by both doctors, she was moved out of Intensive Care to the forth floor where she would receive primary care. Before she was moved, a nurse in Intensive Care explained to Jackson's children that things would be a little different for their mother in terms of her care. "Now the nurses on the forth floor won't be that quick as we are here. You might have to get blankets for you mother and turn her over yourselves. Get to know your mother's nurses. Because their mother's life was precious to them, Jackson's children had no problem with those demands.However, they didn't feel that their mother's care was important as far as her doctors and some of the hospital staff were concerned.Not a day went by where they didn't hear from a nurse are a member of the hospital social services who would tell them to let their mother die with dignity or starve to death. Ray would have to remind them that his mother wasn't on life support. Even her doctors seem to not really care, it was as if they'd given up on her. Ray and his sisters immediately started to investigate other facilities for their mother. Alta Bates was still a consideration, however they were told that the level of their mother's condition was beyond hospital care and the she should be admitted to a nursing facility. During this time, Ray was approached by a nurse at Brookside who asked, "Are you trying to keep your mother alive for you are do you want her to die with dignity. " Hearing this Ray realized that he had to get his mother out of this hospital if she were going to have a chance for survival. He had heard of many people who were actually worst off than his mother who beat the odds because they had people around them who were positive about living. Alta Bates Hospital has a motto, through Ray's head throughout his mother's ordeal, "Life Is A Team Effort. " Unfortunately,that didn't hold true at Brookside. A woman who was a supervisor in the hospital's social service's department also told Ray and his sisters to let their mother die with dignity which is what she did with her mother. Ray replied, I can't understand why you people are more concern with letting people die than giving them a chance to live. My mother is not on life support, she has a strong and healthy heart along with a strong will to survive. In Intensive Care, a nurse looked at Jackson and then at Ray and replied, " I don't understand it, your mother looks healthy, she doesn't smoke, drink nor is she overweight,technically speaking, she shouldn't of had a stroke. When doctor Herrick approached Ray on one of his visits telling him if his mother's condition he was going to 'No Code' her, Ray had no idea what the doctor was talking about. Herrick just pat Ray on the shoulder and walked away not explaining what he meant. Every morning Ray or either one of his sisters would call the hospital, before they'd visit to find out the condition of their mother. At the same time, one are two would be out trying to find a facility for Jackson as well. The also kept in contact with her doctors daily. Then something happened unexpected, Jackson started to show a slight improvement from the usual. She'd opened her eyes and was now in a conscious state. Although she couldn't speak (Aphasia) she could understand certain things. The nurses said they were even shocked by the change in her condition. A nurse approached Ray and said, "I'm not only impressed with your mother's change, but the way your family sticks together and supports her, you know,that's really what she needs to help her more than anything. Doctor Hayden said he couldn't explain why their mother showed a remarkable improvement but even he had to agree that it was a far cry from the woman he said would not make it through a week. When asked about her scan, doctor Hayden said he didn't take much stock in scans that they can't tell you everything. Thompson's response was, this is from a man who said I was over-religious when I would tell him my mother is being watched by God. Jackson shared her room with another woman on the forth floor. when the woman was released, she Thompson, "I 'm getting the hell out of this death trap, and you'd be smart to get your mother out of here. I 'm going to Highland Hospital. " When Jackson was admitted into the Hospital, Hayden told the family that he was giving her steroids to reduce the swelling of the brain. At this time, he said he was going to reduce her intake. AUGUST 11, 1994 At 9:00 a.m. , Ray received a call from Brookside discharge. A representative said she was making arrangements for Jackson to be admitted into a nursing facility in Oakland. The representative told Ray his sister, Ohlson, made the arrangements and Brookside cleared it. Ray immediately called his sister, on her job to confirm. Ohlson said yes she had found the facility the evening before. Ray told his sister he was going to call a number which would give him a rating on the facility. The Representative from Brookside told Ray that if his mother wasn't discharged she'd be moved to the sixth floor to the hospitals nursing facility. Ray asked the representative if they would wait that he and his sister, who was taking off from her job, were going to check the facility out in Oakland and would probably want their mother discharged the next day. The representative said she would do what she could do. That evening, Ray and his sister visited the facility and felt everything was up to par. They made a decision to have their mother discharged from Brookside the next morning. Ray felt good, he had seen his mother early that morning and she seemed alright, although she couldn't speak, she understood when he told her everything would be alright. AUGUST 12, 1994 2 a.m. Ray was sleeping, he and his sister had packed most of their mother's items and were preparing to give up her apartment. Ray was half sleep and half awake, thinking about moving back to the Bay Area to look after his mother along with his sisters. He was also thinking about all that he and his family had gone through in just the pass weeks. His thoughts turned to a woman who worked in the hospital social service who told him, " You know, a boy was admitted to this hospital four years ago, he was in a serious motorcycle accident. Everyone, from doctors to nurses had given up on him, like your mother. The boy's family visited him everyday and prayed and prayed. Do you know, in six months of therapy and rehabilitation he walked out of here alive. Your mother had a stroke, something like that takes time. " Ray believed that time and patients were two things he and his sisters would be looking forward to. At 2: 16 a.m. , Ray was awaken by a phone call from his brother-in-law, Ohlson, who said doctor Hayden had just called and said their mother's condition had taken a turn for the worst. After Ohlson gave Ray the information, they hung up and the phone rang again, it was doctor Hayden. Hayden said he wasn't at the hospital, that a doctor on the 6th floor called him after checking on Jackson. Hayden told Ray he and his sisters shouldn't bother going to the hospital, that they wouldn't want to see this. After hearing this, Ray immediately hung up the phone and called his sister, Rosemary Thompson and told her the situation. Thompson said she had visited their mother around 7p.m. the previous day, just before she was moved from the 4th floor to the 6th. Immediately after she was moved to the 6th floor, she noticed her mother was breathing strangely. Thompson reported her mother's condition to a nurse at the front desk. The nurse reply was that she wasn't Jackson's nurse. Thompson asked her to please find the nurse. Thompson nurse never came while Thompson was visiting her mother. When Ray arrived at the hospital, he was directed to where his mother was on the 6th floor. He walked into a room to find her coughing up saliva continuously, it was as if she were having another stroke. She was not hooked up to a life support, just oxygen, which was not turned on. Thompson was already there and shortly after Ohlson and her husband arrived. From what they could determine, their mother was having a type of an attack, and no one was doing anything about it. Ray ran out to the nurses desk and asked for the doctor who checked on his mother. When she finally called in, her response was, "I'm not your mother's doctor, I merely called doctor Hayden to report my findings, you' ll have to check with him. " Ray asked the nurses on staff why nothing was being done for his mother. A nurse said, "You'll have to speak with her doctor. "Ray pleaded for them to please try to contact doctor Herrick or Hayden. Ray returned to his mother who was still coughing and trying to get her breath, it were as if she were suffocating. Next to his mother's bed was a woman who looked as if she weighed 67 lbs. The woman was crying that she was cold and no one would help her, Ray covered he and returned to the nurses station. Ray looked at the nurses and at that moment couldn't believe what he was about to say, but said it anyway, "You know,I don't want to seem dramatic, but why don't you just give me a damn gun so I can put my mother out of her misery. I might be wrong, but this is a hospital, where lives are not always saved, but you're suppose to try aren't you. My mother has a strong will to live, if you'd give her a chance. She used to be a nurse, and I'm telling you. if anyone of you were in her place right now, she'd be in there giving her all trying to help you. Maybe I'm wrong, maybe you're not suppose to care that much. " At this point, one of the nurses looked at Ray and the other nurse and said, "He's right. " She then ran from behind the desk into Jackson's room with Ray behind her. The nurse turned on the oxygen and used a device to remove the saliva from Jackson's mouth. Jackson stopped coughing immediately, it was as if someone had removed a pillow from her face and she could breathe again. Her skin was cold and the nurse said, she's dying. Ray ran back to the nurses desk and demanded that they get doctor Hayden immediately. He was told they were still trying. Not thinking, Ray ran down to his car, and started praying. When he returned to the 6th floor, he was told that doctor Hayden was on the phone. Hayden spoke incoherently about not knowing that Jackson was issued a 'No Code' by doctor Herrick. At that moment, Ray finally realized what was going on. Hayden said Herrick never discussed it with him. Hyden claimed that he was in San Francisco which is why the nurses couldn't get in touch with him. He told Ray he's instructing them to have Jackson taken down to Intensive Care. Ray asked why wasn't this down earlier, as in yesterday evening when her condition started changing, Hayden couldn't answer him. When Ray returned to his mother, a nurses screamed for another nurse to come into the room immediately. When the other nurses arrived, she was shocked at what she was seeing along with Ray and the others, Jackson sat up in bed and started looking at everyone in the room. Ray told the nurse, "Don't you see she's hanging in there, she doesn't want to die, she has the will to survive and you're all ignoring it. " The nurse stood their with her mouth opened, she said she'd never seen anything like that before, she thought for sure Jackson was going. Another nurse entered the room and told the nurses to get the patient down to Intensive Care. Along with the nurses, Ray grabbed his mother's bed and helped the nurses roll her out of the room. When they got to the elevator, and rolled Jackson's bed inside, its doors wouldn't close, it was on some sort of timer. Ray used his bare hand and kicked at the door to make it finally close, this lasted for about three minutes. When they arrived on the 3rd floor, Ray , aware of the location where his must was be to delivered moved her bed in that direction. However he was told by the nurse to go in the opposite direction. Ray questioned their decision and was told they were correct and Jackson was placed in a room. A nurse on the that rushed into the room and told the nurses they were wrong and Ray was right. The immediately rushed her into Intensive Care. At this point, it all seemed like a plot from a Woody Allen movie, except, this was not funny. No sooner was Jackson rushed into Intensive Care, when a nurse came out and said she had passed away a second ago. A nurse tried to comfort Ohlson who was crying, only to have her pull away and say, " I knew we should have gotten her out of here. We were so close, today would have been the day. " When Ray went into the room to see his mother's body, doctor Hayden conveniently showed up at that moment. he began to speak incoherently about how these things happened and how he didn't understand. Ray put his hand up in front of doctor Hayden and asked him to please leave. Earlene Jackson, like many other mothers, was a woman with a strong will to survive who loved life and her family. What Jackson's family wants, are answers. Answers which will probably prevent other families from going through the hell they've been put through. STATE OF CA!-IFORNIA—HEALTH AND WELFARE AGENCY PETE WILSON, Governor DEPARTMENT OF HEALTH SERVICES 2151 BERKELEY WAY BERKELEY, CA 94704 ' (415) 540-2417 November 4, 1994 Mr. Steve Ray 1337 Curson, Apt. 10 Los Angeles, CA 90046 Dear Mr. Ray: Subiect: COMPLAINT N07 : 02-07221 COMPLAINT RECEIPT DATE: 09/14/94 BROOKSIDE HOSPITAL INVESTIGATION DATE: 09/21/94 INVESTIGATOR: Leon Starkman The purpose of this letter is to inform you of the Divisions findings as a result of our investigation of your complaint. Your complaint has been investigated. The attached Statement of Deficiencies and Plan of Correction form(s) identifies any citations and/or deficiencies issued to the facility as a result of your complaint. If you have any questions, please feel free to contact Francisco Olveda at (510) 540-2417. Your efforts to improve care in health facilities are appreciated. 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O o n A o 2 0 ch c°< >80 Ol O dO <. < 2L - 0 �- C � (D CD 0 ova o 3 �' C '< m CMD -+ ° j \! (D , CD O m c' CD -. j �'i 0 a a o C)�Z r+ Q a) p mo `g9� o =N _ / 0) (.0 ., W m a o m�-� � m 7 C a � M m Q a m m Q n 50 " .. $$o v0 " w s O o v r 3 'oi -3 m-4 mei N •7 0 �O O O 7 ISG IN< Oo m N m N W O ol W , 0 T ON 91 TP W @ ON W � � N ' vo W CLAIM 2, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 14, 1995 Claim Against the County, or District governed by) BOARD ACTION I' )7 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 915.4. Please not D lIMINT 0 JiLd 11�� I119 CLAIMANT: Francisco Chavez Ortiz _ JAN 17 1995 ATTORNEY J, Manuel Ortiz COUNTYCOUNSEL Date received MARTINEZ CALIF. ADDRESS: 2 North Second Street, Ste. 1185 BY DELIVERY TO CLERK ON January 17, 1995 San Jose, CA 95113 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. p 9 � DATED: January 17, 1995 (tIl BATCHELOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ({/f This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: 01 Dated: { �! O / 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 0 DER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is & -true and correct copy of the Board's Order entered in its minutes for this date. FEB 14 IN Dated: PHIL BATCHELOR, Clerk, By . Deputy Clerk LE WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. t Dated: 15 1995 BY: PHIL BATCHELOR b A _ puty Clerk CC: County Counsel County Administrator 1 RECEIVED . N 171%5 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLAIM AGAINST COUNTY OF CONTRA COSTA CLAIMANT'S NAME: FRANCISCO CHAVEZ ORTIZ CLAIMANT'S ADDRESS: 325 Birch Street Brentwood, CA 94513 ADDRESS TO WHICH NOTICES ARE TO BE SENT: J. Manuel Campos, Esq. LAW OFFICES OF CASTRO AND CAMPOS 2 North Second Street, Ste. 1185 San Jose, CA 95113 AMOUNT OF CLAIM: Undetermined - jurisdiction is within the Superior Court, County of Contra Costa. DATE OF INCIDENT: On or about July 15, 1994 LOCATION OF INCIDENT: Marsh Creek Road, near its intersection with Seller Road, County of Contra Costa, California. HOW ACCIDENT OCCURRED: Claimant, lost control of his vehicle in gravel placed upon the roadway by Contra Costa County employees and/or its contractors. NAME OF PUBLIC EMPLOYEE CAUSING INJURY OR DAMAGE: Unknown at this time. It is believed that the County of Contra Costa, its agents, employees and contractors are responsible for the dangerous condition which has caused the injury and damage. INJURIES: The full extent of Claimant's, injuries are unknown at this time. However, it is believed that the incident resulted in serious bodily injuries. l Claim Against County of Contra Costa Re: Francisco Chavez Ortiz January 13, 1995 Page 2 Claimant has sustained substantial pain, suffering, and inconvenience as a result of the injury. Furthermore, Claimant has sustained additional special damages. BASIS FOR LIABILITY: On the part of the County of Contra Costa: County of Contra Costa negligently created and/or maintained a dangerous condition. The County of Contra Costa also negligently supervised its agents, employees, and contractors. All theories upon which liability may be premised have not yet been investigated. Claimant reserves the right to amend this Claim to further allege other, basis for liability. ITEMIZATION OF CLAIM: The full extent of Claimant's damages are unknown at this time. Claimant has sustained substantial special damages to date. General Damages - Undetermined, but are within the jurisdictional limits of the Superior Court, of the State of California. Dated: January 13 1995 / J. Manuel Campos, torney for Claimant Ct\CAMPOS\CLISNTS.PLD\CLAIM.ORT 1 Ree Francisco Ortiz v. County of Contra Costa 2 Case No: 3 PROOF OF PERSONAL SERVICE 4 I, the undersigned, say: 5 That I am now and at all times, herein, mentioned a citizen of 6 the United States, over the age of eighteen years, a resident of 7 Santa Clara County, California, and not a party to the within action 8 or cause; that my business address is Two North Second Street, 9 Horizon Center Suite 1185, San Jose, California 95113. 10 On January 13, 1995, I served the foregoing: 11 CLAIM AGAINST COUNTY OF CONTRA COSTA 12 by delivering a copy of said documents personally to the following: 13 Ron Harvey Liability Claims Manager 14 651 Pine Street Martinez, CA 94553 15 I declare under penalty of perjury that the foregoing is true 16 and correct. 17 Executed on January 13, 1995, at San Jose, California. 18 19 20 21 )Agu el Campos 22 23 24 25 26 27. 28 CLAIM 3. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 14,1995 I �� 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: $50,000.00 + Section 913 and 915.4. Please note all •YerniII�s", ] CLAIMANT: Patricia Prado JAN 2 0 1995 ATTORNEY:- COUNTY COUNSEL Date received OAMINEZCALIF. ADDRESS: 2451 Chruch Lane #46 BY DELIVERY TO CLERK ON January 20, 1995 San Pablo, CA 94806 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. January 20, 1995 PpH�IL gATCHELOR, Clerk DATED:---- n BY: Deputy - 9lle Wig:l/�, a 77. FROM: County Counsel TO: Clerk of the Board of Supervisors ( k1 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: 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. BOARDD ORDER: By unanimous vote of the Supervisors present {V) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: EB 14 1995 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. 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 imrediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the lnited States, over age IS; and that today I deposited in the United States Postal Service in Martinet, :alifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. FEB 15 1995 ' )ated: BY: PHIL BATCHELOR by Deputy Clerk :C: County Counsel County Administrator RECEIVE® 1 da1a.,..� lel ADMINISTRATIVE TORT CLAIM JAN 2 0 1995 2 PURSUANT TO GOVERNMENT CODE §910 3 CLERK BOARD OF SUPERVISM CONTRA COSTA 4 TO: BOARD OF SUPERVISORS, CONTRA COSTA COUNTY 5 You are hereby notified that PATRICIA PRADO claims damages as follows: 6 CLAIMANT'S NAME AND ADDRESS: Patricia Prado, 2451 Church Lane 7 #46, San Pablo, California. 8 9 AMOUNT OF DAMAGES CLAIMED: The exact amount of the damages 10 claimed is unknown at this time, however, claimant reserves the right to amend her claim to 11 reflect the true amount of the damages as soon as the same has been ascertained. The amount 12 of the claimed damages will be equal to or exceed the sum of$50,000. Jurisdiction of this claim 13 rests in the superior and/or federal district courts. 14 15 INCIDENT GIVING RISE TO THIS CLAIM: See Attachment A. 16 17 TYPE OF DAMAGES CLAIMED: On or about July 21, 1994, in Contra Costa 18 County, California, Ms. PRADO was subjected to violations of the civil rights and liberties 19 guaranteed by the constitution of the United States and as provided for in §1983 of the Civil 20 Rights Act. Additionally, claimant suffered assault & battery, false imprisonment, intentional 21 infliction of emotional distress,physical damage to her nervous system, intimidation, conversion, 22 invasion of privacy, humiliation, verbal abuse and property damage all as a result of the 23 complained of incident which occurred on or about July 21, 1994. The exact monetary amount 24 of the injuries and losses suffered by claimant is unknown at this time, however, claimant 25 reserves the right to amend her claim as soon as the same has been ascertained. 26 27 28 I NAME AND GOVERNMENTAL AFFILIATION OF PERSON(S) 2 INFLICTING SAID INJURIES AND DAMAGES: Agents Peixoto, Lown, Coke, Statton and 3 Hansen (first names unknown) of the West Contra Costa County Narcotics Enforcement Team 4 aka WEST-NET. 5 6 ALL NOTICES OR COMMUNICATIONS REGARDING THIS CLAIM 7 SHOULD BE SENT TO: 8 PATRICIA PRADO 2451 CHURCH LANE #46 9 SAN PABLO, CA 94806 (510) 236-5339 10 11 Dated: January 19, 1995. 12 13 PATRICIA PRADO, Claimant Pro Se 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 ATTACHMENT A TORT CLAIM OF PATRICIA PRADO On or about July 21, 1994, I awoke before dawn and decided to take advantage of my privacy by laying under my tanning machine. I fell back to sleep under the tanning machine and the next time I awoke, I was suffering with a terrible headache. I got up from the bed, put on my bathrobe and went into the bathroom to take some aspirin. I laid back down on the bed hoping my headache would go away. Very shortly thereafter, I heard a loud banging sound. I could not tell what it was nor where it was coming from and I became very frightened. I jumped up from the bed and just as I reached the kitchen area of my home, the double doors were forced open and approximately twelve men with drawn guns ran in yelling at me to get down on the floor. I was so frightened, I couldn't move. I had no idea what was happening. It all happened so fast that it is hard to recall everything, but the next thing I clearly recall is being pushed to the floor by Officer Coke of West Net. He shoved me down so violently that my hand hit the plug of my wall clock so hard that the prongs broke off in the electrical socket. To this day, some six months later, I still have a small lump on the butt on my left hand. I also sustained a scrape and bruise to my left eye, although I do not recall the details of that injury. The next thing I recall is hearing one of the officers yell that it was a parole search and being asked where Mr. Faulkner was and where the drugs.were. They insisted that I knew where they could find some drugs. They shoved me into a chair and it was then that I spotted Mr. Woodford. I asked Mr. Woodford what was wrong; if Bill had done something wrong. He replied that it was between him and Bill and that Bill knew what it was about. When I asked him why they had broken the door down especially since he had been there before and there had never been any hesitation or problem with our not opening the door, he handed me a form telling me to "put in a claim". They began a "parole search" of my residence and when I questioned their authority to do so when Bill was not even there, Woodford replied that I had "lost" my rights when I let Bill move in. Officer Woodford went into my bedroom to search while the other officers searched the outer rooms of the home. The officer searching the dining room found a pair of brass knuckles buried in the back of a cabinet and another officer found a double- edged knife in a kitchen drawer. The officers seemed to get a kick out of their finds, laughing about how that would get him (Bill) at least a year's violation. The search continued for about an hour during which time I was forced to sit in a chair in the dining area wearing nothing but a,knee-length bathrobe. I was very uncomfortable sitting amid armed men clad only in my bathrobe and asked several times if I could get dressed and if I could use the restroom. All of my requests to dress were denied and at one point one of the officers replied that no one wanted to look at me. After about an hour, I was allowed to use the restroom, but was cautioned that if I flushed the toilet I would be placed under arrest. I asked if one of the officers could get me some clothes to put on while I was in the restroom, however, they still would not allow me to dress. Attacnment A Tort Claim of Patricia Prado • Page 2 After what seemed an eternity, Officer Woodford came out of my bedroom and told me that it would go alot easier on me if I would just tell them where to find the drugs and that if I didn't, they were going to bring in a search dog. Again, I stated that there were no drugs in my home and that I wished they would bring in a dog so that they would have to leave when the dog didn't find anything. When I heard one of the officers tell Woodford that it would be about an hour before the dog arrived and he replied that he had other arrests to make and couldn't wait, I told Woodford how insulting the other officers had been to me while he was searching my bedroom and asked if he would stay until the dog search was over. He again stated that he was too busy and left. The search was suspended pending the arrival of the canine unit. In the interval I was forced to sit in a dining room chair and suffer verbal abuse and insults hurled at me by Officers Coke and Hansen. The search had been suspended From the time Officer Woodford came out of my bedroom prior to leaving until the dog arrived, no one searched anything. When the dog finally did arrive, before they brought in it, the handler and Officer Hansen went into my bedroom. When they came out, they were carrying a small bag of something they said they found behind my computer. They asked me if it were mine and when I said that it was not, they asked me who else it might belong to. I replied that I had no idea since they had not let me go into the bedroom since they broke in and that there had been several people in there since that time. Officer Hansen told me to shut my "fucking mouth" before I pissed him off even more than I already had. At that point, it appeared as though they were going to bring the dog in and that the dog was reluctant to go inside and had to be made to do so. Not wanting to be around a nervous police dog, I asked to be allowed to go outside on the porch. That is when I saw that all of my neighbors were outside watching what was going on. I mentioned to one of the officers how embarrassing the entire episode was to which he replied that if I thought it was embarrassing at that point, just wait until the San Pablo Police officer arrived to place me under arrest. While I was sitting on the porch waiting for the dog to finish, I noticed Officer Coke stick a knife in my porch banister. It was about that time that the San Pablo Police officer arrived and, after denying my request to be allowed to get dressed, he placed me under arrest. He pulled my arms around behind my back to handcuff me causing my bathrobe to pull apart in the front and expose me to all of my neighbors. When we arrived at the police station, I was placed in a holding cell and, after several minutes, I was given a tee shirt, sweat pants and moccasins to put on. Shortly thereafter, I was released and had to walk back home. When I arrived back at my trailer, my neighbor told me that after everyone left, two of the officers returned and forced their way into my trailer again. Then, one of the officers went inside for a short time and when he came out, they both drove away. Upon looking around, we noticed the words "Pat fucks" carved into the porch railing. It was freshly carved and I know that it was not there before July 21. When I found my purse, I r Attachment A Tort Claim of Patricia Prado Page 3 discovered $93 missing along with 20 silver quarters that had been in a small knick-knack box on my dresser. I immediately tried to reach Officer Woodford at his office but had to leave a detailed message about the missing items because he was not in to take my call. When I finally was able to talk to him, he simply shrugged off my complaints. CLAIM ' .BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 1."4, 1995 �' I Claim Against the County. or District governed by) BOARD 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 6overnment Code Amount: $900.00 Section 913 and 915.4. Please note all •warnings". 0, CLAIMANT: James Swinson sc=R ATTORNEY: JAN 2 0 1995 Date received COUNTY COUNSEL ADDRESS: 26 Longridge Road BY DELIVERY TO CLERK ON January 20, tyff1NEZCAL1F. Orinda, CA 94563 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 20, 1995IL P�LyIOR. Clerk 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 late claim (Section 911.3). ( ) Other: Dated: — g 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is atrue and correct copy of the Board's Order entered in its minutes for this date. 1 /e� �y{��/y��� FEB + 3 1995 r Dated: PHIL BATCHELOR. Clerk, By . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the wail to file a court action on this claim. See Gove"Wnt 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 IT' attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the lnited States, over age 18; and that today I deposited in the United States Postal Service in Martinez. :slifornia, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. )ated: FEB 15 1999 BY: PHIL BATCHELOR by Deputy Clerk :C: County Counsel County Administrator Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 3N�CTIONS 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, 19879 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 rich 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 orm. f # f s * e a e e e f a aE • e • e f e e f • e s e e f • s s e • f �l e a f • e f a f f RE: Claim By �,y ,, j Reserved for Clerk's filing stamp ;.: RECEIVED Against the County of Contra Costa ) JAN 2 0 M or ) 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 cur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or, omission�on a of county or district officers, servants or employees caused the injury or damage? �� � s-'Wover) 5. What are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of(-injuries or damages claimed. Attach two estimates for auto damage. \, 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) B. Names and ad sses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT e e e e � e e e e e ��f e�*a +� a �:>i e � e e • f e e e e e e e e • eeeeeee e ns rh"^ Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: '..(Attorne ) or by some PerAon on lf." Name and Address of Attorney E2 I "]�--"> (Claimant's Signature) , A s . Telephone No. Telephone No. —15�O eeeeeee W W W W Ireeeeeeeeie'i'�'�T7—i"T"ii"'7'"e"i��eee 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 name 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 0109000, or by Doth such imprisonment and fine. N co 0 y w > O u' Z C 0 04�a O & Q d o u rrd p A N 2 N u► ti W fl d ci3 CD O p ' cr- � O CL w � m o Ul �• r `- ``�,R ,n m n O m CL o° ' N tON u � CD N v k tr- C r u O s N nca G r � �6z \ma r rtigoe ' Z8�9 C;AIM S BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA; February 14, 1995 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: $25,000,000,000.00 Section 913 and 915.4. Please note all •Ma gs1WM A CLAIMANT: Barry G1en .Vaden aka Barry Glen Ingram _ JAN 2 0 1995 ATTORNEY: COUNTY COUNSEL Date received MARTINEZCAUF. ADDRESS: PO Box 500 #J-18529 BY DELIVERY TO CLERK ON January 19, 1995 Sierra Conservation Center January 18, 1995 Jamestown, CA 95327-0500 8Y MAIL POSTMARKED: ry 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. January 20, 1995 IVIL BATCHELOR, Clerk DATED: BY: Deputy da,� 77. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (�This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: Z 3 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). 1V. BOARDD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. FEB 14 10 Dated: 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 945.6. Vou may seek the advice of an attorney of your choice in connection with this Matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING l tietlare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. FEB 15 19ALI 9 Dated: BY: PHIL BATCHELOR by puty Clerk :C: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. ALTHOFF SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY -o 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 January 23 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Barry Glen Vaden P.O. Box 500 #j -18529 Sierra Conservation Center Jamestown, CA 95327-0500 RE: CLAIM OF: Barry Glen Vaden, a.k.a. Barry Glen Ingram 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. [X] 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 a amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [] 6 . The claim is not signed by the claimant or by some person on is behalf . [] 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: January 23, 1995 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) RIGINAL INITIAL NOTICE OF ACTION M nX z 0 `' m 1 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA D o z FOR THIE COUiVT[ OF CONTRA COSTA no HT1 2 T co cn cn _ C 3 nM m rn o 4 j BARRZ GUN VADEY A.K.A. BAR.SY GLEN INGRAM Plainti YY s 5 V. CIVIL DIVISION 6 ; 11 THE STATE OF CALIFORNIA 2 1, 13 CALIFORNIA DEF.-.RTTMENT CF CO E-C'TIC,7S 7 j13 T CALIFORMA S'LJFERICR CCURT FORMAL CLAIM FOR CF CONTRA COSTA COUNT`_' CIVIL LIABILITY 8 !4j ThJ CCU.= OF CONTRA COSTA i 5f •li,N- DISTRICT AT--r-=—T CF CCN71 -CET". CCU= 9 6 T CITY OF CONCORD !17 TFr MCUNT DIAELO (CONCORD) DISTRICT 10 Mrm0lip L OCURT :8111!1:_ !10A'CCRD FCLI 7 p �T��IM" 11 Defendant (s)f r, ?arry G en Vaden, Plaintiff o. ,-e :� =_d c. use, do '^erebzT ra FO.7yI 1'- Com, ,P1 "L' CIV!L LI 4SILITY CF T'a T`r�c) ?G IN Nr1%I;D _'_S D=.:.ND.4NT(S)• Said Defendants) are decl arec Sub ect t:, =771 = `ffll. CCF�.INSATCHT DAMAGE 7: ,UTE OF 13 ! T'rtE,NT�-FIVE BILLION DOLLARS �$25,;,K30, ca, In United States Currency for the VICLATI^Y(c) OFPLAINI'IFF•S m'.=L?E_:ONAL rAND7 CIVIL l?G1iT(S) as below 14 COUNT ONE 1 _ - VIOLATION OF CALIFCRUNT A CONSTI=ON I, $ 7&15[BY] DeprT4ivation of the 15 P?=� Z p�J Personal I `c.errety and ~ edca`�THCUT DUE PROCLSS OF 2; LAW 1y the Impr=eor_merr: of P'laiZw r_''s Fe-rsor_ f`-- 30 Jury^87t:-ix-,z 21 W 89 Re?ease from 16 Car=far-�ia State P'-.-:son Confinement ;o rarole C,lstcdrT until role=3e-7ccafior%.- "3etur.^.-Tc-Cus tady-Con_fi ement Fe:,.ed(s) of X02 JULY 89 thru 29 J AN 90; 06 ,vArZCa 9d 17 thru 16 APRIL 9d; 02 SEPT 0 thru_VDE&E' 90; 30NOVE991 thru&JULY92;:21 OCT �2 than 2*1�'93;WITH Fina.L P.V.-R.T.C. PERIOD OF 14 AUG 93 TO 21 OCT 93 DISCHARGE 18 ; M�iratian Date of Parole Custody FOR TOTAL OF APPRaUyATELT SIX (6) YEAR(S) con 1, 'CUS EIMMUOE RIGHT(S) VIOLATIONS) DUE TO CALIFORNIA LEGISLATURE'S 19 IAfflKnORMISCMNINAW ACT OF PENAL CODE $ 666e 20 it RESOD• FOR DETERMINATION OF DAMAGE VALUE' ASSESS TO EE DISCLOSED IN CpXN SSS;,LON OF CIVIL PROCEEDINGS) AS SC2EDULED. - i 21 -1, Plaintiff andUndersigned, declare that the foregoing is true and correct -4 Ta t.'re hest c*" my Tfnow2edge� e_�cited. on-d JANUARY 95 under `" per' - -- �2penalty-dfJu•. 23 24 CCURT'S SIMATURE DATE BLRRy GL,N,N VADEN DATE 25 P. C: BCX 59d # J-18529 - Sierra Conser-etion Center 26 1 Jamestown_, CA 95327-05;o 27 � C=TS SIGNATURE DAZE IN PRO PER 28 �I i) i i )RIGINAL I9ITIAL NOTICE OF ACTIO J .. 1 IN THE MOUNT DIABLO DISTRICT MUNICIPAL COURT OF CONTRA COSTA COUiifiY FOR T11E CITY OF CONCORD 2 3 4 j BARRY CLEW VADEN' A.K.A. BARRY GLE- INGRAM iI Plaintiffs I 5 V. CIVIL D17ISICIT 6 I1 THE STATE OF CALIFCRNIA NO. # 2 T».•. CALIFORNIA DEP=.RT_ME,\rL OF COP�C_"iCP?S 7 i3 1 CALIFORNIA SUFETRICR CCU-1-IT FORMAL CLAIM FOR OF CONTRA CCSTA CCUPIT`_' CIVIL LIA3ILITY 8 CCU=. OF CONTRA CCSTA 5 I T4'T`+ DTjT IC ATTC=, -,4 Y' r_F CC1,IT_- _CSS 1 COUNTY u T.IM CITY OF CON=RD 7] T.1M MOUNT DIABLO (CONCORD) DISTRICT 10 =CIP L COURT Erl !!-!E E CO.NICCRD POLICE I1 Defendants f S� Rarr7 filer_ Vaden, Plai_*itiff of o s.^.z, .Lea cause� uc erebv 12 CL AIM FCR CIVIL LI AMILITY CF 17 ?'=_"_' S) :~J7-1N N ISD -S DE^EA1D?�IT(S). Said Defendants) are �iec ares Sub ect FL'"TIT=�T�� VDI COMFE:JS�TCR� D DACE�I y� OF 13 TWENT-T-FIVE BILLION DOU;-' S �$25jgp0�odD,;nxjl In United States Cur nc7 for the VICLATI^N(S�OF PEAINTIFF'S 77-7 1D i~✓ 'T_'t PE?SQNAL [;ND1 CIVIL RIGHT(S) as below 14 COUNT ONE 1 - VIOLATION OF CALIFOR,%rl CONSTITUTION ARTICIZ I. $ 7&15[BY] Deprivation of the 15 " ??=„i--rbf,f 13 Fersonal I bad?and Fin edbm;+1ITACUT DUE PRCC'LSS OF T;E LAX by the j Impr+sor_�nent of F1-..i.ztif`''s Fe�rsor_ `- 30 J=- 87 t.�ru 21 M;&R 89 Re, ease from 16 Ca -far-ma State P:-:son Conte ne Hent to Parole C.lstcd, until ✓arols-Revocation- Recur.^.-To-CustadpConfine:nent Fed(s) of�2 JULY 8g t.'�u 29 J^�1V 943; 06 M�1RCR 9d 17 thru 16 APRIL 9d; 02 SEPT 99 thru 3d DECLM 90; 30NCVEX 91 thru 04 JULY 92;:21 OCT 92 thru X(1A'93;1411 Final-P.V.-R.T.C. PERIOD of 14 AUG 93 TO 21 OCT 93 DIS-CHARGE 18 3'apiration Date of Parole Custody FOR TOTAL OF APPRMY-ATELT S= (6) iEAR(S) COB TREEOUS EXMNSTVF: RlWr(S) VIOLATIONS) DUE TO CALIFORNIA JZ,=aATURE'S 19 Rte. 1UNrDISCRIMINANT ACT OF PENAL CODE $ 666. RESCURGE' FOR DETR L41ITATION' OF DAMASE VALUE' ASSESSED TO EE DISCLOSED 20 j, aPEIT SON- OF C= PROCEEDING(S) AS SCZEDULED. 21 I -1. Plaintiff ancLUndersigned� declare that "-.e foregoing is true and correct- 7& arredTa the'best of icy knowledge e.ceart.--.on 05 JANUARY 95 under penalty of perjury. 1-2 23 ii j ! CCURT'S S=ATJRE DAM'S' M&17 TU-01 VZE17 DAA 25 P. 01 BCX 59d I J-18529 Sierra Conservation Center 26 dJamestown CA, gS327 7 5J j IN PRO PER 27 :I QTS SICUATURE DAZE 28 �Ii 1 IN THE STTPERIOR COURT OF THE STAT": OF CALIFORNIA FOR THE COUNTY ar m .CWTA 2 3 4 BARRg GLEN VADEN' A.K.A. BARRY GLEN INGRAM Plaintiff(s) 5 V. CIVIL DIVISION- 6 IVISION6 1 THE STATE OF CALIFORNIA NO. # 2 TIHE CALIFORNIA DEPARTMENT OF CORRECTIONS 7 3%_ THE CALIFORNIA SUPERIOR COURT FORMAL CLAIM FOR OF CONTRA COSTA COUNTY CIVIL LIABILITY I 8 4 THE COUNTY OF CONTRA COSTA I 5 THE DISTRICT ATTORNEY OF CONTRA COSTA COUNTY' i 9 6 THE CITY OF CONCORD 7 THE MOUNT DIABLO (CONCORD) DISTRICT 10 I MUNICIPAL COURT 118NI CONCORD POLICE DEPARTMENT 11 II Defendant s li I, Barry Glen Va ens Plaintiff of the enti ed cause, do hereby make FORMAI, 12 I CLAIM FOR CIVIL LIABILITY OF T`1Z PARTY(S) HEREIN NAMED AS DEFENDANTS) Said Defendants) are declared Sub 'ect to; PLfiTITIVJEAND] COMPENSATORY DAMAGE VALUE OF 1 13 r4EN -FTVE BILLION DOLLARS �$25,00,00 in United States Currency for the VIOLATICY(S) OF PLAINTIFFtS FUNDAMENTAL PERSONAL[4ND] CIVIL RIGHTCS) as below : 14 I COUNT ONE 1 VIOLATION OF CALIFORAIIA CONSTITUTION ARTICLE I: $ 7'&Y5[BY]Deprivation of the 15 Plaintiff Is Personal Liberty and Freedom WITHOUT DUE PROCESS OF TM LAW by the Impri"sonmment of Plaintiff's Person from 30 JUT 87 thru 21 OCT 89 Release from 16 California Stater Prison Confinement to Parole Custody until Parole-Revocatiarr, Returzi-To-Custody Confinement Peri od(s) of 432 JULY 89 thru 29 J AN 90-; 06 MARCH 9d 17 thru 16 APRIL 90; 02 SEPT 90 thru 3-DECEM 9000 NOVEM 91 thru 04 JULY 92;,21 OCT 92 thru V MAI'93;WITH Final P.V.R.T,C. PERIOD OF 14 AUG 93 TO 21 OCT 93 DISCILAR E 18 gyration Date of Parole Custody FOR TOTAL OF APPRCK MATELT SIX (6) YEARS) COMM=OUS EXTENSIVE RIGHT(S) VIOLATION(S) DUE TO CALIFORNIA LEGTSLATUBE'S 19 ARM '!tA$TIDISCIUMINAVT ACT OF PENAL CODE $ 666, RESOURCE' FOR DETERMINATION OF DAMAGE VALUE ASSESSED TO 1E DISCLOSED I1T 1 20 OPEN SESSION OF CIVIL PROCEEDING(S) AS SC;MEDULED. - - 21 -I, Plaintiff andUndersignedt declare that the foregoing is true and-correct 22 T& the best of my knowledge, executed on 05 JANUARY 95 under penalty of per jury. 23 I 24 COURT'S SIGNATURE DATE B&RRr GIEN VADEN DATE 25 I P. 0. BOX 5* # J-19529 Sierra Conservation Center 26 Jamestown, CA 75327-0500 27 CTZMIS SIGNATURE DA-7S i 28 i I y 1 IN THE MOINIT DIABLO DISTRICT IMTICIPAL COURT OF CONTRA COSTA COUNTY FOR THE CITY OF CONCORD 2 3 4 BARRi GLEN VADEN" A.K.A. BARMY GLEN INGRAM Plaintiff s 5 V. CIVIL DIVISION 6 1 THE STATE OF CALIFORNIA NO. # 2 TIU CALIFORNIA DEPARTMENT CF C07a-ECTICNS 7 i 3 =. CALIFORNIA SUPERICR CCL'RT FORMAL CLAIM FOR OF CONTRA CCSTA COUNTY CIVIL LIABILITY 8 14 THE CCUNTY OF CONTRA COSTA 5 THE DISTRICT ATTORNEY OF CCNTR 'JOSTA COUNTY' 9 16 THE CITY OF CONCORD X17 THE MOUNT DIABLO (CONCORD) DISTRICT 10 I' 1f-TNICI?Z COURT 1811 T i'E CC iCCRD PCLICE DEP�RI"�CP1T 11 Defendant s . i I, 3arry Glen Va ens Pla%ntiff of the entitled cause, do hereby 7aTmFORMAL 12 CLAIM FCR CIVIL LIABILITY CF THE ?ARTY(S) HE,-EIN NAMED AS DEFENDANT(S). Said i Defendants} are declares Sub 'ect to PLfiII1'IT �M] CGMPENSATORY DAMAGE VALUE OF 13 TWENTY'-FIVE BILLION DOLLARS �$25iC3GGl1� � 1n Ubited States Currency for the VICLATION(S) OFPLAINTIF'F*S_7.7ND�E�:lT:1LPER.SONALFANDI CIVIL RIGHT(S) as below : 14 !i COUNT ONE 1 — — VIOLATION OF CALIFORu'v'IA CONSTITUTION ARTICLE I= $ 7&15[BY]Deprivation of the 15 gl`inti fr's Personal Liberty and Freed a WITHOUT DUE PROCESS OF TFE LAW by the Imprisor�rent of Flainl If-' Pe=rson from om 3�d JUNE 87 thru 21 OCT 89 Release from 16 Cai—1 for-iia State Prison Confinement to Parole Custody until Parole-Revocation Retur-To-Custody Confinement Pariod(s) of 432 JULY 89 thru 29JAN 9d; 06 MARCH 94 17 I thru 16 APRIL.90; 02 SEPT qd thru 31,DECEM 9000 NOVEN 91 thru 04 JULY 92;:21 OCT 92 thru;d MAY 93;WITH Final.P.V.-R.T.C. PERIOD OF 14 AUG 93 TO 21 OCT 93 DISCHAPM 18 gyration Date of Parole Custody FOR TOTAL OF APPRM-MATELT SIX (6) YEARS) i I� CONT11MOUS E7CMMIVE RTGHT(S) VIOLATIONS) DUE TO CALIFORNIA LEG[IMATURE'S I 19 ISCRIl�NANT ACT OF PENAL CODE $ 66. RESOURCE' FOR DETERMINATrON OF DAMAGE VALUE' ASSESSED TO BE DISCLOSED IN 20 i OPEN SESSION OF CIVIL PROCEEDING(S) AS SCHEDULED. 21 -I, Plaintiff and Undersigned, des?ars that the foregoing is true and correct Ta the best of my knowledge, exec ted on 05 JANUARY 95 under penalty of perjury. 22 23 24 1 1 COURT'S SIGIITATURE DATE BARRY' GLEN VADEN DATE 25 �j P. 0. BOX 50 # J-18529 Sierra Conservation Center 26 �I Jamestown, CA 85327-050 27 �I C=tS SIGNATURE DA-TF, iI 28 I I i r PROOF OF SERVICE I, Barry.W. VADEIT, declare that I am the author of the foregoing document and have full Imowledg of said document. content, that I served said document on the party(s) to the matters) therein said document by placing Trite Copy of same in a sealed envelope properly addressed as below listed and thereafter placing said sealed document(s) in the care of the Mailroom Staff of Sierra Conservation Center State Prison, Jamestown, CA thereat to be properly posted and forwarded to the care of the United States Postal Service: 1 j THEk STATE' OF CA LIFORT TA: 6 j TIM CITY OF CONCORB: GOVEERNOr OF ^?= STATE OF CALI~0-TIIA OFFICE OF Tzr-; MAYOR OF TIE CITY ST1:'T"' CAPITOL g?TT =� OF CONCORD CR-0v'NT0, CA 94283-0001 1950 PA--jGTl DRIVE CORTCOR'D, CA 94520 2; T ^ C_"LIFORI`;IA DEPT. OF COF.-�7,ECTTO�,F: D 2-7r'OR OF =t DEPT. OF CORTECTTONw 7] 'SHE MOUNT DIABLO DISTRICT S TAS CA PITC!, BUIID*r1 M MUNICIPIZ COURT FOR TTS CITY P. 0. BOX 942883 OF CONCORD: uAC� 1Z1,.1T^O, CA 94263-0001 Tr MT, DTr.BLO DIS"_TRICT- 1'1L?L7ICIYAL C0URT 3] TIS CAEIFCMIM-,SUPERIOR COURT S' DDTG JUROR, CRIM. DDTISION OFCONTRA COSTA COUNTTY: 195¢ PARKS DE DRIVE SUS RIOR CO=. OF CALIFORXI CONCORD, CA 94520 FOR CON'TVi COSTA C071%TTY OFFICE OF THE COURT ADMIP?ISTR.ATOR 8j TEEM CONCORD POLICE DEj'p {TN i�TT: PRSS=ING_ ,TUROR9 CRIM. DIVISIOIr CONCO POLICE DEPAR7fi' ini' C: F 1020 4AM SETR 'ET ATTTN% C0?,2'ZSSTOrBRtS 017TCE MARTINEZ, CA 94553 77,LIDW PISS 11D. & PAP=DE DR. CON—D =�'=, CA 94520 4'j =- ,, COURTTY OF CONTPLL COSTA: 0 +r CE OF THE COUA'TY'SDMINTISTRATOR ATTR: BO IM OF SL77FRVISOPS 651 PINE STIP-PET MARTIN,z, CA 94553 5i THE DISTRICT ATTOR22Y OF CONTRA COSTA 'CO ." i'Y: OFFICE OF TEE DISTRICT ATTORTCEY OF CONTRA COSTA COU. , 725 COURT STREET MARTINEZ, CA 94553 I, Undersigned, declare that the foregoing is true and correct, ececuted at Jar:estoi,.n, CA on 05 JAl''LTARY 95: under panalty of perju_,^y. .RY VAmx DATE Name 811oR'- 6. d/ Q) P.O. Box S8'0 'Sierra Conservation Centep U.S.POSTAGE s� Jamestown, CA 95327-95-4y " JAN 18,952, ;% STATE PRISON �i=�. � � 0 .5 'sSCC - State Prison ��s`oe7 8 s o-Frc�or- 777*-c ? ispk 71-41:8 80190 OF stM45P,Velso res 1y1tXT11Vcz—cX y�3 f„1 III Ill 1-11111LI1111111111111fills If11l1111list fill 11„11111t11 APPLICTATION"TO FILE LATE CLAIM February 14 1995 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Y BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: Dwight Session jl Attorney: J A N 17 1995 COUNTY COUNSEL Address: West County Detention Facility MARTINEZ CALIF. 5535 Giant Highway Amount: Richmond, CA 94806 By delivery to Clerk on January 13,-.1995- $500,000.00 + Date Received: January 13, 1995 By mail, postmarked on January 13, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. r DATED: 1/17/95 PHIL BATCHELOR, Clerk, By ('���p0 Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( v1f The Board should deny this Application to File Late Claim (Section 911.6). DATED: v, VICTOR WESTMAN, County Counsel, By��-r�.�.— Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( )) This Application is granted (Section 91.1.6). (✓ ) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: FEB 14 1995 PHIL BATCHELOR, Clerk, By 2L . L4 J-206 – Deputy WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court Within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. IP you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703 DATED: FEB 15 1995 PHIL BATCHELOR, Clerk, By r Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIN Dwight Session Westj I id id County Detention Facility OI?G HN E.CH J :'•559 Hr� t� •�:_ G I ro!n FIINIIEC STATE'D 1h��Eh:CE I.eIpormt Com. 944806 9955 OQO15�JfiE-.� Mr. Phil BateMor, Clerk of the CP of w;J_4 J��.k�l.11�`oi 9Jd..L Y.i.r�6.J�0 and County d�1�711rAstmtor County of Contma Costa. Z 1109 D96 527 911e. Street Maftixiez, CA RECEIVED Dwight Session West County Detention Facility 31995 5535 Giant Highway JM Richmond, CA 94806 CLERK BOARD OF SUPERVISORS. December 27, 1994 CONTRA COSTA CO. Mr. Phil Batchelor, Clerk of the Board of Supervisors and County Administration County of Contra Costa 611 Pine Street Martinez, CA 94559 Dear Mr. Batchelor: I am writing this letter to serve notice of my request for a Leave to Present A Late Claim. Pursuant to Government Code § 911.4 to 912.2 and 946.6. The circumstances of my situation warrants the granting of this request. The previous claim dated December 2, -1994, presented to the Board of Supervisors of Contra Costa County was partially returned because "a portion of the claim was not presented within the time allowed by the law. " The denial further stated that " some of the alleged tortious incidents referred to in the claim occurred prior to six months from the filing date of my claim. " I am therefore appealing for this Leave To Present A late Claim. so that my entire case will be consolidated. I declare under the penalty of perjury that the forgoing is true and correct and understand that a false statement herein may result in the dismissal of my claim. y�y Date Sign ure of Applicant TO: Dwight Session West County Detention. Facility 5535 Giant Highway Richmond, CA 94806 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911 . 3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on December 2 , 1994 has been reviewed by County Counsel and is being partially returned to you herewith because: Some of the alleged tortious incidents referred to in your claim occurred prior to six months from the date of the filing of your claim. If you wish to have the incidents considered with your claim, and if you wish to pursue further legal action should your claim be rejected; you must apply for leave to present a late claim as to these incidents . Because that portion of your claim was not presented within the time allowed by law, no action was taken on that portion of your claim. Your only recourse at this time as to those incidents occurring prior to six months of the filing of your claim is to apply without delay for leave to present a late claim. (See Government Code sections 911 .4 to 912 .2 and 946 . 6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911 . 6) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By: Deputy Clerk Dated: DEC 13- 71994 Enclosure Aff.i.davit of_._Mailing I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid, a copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. Date: DEC ' 7 1994By Phil Batchelor by ,"l, Deputy Clerk I Mr. Dwight Session 2 5535 Giant Highway 3 Richmond,Ga. 94806 4 5 6 7 8 9 Dwight Session ) 10 Plaintiff ) 11 ) 12 V. ) 13 ) 14 County of Contra Costa. ) COMPLAINT 15 Centra Costa County ) 16 Public Defenders Office ) 17 and ) 18 ) 19 Evangeline Brown ) 20 Defendant(s) ) 21 ) 22 23 24 25 The undersigned claimant makes claim against the County of Contra 26 Costa or the above-named District in the sum of $500,000.00 and 27 in support of this claim represents as follows: 28 29 -------------------------------------------------------------- 30 1. When did damage or injury occur? (Give exact date and hour) 31 32 August 16, 1994 and thereafter 33 34 1. Where did damage or injury occur? (Include city and county) 35 36 Martinez, California. Contra Costa County. 37 38 3. How did the damage or injury occur? (Give full details; use 3.9 extra paper if required) . 40 41 Mal-intent, Malpractice, Malfeasance by breach of 42 duties by Public Defender. 43 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 SEE APPENDIX 1 49 50 51 52 1 1 2 5. What are the names of county or district officers, servants or 3 employees causing the damage or injury? 4 5 Evangeline Brown 6 7 6. What damage or injury do you claim resulted? (Give Full extent 8 of injuries or damage claimed. Attach two estimates for auto 9 damage. 10 11 Loss of Freedom, Loss of rights, Violation of all 12 due process. Delay in release from custody. 13 14 7 . How was the amount claimed above computed? (Include the 15 estimated amount of & prospective injury or damage. ) 16 17 $500,000.00 General Damages, Stress Aggravation, 18 Mental Stress. 19 20 21 S. Names and addresses of witnesses, doctors and hospitals. 22 23 Not currently Ascertained 24 25 9. List the expenditures you made on account of this injury: 26 Date Item Amount 27 28 Not Currently Ascertained 29 30 31 32 Gov. Code Sec. 910.2 provides: 33 "The claim must be signed by 34 the claimant or by some other 35 person on his behalf. 36 37 38 39 40 41 NAME AND ADDRESS OF CLAIMANT 42 MR. Dwight Session - 43 West County Detention Facility (Cl ant Signature) 44 5535 Giant Highway 45 Richmond, Ca. 94806 46 47 48 49 50 51 52 2 NOTICE 6 7 Section 72 of the Penal Code provides: 8 9 "Every person who, with the intent to defraud, presents for 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. 19 20 21 22 23 24 25 26 27 28 3 1 Mr. Dwight Session 2 5535 Giant Highway 3 Richmond,Ga. 94806 4 5 6 7 9 10 In late January or early February of 1994 Ms. Brown was the 11 subject of a Marsden Motion which I brought before the Municipal 12 Court, Delta Branch, the Honorable Judge Jerry Bellachi 13 presiding. Judge Bellachi refused to appoint other counsel but 14 did consent to allowing me to proceed in Pro Per. 15 16 In that status I was able to arrive at the agreement 17 represented by the plea bargain discussed in the opening pages 16 of this letter. The occurrence of this Mardsen Motion set up an 19 apparent conflict of interest between Ms. Brown and myself. When 20 I was rearrested Ms. Brown was once again appointed as my public 21 Defender. I have to assume that this appointment occurred by 22 virtue of automatic assignment due to our previous albeit 23 unsuccessful attorney-client relationship. 24 25 Since her appointment Ms. Brown has failed to chronicle the 26 history of these proceedings in a way that would provide the 27 court with a clarification of the points of confusion that arose 28 as a result of her failure to consolidate the misdemeanor petty 29 theft with the felony petty thefts. This failure resulted in my 30 detention for two (2) days beyond Judge Fliers order releasing me 31 from custody in March of 1994. At a point in time in February 1 1 she had represented to me that such a consolidation had been 2 accomplished. 3 4 Further. her failure to accomplish this consolidation she 5 represented had been done directly contributed to the misdemeanor 6 charge of petty theft being dismissed and refiled as a felony. 7 At best, the refiling has thoroughly confused the status of that 8 case (in terms of being within or without the scope of the plea 9 bargain) . At worst, the refiling of that case could lead to the 10 need to file a writ of Error Gorim Nobis due to the fact that the 11 scope of the original plea would be much more circumscribed than 12 I reasonably understood it to be. This of course would greatly 13 delay all of the proceedings and give rise to many months of 14 unnecessary incarceration for me. 15 16 Then, after her reappointment as my Public Defender in June, 17 Ms. Brown did not take the necessary steps to excuse herself 18 based on my prior Marsden Motion. Rather, shockingly. in August 19 16, 1994, in Department 15 she stood up in open court and stated 20 she wanted to "make a record that I was hard headed and 21 unreasonable." She took this outrageous tact without any prior 22 notice to me out of anger because I attempted to explain to her 23 that I had already been sentenced on the "new petty theft case." 24 Then, unbelievably, she stood up in open court and stated that I 25 had been the subject of a warrant on charges that I had been in 26 possession of cocaine. Ms. Brown volunteered Sua Sponte. No 2 I request for such information was made by anyone. The District 2 Attorney indicated that Ms. Brown was misinformed. Incredibly, 3 she insisted that such a warrant had been issued. 4 5 First, she was wrong. In fact no such warrant was extant. 6 Second, this was an outrageous violation of her ethical duties to 7 me, her "client." Two (2) days after Ms. Brown's statements 8 injurious to my interests, . I was charged with possession of 9 cocaine. Based on these factors I am prosecuting a claim for 10 legal malpractice against Ms. Brown, the Contra Costa County 11 Public Defenders Office and the County of Contra Costa. Thus, an 12 irreconcilable conflict of interest exists between Ms. Brown and 13 I. 14 15 I declare under the penalty of perjury that the foregoing is true 16 and correct and understand that a false statement herein may 17 result in the dismissal of my claim. 18 19 20 21 22 Date Signidlure of Applicant 23 24 25 26 27 28 29 30 31 3 CLAIM �. BOARD.OF SUPERVISORS OF.CONTRA COSTA COUNTY, CALIFORNIA I • I"� February 14, 1995 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 915.4. Please note all "Warnings". - CLAIMANT: Larry Moran ATTORNEY: Thomas M. Hagler - JAN 17 1995 Date received COUNTYCOUNSEL ADDRESS: 555 Mason St. , Ste 290 BY DELIVERY TO CLERK ON_Ta_ rn�are Af5RTIM$IPALIF. Vacaville, CA 95688 BY MAIL POSTMARKED: Hand D liy red I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. GATED: January 17, 1995 pp BATCHELOR, 0 B�: �eputy ✓I, �i�e . �e IL Clerk 1]. FROM: unty Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: [ " S BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. FEB 14 1995 Dated: PHIL BATCHELOR, Clerk. By0A_A#AQ_AJ . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States. over age 18; and that today I deposited in the United States Postal Service in Martinez. California. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant .as shown above. Dated: FEB 1 BY: PHIL BATCHELOR by + Deputy Clerk CC: County Counsel County Administrator HAGLER& NELSON ATTORNEYS AT LAW 555 MASON STREET,SUITE 290 VACAVILLE,CALIFORNIA 95688 THOMAS M.HAGLER E.BRADLEY NELSON (707)447-4300 _ FAX: (707)447-1133 RECEIVED JAN 1 31995 I' c t, January 12, 1995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. v Clerk, Board of Supervisors Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 Re: Claim of Larry Moran, Conservator of the Person and Estate of Jimmy Dale Van To Whom It May Concern: Enclosed for filing is a Claim for Damages regarding the above-captioned claimant along with a copy of the claim and a copy of this letter; please stamp the claim and the letter with the date you received it. If you have any questions, please feel free to call. Sincerely, VI 's V vf"� Thomas M. Hagler TMH/bw Enc. CLAIM FOR DAMAGES Pursuant to Section 900 of the Government Code of California, the following claim for damages is respectfully submitted: 1. Name and Post Office Address of Claimant: Larry Moran as Conservator of the Person and Estate of Jimmy Dale Van 3536 E. Hammond Fresno, CA 93703 2. The Post Office Address to whom claimant wishes notices sent: Thomas M. Hagler = RECEIVED HAGLER&NELSON a--J bd'- ,,,,oV 555 Mason Street, Suite 290 JAN 13 1995 Vacaville, CA 95688 , (707) 447-4300 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 3. The date, place and other circumstances giving rise to the claim: July 16, 1994 (see continuation sheet) 4. A general description of the indebtedness, obligation, injury, damage or loss incurred, so far as known to claimant: See continuation sheet 5. The name or names of the employee(s) causing the injury, damage or loss, as far as known to claimant: See continuation sheet 6. Amount claimed as of date of presentation of claim, and basis of computation: See continuation sheet. Dated: January 12, 1995 � V Thomas M. Hagler Lawyer for Claimant Continuation Sheet Moran/Van Claim January 12, 1995 3. The date, place and other circumstances giving rise to the claim: Jimmy Dale Van is single and is a resident of the DeWitt Center of Clovis General Hospital at Clovis, California. Jimmy Dale Van is 46 years old and was born on May 30, 1948. At the time of the accident he was unemployed. Mr. Van is currently in a coma or persistent vegetative state due to disabling head injuries sustained as further set forth herein. Larry Moran was appointed Conservator of the Estate and Person of Jimmy Dale Van on September 30, 1994, by order of the Solano County Superior Court in action number P344176. On July 16, 1994, at approximately 1:15 a.m., Mr. Van was driving a 1984 Plymouth, Turismo owned by Dennis G. Bernard, eastbound on State Route 4 west of Bailey Road near and/or within the City of Pittsburg, Contra Costa County, California. For reasons currently unknown, his vehicle stopped in the number two eastbound lane. Mr. Van got out of the vehicle. Shortly thereafter both Mr. Van and the vehicle were struck by another vehicle driven by Gary A. Beard. Mr. Van sustained serious head and other internal and external injuries. California Highway Patrol officers were summoned to the scene. The officers conducted an investigation and prepared a Traffic Collision Report. (See Traffic Collision Report, Exhibit 1, which by reference is fully incorporated herein.) At the time of the aforementioned accident, State Route 4 at the scene of the aforementioned collision was in a dangerous condition that created a substantial risk of accident and injury such as that experienced by Mr. Van. At the time of the accident, the aforementioned roadway and adjacent area was under construction as a joint project of the Department of Transportation(CALTRANS), an agency of the State of California and/or the Bay Area Rapid Transit District (BART), and/or the County of Contra Costa, and/or the City of Pittsburg. The aforementioned roadway and adjacent area was owned, maintained, and controlled by the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg. The roadway and adjacent area at the scene of the accident was in a dangerous condition. The dangerous condition was due, but not limited to, any or all of the following: (1) eastbound traffic was provided no exit from State Route 4 for a substantial distance from west of the accident site and up to and including the accident site; (2) the roadway in the aforementioned substantial distance west of the accident site consisted of two eastbound lanes; the center or number one lane was directly adjacent to a center fence separating the eastbound from the westbound traffic lanes; the number two lane was immediately adjacent to barriers and/or fences and/or retaining walls; (3) adequate shoulders were not provided 2 Continuation Sheet Moran/Van Claim January 12, 1995 for any eastbound vehicular and pedestrian traffic requiring emergency departure from the eastbound lanes and the roadway; it was foreseeable that vehicles traveling eastbound would require emergency use of an adequate shoulder and/or that pedestrians on the roadway would require emergency use of an adequate shoulder; (4) a curve was constructed in the roadway in the eastbound lanes preceding the accident site; because of the curvature and relative elevation of the eastbound lanes approaching the accident site, the headlights of said vehicles would not illuminate other vehicles stopped in the roadway; the headlights of approaching vehicles would not illuminate stopped vehicles because the curvature and relative elevation of the roadway west of the accident site obscured the accident site from illumination by said lights; (5) any regulatory traffic signals, signs or markings installed for eastbound traffic at, near, or preceding the accident site to regulate eastbound traffic failed to warn said traffic of the dangerous condition of the roadway at the accident site; the aforementioned physical characteristics of the accident site created a hidden hazard that in the absence of suitable warning devices could endanger careful motorists or pedestrians such as claimant; and, (6) no warning signals, signs, or markings were installed; said warning signals, signs, or markings were necessary to warn of the dangerous condition of the roadway because the dangerous condition would not be reasonably apparent and would not be anticipated by vehicular and pedestrian traffic using the roadway with due care. Because the roadway and adjacent area at and/or near the accident site had not been properly designed and/or signed, and/or maintained and/or constructed Mr. Van was injured. The injuries to Mr. Van occurred because of the dangerous condition of the roadway. The State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg had actual knowledge of the existence of the dangerous condition of the roadway and knew, or should have known of its dangerous character a sufficient time prior to July 16, 1994, to have taken measures to protect against the dangerous condition by the following acts: (1) correcting the curvature and relative elevation of the roadway; (2) properly maintaining regulatory traffic signals, signs, or markings; (4) providing warning signals, signs, and markings; (5) providing adequate shoulders for emergency use; and, (6) providing safe emergency departure from the roadway and over, through, or around the fences and/or barriers and/or walls immediately adjacent to the roadway. The State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg had the authority and responsibility to take adequate measures at State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg expense and the funds or other means to do so were immediately available to them. 3 Continuation Sheet Moran/Van Claim January 12, 1995 The State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg's knowledge of the existence of the dangerous condition of the roadway was due in part to accidents which took place on the roadway before July 16, 1994. It is alleged on information and belief that said previous accidents were reported to the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg and that in some, if not all, of the previous accidents, State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg employees investigated and made reports of the accidents as did other employees of the State of California and/or the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg. Furthermore, the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg had knowledge of the extremely high volume of vehicular traffic traveling eastbound on State Route 4 west of Bailey Road. The State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg took no action to correct the dangerous condition. It is further alleged on information and belief that complaints were made to the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg before July 16, 1994, concerning the dangerousness of the roadway, but no action was taken by the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg to correct the dangerous condition. Said State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg had both actual and constructive knowledge of each of the dangerous conditions previously described because employees of said State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg regularly inspected the roadway. The aforementioned dangerous condition of the roadway was created by the negligence of the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg and its agents and employees, because each condition described above is within the control and responsibility of said State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg. 4. A general description of the indebtedness, obligation, injury, damage or loss incurred, so far as known to claimant: Mr. Van has suffered serious and disabling physical injuries from the accident. (See Exhibit 2, copy of Declaration of Thomas E. Leonard, M.D.). 4 Continuation Sheet MoranNan Claim January 12, 1995 5. The name or names of the employee(s) causing the injury, damage or loss, as far as known to claimant: The State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg and unknown employees of the State of California/CALTRANS and/or BART and/or the County of Contra Costa and/or the City of Pittsburg. 6. Amount claimed as of date of presentation of claim, and basis of computation: Property damage to the 1984 Plymouth in excess of$2,500.00; loss of use of the vehicle in excess of $500.00; lost wages, including overtime loss, in excess of $500,000.00,- unascertained 500,000.00;unascertained hospital, ambulance, medical, and physician costs; unascertained future medical costs; and unascertained amounts for pain and suffering. 5 EXHIBIT 1 STATE OF C.V WRMA TRAFFIC-,N, LB810N FiFPRT AUG 4 1994(P So'PA 1 (rAW2-92) OM 0<2 t3 92 6�. ►.or f of SPtC1AL CONOTIHOma - PRANS R MTA Pam crrT JLttCUNRE 1DASTCT LOCAL R"IORTWAdS dJISIID MORT 6 p ualac_ 1 .sA 2� Numsex Mr a mum Cow" RIr0KT1NG Osrwcr SEAT i OCCUR RED ON MO. DAY Y LAA TIME(xaa) NOC s OFSICEA L D. - Z SR E/B 7 /09Z•6 O ------o----------------------------------- W-L"rOST NPVRYATION DAY Of WELD( TOW AWAY MOTOGAAPHS 1Y: SSS FEETIM*ws W Of, c-c- 20:13 S M T W T S ®TEs pND Asn AT*n%?4E flON WYK � STATE HWY RCL �`jD+�} �� ��CL.I(r CiLwlU ) ©°R` Sj FEET/ os (7A I L� �� ®ra ❑N° Sb 682- 5 PARTY loFwvE"L1C33al NWaEA STATE CLAff SAFETY YEA YEAR YAKSl1/00ELICOLOR ENfI NWIER STATE: A CA 1?9 FoAa Mutrnv.j 6, zaok L A4-r z YOE.z sy -cam; . . . . . . . . . . . . . . . . . . . . . . . QA[Y" NAY[(FIRST.WOOLS.LAST) - FED[[ ADDRESS OWNER'S NAW" ®SANS TR IAN RIAS OY[R PARKED CM I STATES ZW OWta"ADOREaf ®SAME AS ORIVIA ... VEMGLI ncY• SU HAJR wns I Hoomrr I WSJONT I MKTHOATS RAS" Dta►cf+noN OFVLHCL"ON ORDERS or.' ER 0 O"C3A ❑DRIVER ❑OT}I - CJST YEl, i DAY YEAR ❑ 6Q.1 BaJ SMI 5S - �z �4 �y JoLJ.a i �510� 5 w OTHER HOME P"AMS aWw[ia II70PK , R MECHANICAL DEFECTS: NONE Arf ARENTgREFEII TO NA,,,❑ Cl ( SID , --2-Z-77SOO ( S10 ) 3--70- 94joa CHF USE ONLY DEEUfI"VEHICLE DAiAA4l ALJ SHADE w DAALLGED AREA WfiALANCf CARR"R POUCT NWSE7{ YL}tGl"TY/[ ❑` ❑— 0I4AIOR AAA E '-35 9 9 - 1 iL-- R--,- prT AL DNLOf ON fTTi""T OR HIGHWAY f►Eto ICF DOT C7 CA D ICC D PUC D T74YEL CAB S S .uw Z-�3A'1v�- I C:::Ii,: PARTY DI vr"ucUBINLYa"R aTATE "A" SAFETY VSK YEAJI "IC"I ll—.L/COLOR [Nsl NLaln 3Jl STATE EOI"F. SyCA P-y Tu�IsM� ORIVEA IKAMS(MAST,�.LAST) ❑ hiOa� _ I YtDLi AOORI3a OWN&"NAM" ❑fI YE Al ORYUI TAUVI _ . ❑ � 1-�t S L*wC C3C� P""2 CITY I STATSI of OWWEAT1 ADORS.W ❑SAME AS DRV EA V E"CL" ❑ 3(.8 5'4 MUL,5E�y Qi Ak< � �o a". I S" HMR "12 /IOOxT WV WRTHOATII RACI OlSpowncN of YLNIc L"ON ORDERS of: ©OFrICLR ❑oRrYEw [301-mot CuIT YO. OAT YEAR ❑ �f�+.PLc25 Tow Sio� 75 - 4y1`7 OTHER HOW r"ONa SiArr[SS MIONa PISOR MLCHAN/CAL DEFECTS: NONE Asf ARINT� REFER TO KIII -110 ( } ( CH►USE ONLY D[SUUaE VCMCLI DAMAGE SHAD[w DAMAGED AAAA IwA+C"CAAAR POUCY NUMa"R YENS I TY"HauA "I t OP JONS7'R"tT114011a"WAV _ SPEED ICF DOT a CA D ❑ Kx C3 MNOR Fuc❑ En awff S(2� E�8 S PARTY ORTYEI-z uc'Nsa NLNaEK STATI 7CLA34 SAFETI VDL YEAR MAR"i)dooELi COLOR LIfE NwSER TTAr. 3 6141Z-7$ DRIVER NAM"(FIRST.MIDDLI,LAST) ❑ TM,, = V PtOli STREET ADoac" OWNS""AMI ❑SAME AS OMY[.. TRIAX 9 bzlq SrLv�� _ X12 PAAKED CTTYI STATE 133 7 F OWNIRADORESa ❑SAME AS DRIVER Y[MICU ❑ SuESL.I.? Cme CA GI-t58S HCY• SEXHAIR EYES "WHYW MffTHOATl BALI DISPOfITioN Of YtMCLE ON ORDERS Of: ❑OFRCEA ❑ORfVEA ❑OTHER o M � a� 60 210 5 30 y"m DAY rs OTHER HOME►TION[ ausomss FNOt a PMOA IY[puJaCAL DEFLCTL. NON"AFPA ADIT❑ MEEK TO NARRAT'-YL ❑ ( CHP U31 ONLY DESCrat VEHICLE OAMALE s ADE w OAMAam ARE' VEHICLE TYFI NauRDlcfc7RnLR— ►DUCTNwalR DUNK. 11Notts0IaNOR MOO. 11 MAJOR El TOTAL OI OI ON fTREIT OR ManwAY f►t[O ►C7 DOT D CA D KC 13 Fuc D TRAVEL UAYr PREF AAtA1 HAw - --�.. r.,., OISPATCH NOTIFIED REVIEWC1 HAMS _ IOATIXwcD(`oCri-�`5 5r0 �oqZ b C3 YES Q NO E3 WA • � - / 37AT[O F CAU IO RNA TRAFFIC-COLLISION CODING , "..G[ *� DAT[OF COLLI3#ON ./ boo) MC7C NLNA&" r L D[ NUMB&A mo • / DAY 16 Y[AJ `t C•(�7 432DD `Dq6•W - 7%2 --}j OWN["NAMIJ ADDAM= - NOTWED PROPERTY �Y[7 []NO DAWIGE D[scwvna+OFDAYAcs SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLE L-AIR BAG DEPLOYED U I C BICYCLE-"a MET A-NONE IN VEHICLE -AIR BAG NOT DEPLOYED DRIVER 0.HOT EJECTED _ 1-FULLY EJECTED B-UNKNOWN M-OTHER V-NO 2-PARTIALLY EJECTED C-LAP BELT USED p.NOT REQUIRED W-YES 3-UNKNOWN D-LAP BELT NOT USED I-DRIVER 1 2 3 2 TO 6-PASSENGERS E-SHOULDER HARNESS USED PASSENGER. 4 S 6 7-STATION WAGON REAR F-SHOULDER HARNESS NOT USED CHLDRESTAAINT x-No -_ 8.REAR OCC TRK OR VAN G-LAP/SHOULDER HARNESS USED O-IN VEHICLE USED Y-YES Si-POSITION UNKNOWN H-LAP/SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED = 7 0-OTHERJ-PASSIVE RESTRAINT USED S_ IN VEHICLE USE UNKNOWN K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(•)SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTORTRAFF�CONTROL DEVICES 2131 TYPE Of VEHICLE 23 1 MOVEMENT PRECEDING LIST NUMBER (o) OF PARTY AT FAULT COLLISION + at A VC SECTION VIOLATED: a �p ACONTROIS FUNCTIONING APASSENGEA CAR I STATION wAPON X ASTOPPED �t23�-1 cl vG. c]NO B CONTROLS NOT FUNCTIONING IBPASSENGER CAR W/TRA1 B PROCEEDING STRkGH7 s B OTHER IMPROPER DRIVING C CONTROLS OBSCURED IC MOTORCYCLE/SCOOTE RAN OFF ROAD D N CONTROLS PRESENT/FACTOR D PICKUP OR PANEL TRU D MAKING RIGHT TURN C OTHER THAN DRIVER' TYPE OF COLLISION E PICKUP/PANEL TRU W/TRAILER E MAKING LEFT TURN D UNKNOWN IHEAD-ON F TRUCK OR TRUCK CTOR MAKING U TURN . E FELL ASLE077B SIDESWIPE GTRUCIC/TRUCK CTOR W/TRLR_ G13ACKING ZC REAR END H SCHOOL BUS SLOWING/STOPPING WEATHER( MARK I TO 2ITEMS) D BROAMDE I OTHERBUS I PASSING OTHER VEHICLE ACLFAR E HIT OBJECT J EMERGENCY ,J CHANGING LANES - B CLOUDY F OVERTURNED KHlGNWAY NST.EQUIPMENTK PARKING MANEUVER C RAINING GvEHICLE/PEDESTRIAN L BK:Y FIC ENTERING TRAF D SNOWING OTHER•: ER VEHICLE OTHER UNSAFE TURNING E FOG/VISIBILITY FT. MOTOR VEHICLE INVOLVED WITH PEDESTRIAN XING INTO OPPOSING LANE F OTHER-: ANON-COLLSIOM MOPED PARKED G WIND PEDESTRIAN P MERGING LIGHTING OTHER MOTOR VEHICLE TRAVELING WRONG WAY A DAYUGHT MOTOR VEHICLE ON OTHER ROADWAY OTHER ASSOCIATED FACTOR(S) OTHER•: B DUSK-DAWN E PARKED MOTOR VEHICLE 1 2 3 (MApK 1 TO 21TEMs) CDARK-STREETLIGHTS F TRAIN Avc 9"0""0": CfT[D -,4,10 DARK-NO STREET LIGHTS BICYCLE Dyu DARK-STREET LIGHTS NOT ANIMAL: BvcucnONwDLAnDN: cl, D FUNCTIONING H ❑Ya ROADWAY SURFACE SOBRlE77-DRUG FIXED OBJECT: rvc m 2 2 3 PHYSICAL A DRY IE3,n (MARK I TO 2ITEMS) B WET OTHER OBJECT: HAD NOT BEEN DRINKING ('.SNOWY-ICY `1 D D SLIPPERY(MUDDY,OILY,ETC.) E VISION OBSCUREMENT: B H80-UNDER INFLUENCE. HBO-NOT UNDER INFLUENCE' INATNTION' ID HBO-IMPAIRMENT UNKNOWN' ROADWAY CONDITION( TEPEDESTRIAN S INVOLVED G STOP j GO TRAFFIC E UNDER DRUG INFLUENCE (MARK I TO 2 ITEMS) A H ENTERING 1 LEAVING RAMP NO PEDESTRIAN INVOLVED I PREVIOUS COLllSiON F IMPAIRMENT-PHYSICAL' A HOLES,DEEP RUT• Cppgg( ,IK Vy pgSAU( IMPAIRMENT HOT KNOWN B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION UNFAMILIAR WITIi ROAD NOT APPLICABLE C OBSTRUCTION ON ROADWAY• K DEFECTIVE VEH.EQUIP.: urt D CROSSING IN CROSSWALK-NOT I SLEEPY/FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTIOM []POO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK I IL UNINVOLVED VEHICLE I I JAKAZARDOUS MATERIAL FLOODED• INROAD-INCLUDES SHOULDER X OTHER- G OTHER': I IF NOT IN ROAD NONE APPARENT I-{NO UNUSUAL CONDITIONS IG APPROACHING/LEAVING SCHOOL BUS RUNAWAY VEHICLE SKETCH S2� MISCELLANEOUS fRTM -K� DO T y >r _._�Q Cat N R —14C CHP — P3 , nA PD/S0 C:T OTHER — 'ATE OF_CALIFORr4a ljLQRE •/ WITNESSES'l PAStL SERS .AGE 3 AT'D OF C'DLUSION TIME RADD) NCIC NLBABEA OFFICER I.O. NUMBER 932-0 092- 7,1 'I'ITN ES3 ►As3wcER EXTENT OF INJURY ( "X" ONE ) INJURED WAS ( "X" ONE ) PARTY SEAT SAFETY ONLY ONLY AOE BEX FATAL SEVERE OTHER VISIBLE COMPLAINTNW BEA POS. EOVI P. EJB© INJURY INJURY INJURY OF PAW DRIVER PASS. PED. BICYCLIST OTHER �tt ❑ �6 ❑ ❑ ❑ ❑ I ❑ 29 1 ❑ ❑ 3 0 IAMER .O.B./AODRESB TELEPHONE I - 3 `c-,= Pc, IJ INJURED ONLY)TRANSPORTED BY: ., T TAKEN TO: I CA+— 'STA a, A�/Z AM4u4AJ�-E BIONL1�R {��Plrq� L.c�4L_I�*nT Cl�c }� )ESCAIBE INJURIES I r-AG4t. -79-A--4 LIJITLI EAACEW I ❑ VICTIM OF VIOLENT CRME NOTIFIED ott I ❑ r � r� ❑ ❑ ❑ I � I � ❑ ❑ I ❑ ❑ I � Irl � lo i NAME I D.O.&.I AOORESS TELEPHONE I �r-_L_ 'J c1= Cr (INJURED ONLY)TRANSPORTED BY: TAR EN TO- ' I f-c024",,j !"It�ICAL POJS�. ( A�'�+�1 �14L�LP uoSPITa� CoJcoa� I DESCRIBE rWUMES d,, /• 1 Tb C. ,i �I • ❑ VICTIM OF VIOLENT CRIME NOTWED �❑# ❑ .6M ❑ ❑ I ❑ � I ❑ m ❑ ❑ I ❑ Ir I3UIb I NAME I O.O.B.I ADDRESS TELEPHONE cyrc PA r �'�-z� �8) 508 6�ur: �,2 aa-;)oc:: C.a 945Dq j JNJUAED CHL Y) PANS PORTED BY: TAKEN TO:� I L , M R T laE� OESCRBE INJURIES I ❑ YICTIM OF VIOLENT CRME NOTJ140 ❑ ❑ i6M ❑ ❑ I E& ❑ ❑ EL4 ❑ 11 El c o I NAM{;D O.Z/AOORESS TELEPHONE L F4QLDu I•; - �1 -7 Q� .2503 }-�vMPre,.� C�..�-r)o��: CA Q'-�Sdi' S10 7� -�rq i 9NJURED ONLY)TRANSPORTED BY: TAKEN TO: AMR Ms o,Ast-o OESCRIBE RUURIES T ) ❑ VICTIM OP VIOLENT CANE NOTiRED ❑tt ❑ �s F ❑ a'- ❑ ❑ ❑ ❑ ❑ I 1 6 o NA E.O.O.B.:ADDRESS TELEPHONE (l"1T i - 61�-m jaz CA gL+S53 510 zzg- 83 ),NJUREO ONLY)TRANSPORTED BY: TAX EN TO: MAP, MT �4Pt_O DESCRIBE INJURIES ❑ VICTIM OF,1CLENT CRIME NOTIFIED ❑tt ❑ 1.5 ❑ 7 ❑ ❑ ® ❑ ❑ ❑ 1 1 15 o HAMS I O.O.M.I ADORE&S TELEPHONE F-(2- 5-�� -7�t (v,T Vi I"14�TtA.) CA Li�i553 310 ONJURED ONLY)TRANSPORTED BY: ITARE TO: AWL �Q OESCR&E INJURIES CD I-J O /Q ❑ VICTIM OP ML04T CRME NOTIRED /AV FIRER'& l 1.0.MLOA&IR M0. DA♦ YEAR REVIEW I"NAME MO. DAY TL CHP 555-Page 3(Rev. 7-87) OPt 042 87 »- STATE OF CALIFOdNPA INJURED / WITNESSES,/ PASS' 'GERS _ PACE DATE QF COLUSION TIME(2A00) IC NUMBER OFFICER L0, NUMBER /-2NC 5 .ZD /09.2 7-20 EXTENT OF INJURY ( "X" ONE ) INJURED WAS ( "X" ONE ) WITNESS PASSENGER ACE SEX PARTY SEAT SAFETY ��� ONLY —LYNUMBER POS EOIEP, FATAL SEVERE OTHER VISIBLE Com PLAINT WJURY INJUEEY INJURY OF PAIN DRIVER PASS. PED. EIlCYC:J57 OTHER 11 c tt ❑ 6i rt El ❑ 11 El 111 El11El t NAME I D.O.B.I ADDRESS TELEPHONE Ca 9y565 (INJURED ONLY)TRANSPORTED BY: TAX EN TO; DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ ❑ ❑ ❑ I ❑ lo 1 ❑ ❑ 1 1 1 1 NAME 10.0.13.1 ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTFlE: ❑x I ❑ i ❑ ❑ ❑ ❑ I11 ❑ ) ❑ i ❑ I NAME/O.O.B./ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAX EN TO: CESCRBE INJURIES VIC.,M OF VIOLF.rT CXME V07PE: ❑� ❑ I ❑ ❑ ❑ ! ❑ 101 ❑ ❑ 1 ❑ 10 1 1 1 NAME I O.O.S./ADDRESS TELEPHCIIE JNJUREO ONLY(TRANSPORTED BY: TAKEN 70: DESCRIBE INJURIES VICTIM OF VIOLE`r,CRME NCTIPE: ❑tt ❑ ❑ ❑ -I ❑ ❑ ! ❑ i ❑ 1111 ❑ 1:11 . NAME•0.0 B..ADDRESS TELEPHONE (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRIME NOTIFIED ❑� ❑ Cl ❑ ❑ ❑ I ❑ ❑ ❑ ❑ I ❑ I If NAME/O.O.L/ADDRESS TELEPHONE ONJUREO ONLY)TRANSPORTED BY: TAXEN TO: DESCRIBE INJURIES VICTIM OF VIOLENT CRME NOTIRED PREPARER'S NAME 1.0.NW EER OAT TEAR REV IEwER9 NAME MO. DA1 MO,7 — � - CHP 555-Page 3 (Rev. 7-87) GPI 042 ]TwTC 7r Gwllr Owhlw FACTUAL DIAGRAM S Dw T< Cr GO tLISIGw I (S.Oe� MCIC Mu[w,.�]C rw� Or Qw]I.�O. MU M�7.Cw,,/ u o. 7 o w r /V LL r.. /4 f I.�. {J'�(l I �� /^'C7 / ',�L.{p •• ¢ ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE - �/4SANAlT �¢o�CW�ly) 3 IAf , OICATC '' Wf11TC EDIa� i.�vE . © f..�QC 5���� QETOI IJ I�T wA1,.L. - �?`•'\ 'c. � t 7 �EN�Gc� Lorin raor\J - a�•� ,sFr s/oF /� 3 Fr 4AA0 f Xr:_ Z/00&, �f-Z �F Cvycclw 7�0 r'r vJ�f. 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PREPARER'S NAME AND I.D.NUMBERDATE T�� S NAME DATE Use previous editions until depleted. 90 5>"1.41 STATE OF CALIFOnN!A NARRATVE/SUPPLEMENTAL CHP S56(Rev.7-90)OPI 042 Page 10 ' DATE OF INCIDENT/OCCURRENCE TIME 12400) NCIC NUMBER OFFICER LD.NUMBER NUMBER -t -q 12 43 Zo o `7-.20 . -X'ONE ' X'ONE TYPE SUPPLEMENTAL fX-APPLCABLE1 Narrative ®Colfision report C] GA update ❑Fatal Cl Hit and run update ❑Supplemental ID Other: ❑Hazardous materials ❑School bus ❑Other: CrrY/COUNTY/JUD,CIALOISTRICT REPCRTINGDISTRICTBEAT- CrrATYJNNi.RleF_p !LOCATIOWSUBJECT STATE HIGHWAY RELATED ❑Yes ❑No 2, SuMM.4AaV COLLd 6J 41 A,14-5 C�V✓/�/(1- I�/ `7'Q D- 3 -S,�-7' of /L��� /AJ T;,lE �. 46.JE . !,✓� T.P,Q VEL 1J�J(r •`�r4G�,X' 1 4 -75 M IAW At-o-)L- 41 t1 G A/JD•rH ClZ ✓5J4►C1-�. W4c,r j rdA4CM /,.1 7I C x .Z trg�JC • 4- 3 WAS .S rq�D,A 0 -) OCE s. 4k,Z., t/•l t✓4 5 5 rt�4�E 7. 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IMPAC--r l.,>IT)" 31. 17an,-A J T�> - PREPARER'S NAME AND I.D.NUMBER DATE REVIEWERS NAME OATS S �09�6 7.1a-9 Use previous editions until depleted. 90 57541 ST:,TE OF CAI IFORNIA NARRATIVE/SUPPLEMENTAL CHP S56(Rev 7-90)OPI 042 �` "y Page 1.r DATE OF INCIDENT/OCCURRENCE TIME(-1400) NCIC NUMBER OFFICER I.D.NUMBER NUMBER -7-/6- 9y 0/�5 + �i3zo 09 X-CNEX ONE TYPE SUPPLEMENTAL rX-APPLICABLE) r�Narrative Collision report ❑SA update ❑Fatal ❑Hit and run update ❑Supplemental ❑Other: ❑ Hazardous materials ❑School bus ❑Other: CITY/COUNTY/JUDICIAL DISTRICT REPORTING DISTRICT GEAT CITATION NLMBER LOCATION/SUBJECT STA i.H HWAY RELATED ❑Yes ❑No 1. 6kL,As� Cc>JT' T- t S V-2 T 2. - SA r _ 3. tT< 7 rJ K -vZ S IL,r4T TGi60A-5 1,J 4. �T �i�t►W i T WA b ALAL Lam, pnJ � !�`!� LtLr+1 i,ABCs- G4, t E L`�.), 1T I F 5. Tta� = T1JG G�LL_15,n.J , �i-5cAFJ L Q< 6. 7. 9. ,1 10. - C, 6 FEE CC- 11. 'p T=tL p A64,A36; - l ►= 2 1bLATI0rJ f .2-Z34'Ci VC- , 12. 13. 14. 15. 16. 17. 18. 19. : 20. 21. - 22. 23. 24. 25, 26. 27. 28. 29. 30. 31. PREPARERSS NAME AND I.D.NUMBER DATE REVIEWERS NAME DATE Use previous editions until deleted. ao sus+, (c- 12— O,PA RT1I elIT Or CALIr Ow NIA MION\IAY PATROL ACCID,NT NVMR¢R ACCID<NT IOCATi AG CID,NT DATA T,ST SKID DAT, SKID-SPEED INFORMATION -206 SQ`I �6 L'fF&"� 7-16-Q`� { ROAD CONDITIONS ACCIDENT SKID DATA CENTRIFUGAL SKID TY r,r�r ROAD Y - L,NOTN �j." LOGK HD WH(EL TOTAL 2 D9 CONDITION _ _- , R�,• K/(] f�p CN ORD I�Avr`1 LCl� C7[7v� t.n. �0 1 .2 C 7 ree �o� ORDINAT< ORAD,/DIR,CTION � _ R.n. AccID, T V,NICLa (year, make,model) LD" "T ONCIT /}'�:ti'\� iii\•\•:':V/:�:•.G f'GY' V� I V S�Q�fJ� K �.h�1 TEST SKID INFORMATION NO. MPH F. R.F, L.R. R.R, LON afi ST DETONATOR OTHER DATA D TANG DRIV,R I.D.NUwBER V,NICL,LIC.OR <DUIP.NO. MAKE YEAR/MODCL 7.. ACTUAL SPC,D DATE CALIBRATCD RADAR 5PS:QD 3. METHOD SKIDMARKS MEASURED WEATHER(teMp.) TIME MINIMUM SP<,D 'ROM _ I �CHART (over) ACCIDENT FT�7T.,. ACCID<NT T<ST ACCIDCN JIKSTX11TAP, ROLATAP< DOTN,R Q ROLA TA P< O OTN,R 1 ZJ INV,STIGATINO OW11C,R—ACCIO,NT I.D.NUMO,R ]C011, Or rRIC110N 3^<,D SKID 0-1ceR I.D,NUMQ,R Ste.-•._ DRAG SLED DATA SLED I PULL W,IGNT ORMULA CALCILAT<D CO,r. �"UliTICIT TAB'_, ADJV Si<O CO[rrICI,NT IrLCD WT. I ♦ - NC4.Tr-i Wc,77 S CALCULATIONS/DIAGRAM V = 3o P� �5,-,n•�a;`� f�'^p'c_T SF�.� �DMau� (3a� o..� /'- I s SraTcr^cr>> a,x� vrr11L� DAn. -sal V:= h`38a1 = �E, rt 'tom V- 6G,z.5 (SPH .V__V J� 77.-31 MPh SY-MBOLS FORMULAS EXAMPLE: C NTRIFUGAL SKIDMARK (—co<rrlcl<Nr or rRICT10N c—cnoRD (►rl j- Y��JJ R c° . ^I c wIDDLe ]Vw SIR V—SP,Qq (MPNI m—MI D.OROIN AT, 1 l_ d—SRIo I,¢naiN (rT( R—RADIUS (r T( sa' cN ORD CHP 125 (Rev 7.R61 OPI 031 Destrov editions prior to 12.81 EXHIBIT 2 AT�TORNNEEY OR PARTY WITHOUT ATTORNEY(Namf d Address): TELEPHONF "O.: FOR COURT USE ONLY Thomas M. Hagler CA Bar ' _ 6072 (707) 447-4300 ' HAGLER & NELSON 555 Mason Street, Suite. 290 Vacaville, CA 95688 - ATTORNEY FOR(Name): Larry Moran SUPERIOR COURT OF CALIFORNIA, COUNT`( OF SOLANO STREET ADDRESS: 600 Union Avenue MAILING ADDRESS: P. 0 . Caller 5000 CITY AND ZIP CODE: Fairfield, CA 94533 sir7 t,i l CBRANCH NAME: -t' '.----. _.... —. ONSERVATORSHIP OF THE ® PERSON ® ESTATE OF(NAME): I Jimmy Dale Van Proposed Conservatee i CASE NUYSER: DECLARATION OF MEDICAL OR ACCREDITED PRACTITIONER 1 I, (name): Thomas Leonard, M.D . hereby state: 1, a. 0 I am a duly licensed medical practitioner, and the proposed conservatee is under my treatment. My office is located at(address): 190 Hospital Drive Vallejo, CA. 94589 b. Cj I am an accredited practitioner of a religion whose tenets and practices call for reliance or prayer alone for healing, which religion is adhered to by the proposed conservatee. The proposed conservatee is under my treatment. My office is located at (address): 2. The proposed conservatee is unable to attend the court hearing on the petition for appointment cf a conservator set for (date): September 30., 1994 and will.continue to be unable tc attend a court hearing until (date): CI for the.for_seeable future because of medic-a; inability. Supporting facts are stated below ® stated in attachment 2. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and c ect and that this declaration is executed on (date): .8_25_94 . . . . at(place): .190. Hospital. Dr.. a.l le 1 ., CA (Signature of declarant) Thomas E. Leonard , M.D. Emotional or psychological instability shall not be considered good cause for the absence unless, by reason of the instability, attendance at the hearing is likely to cause serious and immediate physiological damage to the proposed conservatee. Form Approved by the Judicial Council of California DECLARATION OF MEDICAL OR Revised EfiGC-335(81�ary 1,1981 ACCREDITED PRACTITIONER DECLARATION OF MEDICAL OR ACCREDITED PRACTITIONER IN SUPPORT OF PETITION FOR APPOINTMENT OF PROBATE CONSERVATOR OF THE PERSON AND ESTATE OF JIMMY DALE VAN THOMAS E. LEONARD. M.D. A PROFESSIONAL CORPORATION INTERNAL MEDICINE AND CARDIOPULMONARY DISEASES 1 90 HOSPITAL DRIVE VALLEJO. CALIFORNIA 94589 (707) 552-6383 August 25 , 1994 Thomas M. Hagler Haglar & Nelson 555 Mason Street, Suite 290 Vacaville; CA 95088 RE: . Jimmy Dale Van Dear Mr. Haaler: Mr. Jimmy Dale Van is being followed by me at the Springs Road Living Center. His diagnosis is Status post multiple head trauma, Vegetative state. Mr. Van is permanently and totally mentally and physically disabled. Sincerely, Thomas eonai, -, .D. TEL:njp Attachment: Declaration of Medical Practitioner CLAIM l `� BOARD OF SUPERVISORS OF, CONTRA COSTA COUNTY. CALIFORNIA 91 February 14, 1995 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 Mount: $605.96 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: California State Automobile Association , Inter-Insurance Bureau _ , JAN $ 1995 ATTORNEY: Claim No. 07—K269474 Date received COUNTY COUNSEL ADDRESS: 1700 Somersville Rd. BY DELIVERY TO CLERK ON January 17, 199YARTiNEZCAUF. Antioch, CA 94509-0951 BY MAIL POSTMARKED: Hand Delivered Via: Risk Mint. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p DATED: January 18, 1995 tgIl BATCHELOR. Clerk 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( "'This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( Other: Dated: / / BY: / eputy 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). 1V. BOARD ORDER: By unanimous vote of the Supervisors present (✓] This Claim is rejected in full. ( )' Other: I certify that this is a -true and correct copy of the Board's Order entered in its minutes for this date. Dated: FEB 14 19 PHIL BATCHELOR, Clerk, By &A Ou Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now. and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California. postage fully prepaid a certified copy of this Board Order anb Notice to Claimant, addressed to the claimant as shown above. FEB 15 gA Dated: BY: PHIL BATCHELOR by4LJp Deputy Clerk CC: County Counsel County Administrator 041-c c .)..Nv jaded tr6.__6 T-.4:T (E6'47 OL-4 California State Automobile Association 1700 Somersville Road Antioch, CA 94509 -0951 Gs,,,• 1a5,•�e California State Automobile Association ife As <*> Inter-Insurance Bureau January 13, 1995 RECEIVED Ron Harvey, Risk Management, 6th Floor Contra Costa County 651 Pine Street 1 .7 1995 Martinez, CA 94553 W CLERK F SUP Vi ONTRAC COSTA CO- Re: Re: Our Insured: Webber, James E Our Claim No.: 07-K269474 Date of Loss: 122-19-94 Your Insured: Your driver: Steve Bridges Your Claim No.: Dear Mr. Harvey: This is notice of our subrogation interest arising from this loss. We have arranged settlement with our insured. Please make your payment directly to the California State Automobile Association Inter-Insurance Bureau(CSAA-IIB). Attached are itemized bills to substantiate our subrogation claim. Repair Bill 556.19 Loss of Use 30.00 Tow/Storage Miscellaneous 19.77 TOTAL 605.96 Your driver struck rear of our insured's stopped vehicle. Our insured has reported an injury. Sincerely, _.._.L ine o re laim Representative 510 754 2210 extension 243 1 7 0 0 S O M E R S V I L L E RD . A N T I O C H , CA 9 4 5 0 9 - 0 9 5 1 ( 5 1 0 ) 7 5 4 - 2 2 1 0 F1114(5-93) Clair. For Damages In accordance with Section 910 of the California Government Code, this is to formally place you on notice of our subrogated claim for the loss described below. Date: 1-13- • , California Claim is hereby made and filed against the County of Contra Costa as follows: Insured/Claimant's: James E Webber California State Automobile Association Inter-Insurance Bureau ADDRESS OF CLAIMANT(SEND NOTICES TO THIS ADDRESS) REFERENCE FILE 07-K269474 DATE OF OCCURRENCE 12 19 94 PLACE OF OCCURRENCE C1nvton NATURE AND AMOUNT OF DAMAGES(IF UNDER$10,000)INCLUDING ESTIMATED AMOUNT OF ANY PROSPECTIVE CLAIMS Body Dama e to rear of insured vehicle, along with rental expenses and out of pocket rental for ITEMS MAKING P SAID AMOUNT AND BASIS FOR COMPUTATION OF AMOUNT CLAIMED Mr. Webber Rena;r 556.19 CSAA Rental 30.00 Insured rental 19.77 NN TURF OF DAMAGES(IF OVER$10,000)-NO DOLLAR AMOUNT TO BE SHOWN(§910(f)GOVT.CODE) COURT HAVING JURISDICTION(CHECK ONE) ❑ Municipal Court ❑ Superior Court NAME OF PUBLIC EMPLOYEE(S)CAUSING SAID DAMAGE(IF KNOWN) Steve Bridges/Contra Costa Fire Dept Facts and Details of Occurrence/Transaction: Insured stopped in traffic on Northbound Kirker Pass when Mr_ Bridge's veh;rle struck & damaged rear of our insured vehicle. Mr. Webber is also r=nrt-ing an injury r1a;m_ The amount indicated on this form doesn't included Mr. Webber's Anil f r inj11rW, he'll handle di ec ty with Contra Costa County. California State Automobile Association Inter-Insurance Bureau Lorraine Moore By: F1688(Rev.7-90) ��_• Assi nment of Claim and Subrogation Agreement p California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned ofthe sum of Six Hundred five and 96/100---- a sum estimated to be ------------------------------------------------------------------------------------------------ Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number K269474 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- 19th INSURANCE BUREAU, said loss and damage having occurred on or about the day of December19 94 , the said undersigned hereby assigns and transfers to said Bureau�605.96 said claim in the above amount plus additional claim for damage resulting from said accident, not covered under said pol' of insurance, in the amount of$605.96----------- , constituting IN a total claim Ela total estimate in the amount of$ 60 . ------------ Said Bureau is hereby subrogated in James E Webberplace and stead to the extent of the above amount of the said total claim and is hereby authorized and empowered to sue,compromise or settle ildames E Webber name or otherwise to the extent of said total claim for loss and damage,and to endorse in my name any check made payable to me therefor,and collect and receive any money payable thereby. The undersigned covenants that ha not released or discharged any such claim or demand against such party or parties and that will furnish to said Bureau any and all papers and information in posession, necessary for the proper prosecution of such claim. Dated at this day of 19 WITNESS F1433(Rev.12-89) jJ" EAS03- j JAN 9 '95 Received it- -Car 4 �y 1717107 -- --- -- ----- AI000 pp_ EDGAR WEBDLR' 05-152 AIR CAR 1 cMI�I' ..... CAFtNO. .... Color... �',1�1 � D E P. Lic.No. Lic.No. —�4 1111111 Ig�qqgg.''. IIVtrJOOU l_lu- - --- (�t ��.L_EY OUT 1-02- 5 D L TY.Ib.59 OUT Date -�---Time -- 941,:P61-1611 till-625-122.19 29 IN_ D&I -03-95 T'Tt28 IN Date Time Mileage 1' - LF Mileage Ending Ending PHONE Mileage 1 4 Mileage Beginning Beginning - - '----- ------ ----- --._._. ---- --- -TOTAL- .. ...... �' TOTAL. ............ .... ..._-.-....-- -- ------- 0RRD M&T ..�--`---- --- IPd000 GASLEVELI Or'1CJ 011t : F GAS LEVEL 2' U oe O r^i g In: -t= E 1/8 2/8 3/8 4/8 5/8' 6/8 7/8 F' E 1/8 2/8 3/8 4/8 5/8 6/8 7/8 F sF 1�-- --- - MAXs --15. 001 3 1•)AYS DATA 0 IME�tiRD _ - ---- ----- g�113?^�/TYPE DODGE- RAM $ 19. 77 y Mies @0 0 a 0 . Ijll)I r L1N1� ccT FIECK Hours @ PER DAY FREE MILES DAILY ...... . PER MILE AFTER ..... DATE I METHOD ._......_. r PER WEEK ____._____. FREE MILES WEEKLY �.—___PER MILE AFTER - — C d y ZI $ 1 5. 0" _PER FREE MILES --PER MILE AFTER t CG# RENTAL DISCOUNTS. ' El 24 HOURS DAY ElADD'L HOURS @ BE RETURNED BY - - ---------------- ON_----- DATE SUB TOTAL 4 4, . 9 8 UALIFY FOR ytTHIS SPECIAL RATE--OTHERWISE IT REVERTS TO THE r. — A�1T64,F/tL.t i�i' t,E159 E x p i r•a s 04-96 $ Sales .7a Zt�71iC r4� - CC# Refueling �++ 00 k 00 i'F 03-95 -- ----- 1 .Amts Tot 1" . $19. 77,1 LBw 6,..)C) / - 30. 0 .SPECIAL INSTRUCTIONSI Authorized AUth Codi . 002060 Aw At_tth Alnt 150.00• 4co. '77 _....-- ...._..._..._-------- ---------—------ _ Less Depcsds J.9. 7 _ _ ••' +r r '. CONCORD—MONUMENT:°p mt.Blisd O—� California State Automobile Association Inter-Insurance Bureau 2 o (50.0 Q$ ,.. Q79.1 ._,7....R Lp$& !� Lg1�4� ,t� 7 hJg�f�[y$�NFye{� {I- 7� )F,I.M-n4 C1J7'--K V9�•I•7' 4 11C.1:11:Y M.- I J�AML_,, E � DA�J I.'-10-..-(.�5 Tp(PE KINOOFLOSS SMF CLAl�tar(rrM-I�, JA11F..'a,f. PAY $30. 00 z� IIJJ ll VV,,..33 t _ r S/4. IN.iJ.L V�/1.1 x705 .. Through m D I J J Renk of America NTBSA 11=35 O-n San Francisco Commercial Banking 1210 O- ry `!� 345 Montgomery Street Z 3 '7 f I I Ei ��11 TY \JD I�.(aC]st San Francisco,CA 94104 1 M m mm I r'IIV: , [74- 17:17afJ7 -- mM STANDARD RENT A CAR INC' mm 1.945 N f=l Nr.:; 97• STE /+n116 ' o E { R E..GIV O D A 937.27 4A11TR SIINTURF J.1 V/�l 171 'i 1 1150 3 2 3 70008u' 1: b 2 L000 3 58P: i 2 3 301119094811' .r-mac..--,.,__•�.-•�.�_=�.�—:���.�_—:�:�.—•� ,_± PRINT T=5455 L=T5455 OPER= 1/12/95 14 : 53 :45 AINQ-10 AUTO CLAIM MASTER SUFFIX INFO 5455 INSD: WEBBER, JAMES,E CLM-NO: 07-K26947-4 DOL: 12-19-94 SFX CLMT KOL DO REP CB-RESV CB-OS-RESV STAT O1 INSURED COL CON 18329 1670 . 00 1113 . 81 OPEN STR: 5237 IRONWOOD LN CITY: OAKLEY ST: CA ZIP: 945610000 SUBRO ARB SALV MP-TRST LIT X-INSD-POL-NO L-P OPEN L-ACTY-DT: 12-21-94 CUM-PMNTS : 556 . 19 COV: 250 NO PAYEE DO REP FOR DRFT-NO DRFT-AMT ISS-DT DTC BK O1 *M & T AUTOBODY & PAI CON 17163 17163 L2422545R 556 . 19 12-21-94 F B 28 01=INQ-MENU 05=CLM-MSTR 10=SFX-INFO 20=RECOVERY 28=INSD-VEH SFX: 01 / 03 NEXT-ID: NEXT-DOL: Estimate ID: 845 a5 *� Committed Profile ID: Mitchell Standard M & T AUTO BODY 2291 VIA DE MERCADOS CONCORD CA 94520 (510) 685-2294 Damage Assessed By: MARK AZEVEDO Appraised For: CSAA Concord Claim Number: 07-K269474 Insured: JAMES WEBBER Address: 5237 IRON WOOD LN OAKLEY CA 94561 Home Phone: (510) 625-0929 Mitchell Service: 910520 Description: 1990 DODGE CSTM 250 P PICKUP VIN: 187KE268XLS639286 License: 4806611 CA Mileage: 57,309 OEM/ALT: 0 Color: WHITE Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type_ Operation Descriotion Part Number Amount Unit 1 052220 REFIN REFINISH R SIDE PANEL OUTSIDE 1.5* 2 053020 BODY REPAIR *R PICK-UP BOX SIDE PANEL 0.5*# 3 AUTO BODY OVERHAUL REAR BUMPER ASSY 0.8 4 061970 BODY REMOVE/REPLACE REAR BUMPER STEP TYPE BAR 55029883 350.00 INCL 5 933002 REFIN ADD'L LABOR CPR CLEAR COAT 0.5* 6 936008 ADDIL COST PAINT/MATERIALS 34.97* * Judgement Item # Labor Note Applies _ I. Labor Subtotals Units Rate Totals II. Part Replacement Summary Amount Body 1.3 48.00 62.40 Taxable Parts 350.00 Refinish 2.0 48.00 96.00 Parts Adjustment 5.00% 17.50- Labor Subtotal 158.40 Sales Tax a 8.25% 27.43 Labor Summary Totals 3.3 158.40 Total Replacement Parts Amount: 359.93 III. Additional Costs Amount I. Total Labor: 158.40 Taxable Costs 34.97 II. Total Replacement Parts: 359.93 Sales Tax a 8.25% 2.89 II1. Total Additional Costs: 37.86 Total Additional costs: 37.86 Gross Total: 556.19 Customer Allowance: 0.00 Customer Responsibility: 0.00 Net Total: 556.19 ;TIMATE RECALL NUMBER: 12/20/94 09:50:56 845 itchell Data Version: DEC-94 A Copyright (C) 1990, Mitchell International Page 1 of 1 All Rights Reserved - AW - .v_v . — — INSURED ``!!""4��''® California State Automobile Association Inter-Insurance Bureau v CLAIM OR POLICY NO. DATE OF LOSS ❑ INSURED / CLAIMANT ❑ CLAIMANT FROM FILM El NEGATIVE fi UC� ❑POLAROID DATE HOUR ❑A.M. ❑P.M. BY LOCATION PLEASE ATTACH PHOTOS WITH SCOTCH TAPE MAKE OF CAR—Y40 LICENSE NO. DATE HOUR ❑A.M. BY LOCATION MAKE OF CAR—YEAR LICENSE NO. DATE HOUR ❑A.M. L BY - LOCATION MAKE OF CAR—YEAR LICENSE NO. P1440,Rdv 9.91) Photo Page INSURED California State Automobile.Association Inter-Insurance Bureau Orn/V4/ CLAIM�O-7R�POLICY NO. DATE OF LOSS ❑ INSURED 0/ — ct4-7 ❑ CLAIMANT CLAIMANT FROM FILM El NEGATIVE ❑POLAROID I y DATE i HOUR ❑A.M. C BY LOCATION I I MAKE OF CAR-Y40 �� ! LICENSE NO. cone, I 1 DATE HOUR ❑A.M. ❑P.M. BY LOCATION MAKE OF CAR-YEAR LICENSE NO. 1� DATE HOUR ❑A.M. BY j LOCATION i 1 I MAKE OF CAR-YEAR + LICENSE NO. F 1440(Rev.9.91) CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFORNIA February 14, 1995 9 a Claim Against t1he CvuW"y, 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: $100,000.00 Section 913 and 915.4. Please note all • ruin CLAIMANT: Robert Cole JAN 18 1995 ATTORNEY:- COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 548 Palms Dr. BY DELIVERY TO CLERK ON January 17, 1995 Martinez, CA 94553 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. DATED: January 18, 1995 �qll �ep�iyLOR. Clerk �„ 11U.41 ll. 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 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �� BY: �/✓�- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a -true and correct copy of the Board's Order entered in its minutes for this date. n� Dated: FEB 14 1995 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in flartinez. California. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant asshown above. Dated: FEB 15 1995 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim 'to: BOARD OF SU.PERVI!WRS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADQ T 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 319 19879 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 4911.2.) 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. J 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 or! . f f 9 • • 9 9 0 • • * i f ; 9 • f ! f • f a • • a 0 0 i 9 0 0 • i ! • * f � ! � • • • RE: Claim/By ) Reserved for Clerk's filing stamp S � - r�►� ��- RECEIVED Against the County of Contra Costa or ) .IAM I TIM 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 $ /00, Un O and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exalt date and our) S Ccs )— wzyz �,,,� c� 2. Where did the damage or injury occur? (Include city d county) 3. How did the damage or injury occur? (Give full details• a extra paper f required) / 6>7 SS{ P�-04C_C_* lq,.�f c.-C /00S-(V 0L�- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? It 5. What are the names of county or district officers, .pervants or employees causing the damage or injury? Ot A4 5. What damage or injuries do you claim resulted? (Give Hull extent of injuries or damages claimed. Attach two estimates for auto damage. 61 V A 0 7. How was the amount claimed abovecomputed? (Include the a imated amount o any n prospective injury or damage.) " pe, ,)Z) Cc; 6 Liz, ���zeWcfi ' B. Namesrr rraddresses /Ioftwitnesses, do rs and hospitals. LU 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 1�i rrA S / i1-6st S i • • e e e e s f e *s `e �i� iie_ e�`i� e �s e f e • �t e • • e �t f s • • f f e f • • e fay Gov. Code Sec. 910.2 provides: "The claim be signed by the claimant SEND NOTICES TO: (Attorney)---l . orb a perawl on hia behalf." Name and Address of-Attorney ° -7-Claimant's Signature Paco, _ A ss 4V+(A 7- 5`, Telephone No. Telephone No. ef • ss • e * • as • * * tof see 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 ($19000), 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 Doth such imprisonment and fine. crs Cd • o- ��y" " CLAIM BOARD 01' SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 14, 1995 Claim Against the County, or District'governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,000.00+ Section 913 and 915.4. Please note all •Yar�}ngimm A II�W CLAIMANT: Suzanne de Gregory JAN 2 b 1995 ATTORNEY: COUNTY COUNSEL Date received MMTiNEZCAUF. ADDRESS: 9 Avenue Roi Albert BY DELIVERY TO CLERK ON January 25, 1995 06400 Cannes, France BY MAIL POSTMARKED: -January 19. 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. r" IL BATCHELOR, Clerk O QJ DATED: January 26, 1995 : Deputy 1I. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (t/f This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying Claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: &U4X, Deputy County Counsel III. FROM; Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: FEB 14 1995 PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) subject to certain exceptions, you have only six (6) months from the date this notice was personally served or feposited in the mail to file a Court action on this claim. See Government Code Section 945.6. fou may seek the advice of an attorney of your choice in connection with this matter. If you want to consult m attorney, you should do so ieeeedistety. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all times herein aentioned, have been a citizen of the fnited States, over age 1B; 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 Claimant, addressed to :he claimant As Shown above. rated: FEB 15 1995 BY: PHIL BATCHELOR by JA Deputy Clerk :C: County Counsel County Administrator IC �..: 1 MAI L�l MIT LUFTPO - r0 SI1:A i ,� � ., o 10 40 �17` AW AdEr AV AV ® '® 0 Sl� AAWW :` 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 January 26 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Suzanne de Gregory 9 Avenue Roi Albert 06400 Cannes, France RE: CLAIM OF: Suzanne de Gregory 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. [x] 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. [] 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: January 26, 1995 at Martinez, California. i 4 Cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) Norman et Suzanne de GREGORY Residence Albert ler 06400 CANNES – tt TEL : 93.43.38.461 JAN 2 4 IM �� �i C.`.o.tQ �•�Afr. �� L � f'� Z4f,.,•cGL elvl+u- C-i'}—tj Cl')::1TY la�R' Q• , ,�Tlf, - *PA) c Q s A,. s `c� �. cry t - 0. C--{-s &A-L LaiJ p.H re. t tQ vizi'Do- doe G<- 1M �o C�._ rrv��. 2.JA►Q k.I7 lam'` (,�eQQ oma, t� e, �4�0%lft UerQ"di -oJ4, w �°'' adder 1 314 - t W+- ��r`tom s�{�,•S(-� 0. ��M'r'A o�Q �2,h.'� � 9 .-�,e,.�h-'�A�` 9 cin-,.�.�d �.�-�►c. �.�. �I-� aec,dam- J�cwe,lo A.to rm c Ogtll t,ms e� cam; - RECEIVE® AN-4 5 1995 CLERK BOARD OF S 'PERVISORS car3rt;A cesTA ca. R E C E d"VE® CONFIDENTIAL 2 5 995 COUNTY COUNSEL'S OFFICE JAN CONTRA COSTA COUNTY MARTINEZ, CALIFORNIA CLERK�ON7 ACOS A CO. MEMORANDUM Date: January 25, 1995 TO: Jeanne Maglio, Clerk of the Board of Supervisors FROM: Victor J. Westman, County Counsel By: Gregory C. Harvey, Deputy County Counse RE: Claim of Suzanne De Gregory Please treat the attached letter as a claim. STATE OF CALIFORNIA — STATE AND CONSUMER SERVICES AGENCY PETE WILSON,Governor C 111. state of Department of Consumer Affairs 400 R STREET, SACRAMENTO, CA 95814-6200 (916) 322-0551 December 21 , 1994 Ms. Susan De Gregory 9 Avenue Roi Albert 06400 Cannes, France Dear Ms. De Gregory: Gover^or Pete Wilson has received yo,, r Correspondence regarding a billing issue with Delta Memorial Hospital in Antioch, and has referred your letter to the California Department of Consumer Affairs (DCA) for research and response. The Medical Board of California (Board) licenses and regulates physicians, surgeons and other related healing arts practitioners. The Board also initiates investigations of complaints against physicians and surgeons and, if necessary, submits cases to the Attorney General's Office for legal action. The California Department of Health Services (DHS) has jurisdiction over the certification of hospitals in the state. I have taken the liberty of forwarding your letter to the DHS Divisicn of Licensing and Certification for their review and possible action. You may contact them directly regarding the status of your complaint at: Department of Health Services Licensing and Certification 1800 3rd Street Sacramento, California 95814 (916) 445-2070 In an attempt to mediate your complaint, a member of my staff contacted Petra D11CU11, LITeCwIivi FaiiCiii AcCvit11tu1g at Della .v..,..a.,rlaa iiOSli:tai. MS. 1)"..aOP. was genuinely concerned about your dissatisfaction with the hospital and offered to address your concerns and attempt to resolve the issue. She explained that your statement shows no record of a health insurance provider and your account has been paid in full. Ms. Dixon asked that you contact her with questions or concerns at: Petra Dixon, Director of Patient Accounting Delta Memorial Hospital 3901 Lone Tree Way Antioch, California 94509 (510) 779-7200 Ms. Susan De Gregory December 21 , 1994 Page Two Your concern with California Emergency Physicians, a separate medical group, seems to be the cost of the treatment, not the actual standard of care. Many factors are considered in the costs for medical treatment. The facility was obligated to provide you with an itemized billing, which you submitted with your complaint. State agencies have no jurisdiction to regulate costs for medical treatment facilities. Your correspondence states the reason for your injury was an accident which occurred as a result of inadequate sidewalk repair in the City of Antioch. If you have not already done so, you may wish to fiie an accident repuit whit Contra Cusia County. They can be reached at: Contra Costa County Counsel Michael D. Farr, Deputy County Counsel 651 Pine Street, 9th Floor Martinez, California 94550 (510) 372-0292 Thank you for contacting Governor vJ i son. I hop tris irlf�-maticn is helpful. if you have further questions, please contact Gina Ebling of my staff at (916) 322-0551. Sincerely, l tLOWAYNES , onsumerServices Division cc: Department of Health Services Division of Licensing and Certification w/attachments Petra Dixon, Director of Patient Accounting Delta Memorial Hospital