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HomeMy WebLinkAboutMINUTES - 02281995 - 1.25 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 28, 1995 0 . . 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: $1,238.97 or $1087.49 Section 913 and 915.4. Please note all •M' in gs" � �S , a CLAIMANT: Darci Gonzales y ATTORNEY: COUNTY COUN8CL Date received February 6, 1" TiNZZCALIF ADDRESS: 169 E. 15th St. BY DELIVERYTOCLERK ON Pittsburg CA 94565 BY MAIL POSTMARKED: February 3, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OIL BATCHELOR. Clerk DATED: 'FPhniarv7 1 AA5 : Deputy ^ . I1 FROM: County Counsel TO: Clerk of the Board of Supervisors ( Jr 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: t-" $ - S SP BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. FES 2 8 1995 Dated: PHIL BATCHELOR, Clerk. Byk, 0%J.J , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 943.6. 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: 8 10 BY: PHIL BATCHELOR b L (7 poly Clerk CC: County Counsel County Administrator O � ? LoLL L a l Y Y— ts 1 •lww. ✓I �' iYY2 n {� j o QW p Cf) M:Q CD p s6 i O 0 4 4-) M s L O +) 4-) d• (Q (J) (^1), CSS p' W .C�C r4^ U +S G U] 0 C:) 4"' Fri ::1 O —4 �4 O O Ln Rf Ln to f LO W 4-J Q) U7 rcC N •I-1 $:I U7 O -1 �4 U 4 �4CPI -W (o ko —4 C4' r-Iw C(ia to= BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clai.:s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or' before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to -personal property or growing crops and 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. j,(Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,. rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal, Code Sec.. 72 at. the end of this form R£: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa—) or ) -FEB — 61995 District) Fill in 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: �(i�. l.6J' 1. When did the damage or injury occur? (Give exact date and hour) 7/9 el— 01,�P eok to` b" '?`v7, tcew- "_1 of a.l- 'TP�i. — 2. Where did the damage or injury �- occur? (Include city and county) �L above-` R 2Ci b e e C. 1 0 C--. C��'- ��.P A) ere.2�_- Ra.a Y 3. How did the damage or injury occur? (Give full details; use extra paper if required) L�¢v 'r � tir,Li Aea)/ �2..vr�l�, �a j✓Lu.LQ-cam . �G2-� '� v lu Ai L.(_ ..� v�4 2)Cv1 P� ,OI Q>,Q�l�.1,4�-e— uL0 te�1 ,�Q 9 ILA i4. What parti�act or omission on the part of county or district officers, "7V servants or employees caused the injury or damage? e �bG � �l �. wnat are t,ne names of county or district officers, servants or employees causing the -`a:-�--ge or _� J.n jury? �/T-0 / —4 D 11LW Il' t t)ld bn 5 f�p� --- ------ -- - -------------- 5. ge orinjuriesdo you claim resulted? (Give full extent of 4a s or damage claimed. Attach two estimates for auto damage � eV�� :� ,cwt..� �, Q�J„L�ea.�.�` � �cU��e���:�—• 41Qu0n.4&- -alki (1irc .Last Oce s' :`i�ems- ✓o� ��i�rn�. a,�3 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) __ 3l 5. Names and addresses of witnesses, doctors• and hospitals. AoL tce- IQ 9. List the expenditures you made on account of thi ident injury: DATE ITEM AMOUNT 141,71,vq, 13 q -�- Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: -(Attorney) -' ` or by some person on his behalf." Name and Address of Attorney �1 Claimant's Signature �6 m 6- 9�s 6S Addres Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: - "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison; by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. l MC HUGH'S TOWING -a Qs7z- A�11 t �dRE�346 � ' Ro2297-D Arnold Industrial Way CONCORD,.CALIFORNIA 94520. Setv"ide (510) 676-1311 DATE r�`� TI &m.,NEdUtS rL(7 DY -"°""1 f'.O,NO, NAM ET Y� PHONE,,,-_ ADDRESS I CITY"i n STATE ZIP. a LOCATlON�OFiVEHIC6E,,- (~ YEAR; IkE,MQUELCOLOR DRIVER (-i,5-7/-'�i�,G- lam;ty"d"� I. STATE PLAJE NO. r VEHICLE I.D.NO. REGISTERED OWNER MILEAGE a SERVICE TIME EXTRA PERSON - FINISH FINISH FINISH START START START TOTAL TOTAL TOTAL REASON FOR TOW' ': SPECIAL EQUIPMENT ' ❑ACCIDENT _ ❑ABANDONED ElFLAT-TIRE GLE LINE WINCHING ❑ARREST • - ❑STOLEN CAR _,kyr ❑OUT OF GAS. ❑`Dt L•1O.NE WINCHING C1 UNREGISTERED ❑BREAK DOWN ❑IMPOUNDED ❑SNATCH_BLOCKS ❑TOW ZONE ❑LOCK OUT1�¢�fir'=r{j C3 SCOTCH BLOCKS,: J, ❑SNOW REMOVAL ❑START El " ❑DOLLY - TYPE OF TOW TOWED PER ORDER OF, VEHICLE TOWED TO I' FIRST TOW ' El SLING/HOIST TOW El STATE POLICE - - ❑FLAT BED/RAMP ❑LOCAL POLICE -i• + T - SECOND„TOW ' WHEEL LIFT OWNER (� ❑ ny ❑Dr_ALER r �IN t� is STORAGE FROM TOWING CHARGE j MILEAGE CHARGE TO 4_ DAYS®$ . PAID BY . EXTRA PERSON ! -YI r DRIVERS ❑CASH ,_ ❑CHECK LIC.NO. SPECIAL :a LL.. EQUIPMENT ++' ;6-CREDIT CARD_❑MC ❑VISA- El AMEX DAT /� ' 1 ., ' LABOR CHARGE I 7��E P� STORAGE CC NO ! OPERATOR SSIGNJATURE - ,,J j DATE •,. �.� TRUCK NO a - - - y SUB-TOTAL ! . rAUTHORIZED SIGNATUREyDATE �t ) 1a�.yf?�I �'r ` t9..1•l� t. i TAX I . VEHICLE RELEASED TO DATE E. _ _ TOTAL '0;� i'"-- I - Not respIheft r fog loss r damage to vehicle -'!Thank You - � x 1 incase of fire theft or any other cause beyond our control� It �d G�'l 1 CALIFORNIA AUTt.7lylOTIVE RN 167041 PHONE 427-775.7 Saturday January 14, 1995 3'25 EAST 10TH STREET Customer: GONZALES, 6ARCY PITTSBURG, CA 94565 Address: 169 E15TH ST PITTSBURG CA 94565 Estimate Amount Auth by Phone Date Time By ORIGINAL $160.55 01/14/95 9:37 AM Contact Ph: S ? 427-6711 OTHER PH: { ) Vehicle: 1984 Ford MUSTANG LX 6G License/Tag: Odometer: I00004 VIN Te Shop Price Parts Labor ch Code Description Estimate Part Id Part Description Qty Each Amount Amount 2 X R&R FUEL LINES 8160.55 $76.55 $A.N . ALL CLAIMS MUST BE ACOMPANIED BY THIS BILL. PARTS TOTAL $76. 55 GUARANTEE: We guaranty the work performed by us for a period of 90 days or 3000 miles. I HERE BY AUTHORIZE REPAIRS TO BE DONE WITH NESESARY MATERIALS REVISE-ESTIMATE LABOR TOTAL, $134. 00 MAY BE AUTHORIZED BY ME VIA TELEPHONE,YOU AND YOUR EMPLOYEES AY OPERATE THE ABOVE VEHICLE FOR PURPOSES OF TESTING INSPECTION OR DELIVERY AT MY OWN RISK. AN'EXPRESS MECHANIC'S LIEN IN ACKNOH 6R ON THE ABOVE VEHICLE TO SECURE THE AMOUNT OF REPAIRS THERETO YOU WILL NOT BE HELD RESPONSIBLE FOR LOSS,DAMAGE ARTHEFT STORAG CHARGETOFR15.00OA DAYCAUSE WILL BE ADDED TOCTHERFINAL BILL AFTER 72 HOURS OF COMPLETION OF REPAIRS .ALL CARS WILL BE LIEN SOLD AFTER FORTY DAYS SUBTOTAL $160. 55 SALES TAX Customer Signature jTOTAL $160. 551 €�-ssL_IF�1RNIA AUTOMOTIVE — t�1�t-"[3f�€3�i�-#1r—�2� R1- 1 -17'12 41 P1-$COiNIE 427-7757 Wednesday January..11, 19`75 3 5 EAST 10TH STREET Customer: GONZALES, RRCY PITTSBURG, CA 94565 Address: 169 E15TH ST PITTSBURG CA 94565 Estinate Amount Ruth by Phone Date Time By Contact Ph: 4 ? 427-0711 OTHER PH: t ? - ORIGINAL $115.00 01/11/95 1:10 PM? } Vehicle: 1984 Ford MUSTANG LX 6Gh' License/Tag: y Odoneter:, 100004 VIN ; Te Shop Price Parts Labor ch Code Description Estisate Part Id Part Description Qty Each Amount Amount 2 X REPAIR FUEL. SYSTEM $75.00 $75.00 2 X TOW $40,eeb $40.90 ' r ALLCLAIMS MUST BE ACOMPANIID BY THIS DILL. �PARTS.TOTAL __— GUARANTEE: We guarante the horn performed by us for a period of 90 days or 3000 riles. I HERE BY. AUTHORIZE REPAIRS TO BE DONE WITH NESESARY MATERIALS,REVISE ESTIMATE LABOR TOTAL $3. 15. 00 MAY BE AUTHORIZED BY ME VIA TELEPHONE.YOU AND YOUR EMPLOYEES MAY OPERATE THE ABOVE VEHICLE FOR PURPOSES OF TESTING INSPECTION OR DELIVERY AT MY OWN RISK.. AN EXPRESS tiEGHANIC'S LIEN IN ACKNOWLEDGE ON THE ABOVE VEHICLE TO SECURE THE AMOUNT OF REPAIRS,THERETO YOU WILL NOT BE HELD RESPONSIBLE FOR LOSS,DAMAGE OR THEFT,ACCIIENT OR ANY OTHEW CAUSE PE-YON YOUR CONTROL. A STORAGE CHARGE OF 15.00 A DAY WILL BE ADDED TO THE FINAL BILL AFTER 72 HOURS OF COMPLETION OF REPAIRS ,ALL CARS WILL. BE LIEN SOLD AFTER FORTY DAYS SUBTOTAL 00 SALES TAX Customer Signature o t" ,.Jv;��: •r ,J TOTAL -1:115. vio ALL PAYMENTS CASH UNLESS PRIOR ARRENGMENTS AR MADE BATCH 000,10136 601 STOPE It L: r • tt ,C ;` ik.4 � L 3`�tk CENTER ULAC•lN , .. �1 11�� V...tC yJ,a u f 7 ft •. •, f t Y✓ } . .'I [ faiil /yl. JIM" 09 r tf 1gi't. Ct tl tt , A4 rs p M '�1. l4H'.14Cr'.shP EXF ! 6 ! z 1 UE E. r� 1 a'- n t!wtIim _ � TOW AN01 t,f;'k �.AiCC,0(L!i 41 i� jr tp��{}� Tr #L�,'L{i r Lii4Vi Cj� #:F}I»'{UNK',I f!;Jh .rllLfi(ll —L#al ll��i34_ v� C ESTIMATE - GOMEZ BROS. CUSTOM PAINT AND AUTO BODY l OF REPAIRS 2160 Piedmont Way, Pittsburg, CA 94565 Phone (510 439-1808 NAME r /` �'�' 1/`�'I -�fi�J ADDRESS /y� / � f 4/5 �' S1� 1 � / PHONE NO. MAKE Oleb YEAR STYLE M SERIAL# /(/7 /- CGT,3R 4 10q? LIC.# / 1/3:7W DATE INSURANCE CO. Z h& ADJUSTER 0 333 CLAIM # ESTIMATOR FRONTLabo ® SIDE RIGHT Hours , BUMPER FENDER FENDER Bumper Brkt. »' :` Fender Skirt „ Fender Skirt Bumper Guard P Fender Ext. Fender Ext. Bumper Reinf. Fender Midg. Fender Midg. Bumper Pad W. O. Midg. W. 0. Midg. Gravel Shield Cowl Cowl Valance Headlamp Headlamp Headlamp Door „.-au, Headlamp Door HEADER PANEL Sealed Beam Sealed Beam Grille Park. Light Park. Light Grille Mldg. Side Mark. Lamp Side Mark. Lamp . Grille Brkt. Vert. Supt. DOOR, FRONT DOOR, FRONT Door Hinge Door Hinge Door Reinf. Door Reinf. CORE SUPT Door Mldg. Door Midg. ; Radiator Door Handle Door Handle Rad: Shroud Door, Glass Door, Glass Rad. Hoses Anti-FreezeDOOR, REAR DOOR, REAR Fan Blade Door Mldg. Door Mldg. Fan Belt Center Post .y Center Post Fan Clutch Rocker Panel Rocker Panel i '. Rocker Midg. Rocker Mldg. x� A.C. CONDENSOR QUAR. PANEL QUAR. PANEL Recharge A.C. Quar. Ext. Quar. Ext. ._.. Air Cond. Line Quar. Wheel Hse. Quar. Wheel Hse. Dog Leg Dog Leg Quar. Mldg. Quar. Midg. HOOD Wheel, Open Midg. Wheel, Open Midg. Hood Hinge Fender, Rear Fender, Rear Hood Midg. Tail Lamp Tail Lamp Hood Latch Side Mark, Lamp Side Mark, Lamp Ornament "3 REAR OF CAR MISC. ITEMS Name Plate Bumper Top ` g a Bumper Brkt. Antenna Bumper Reinf. Battery SPINDLE Bumper Guard Gas Tank Wheel Bumper Pad Frame a Tire %Worn Body Panel Cross Member << Hub Cap Gravel Shield Motor Mts. Up. Cont. Arm Floor Undercoat Up. Cont. Shaft Towing &Storage y , Low. Cont. Arm TRUNK LID P jRefinish As Nec. ; 17 { Low. Cont. Shaft } Trunk Lid Midg. r RECAPITULATION WheelAlign Trunk Hinge Trunk Lock 13,g 4/6 w 6 Labor Hrs. 0$ ` r $ u/�^/f �� WINDSHIELD Lic. Light Parts $ Adhesive Kit Back-up Lamp Moulding Tax $ //.?, Open Items Material $ If the customer wishes to claim used and/or damaged parts, please check this box ❑ 1 hereby authorize the repair work listed to be done along with the necessary parts and materials.My car will be driven by your employees Sublet $ to make required tests at my risk.An express mechanics lien is hereby acknowledged on above car or truck to secure the amount of repairs thereto.I hereby waive the Statute of Limitations and if any action on this account requires employment of an attorney I agree to pay 11/2% interest per month which is an annual percentage rate of 18%from date,reasonable attorney's fees and court costs.Storage.will be charged 48 hours after repairs are completed.Not responsible for loss or damage to cars or articles left in cars in case of fire,theft,accident or "y any other cause beyond our control. TOTAL $ Authorized by x Deductable $ • ' ..��.-- 4 r� • ....i"". ' ,�r�. � F,r:�°ZJ:Elt�4=' �•ti:�>."��(,•11,�,;'J'✓'�...'�,^F,-r�.z,..i.---a,c,tf=...-.r.^5.�'H��_-rn1L�s��r•r -,^-may-'K, '., r_� ,..- `, ,,. it JESS HERNANDEZ BODY SHOP .. 107 Bliss PITTSBURG, CALIFORNIA 94565 ESTIMATE OF REPAIRS 24 HOUR TOW UG Phone: 432-3000 NAME ADORES CITY STATE ZIP DATE 1¢4. F CA Y R LICENSE NO. MILEAGE MOTOR NO. AND/OR SERIAL NO. IN RED A0JU ER + INSPECTOR PHON HOME BUSI SS FRONT Lbr. Lbs. Lbr. Hrs. PARTS LEFT His. PARTS RIGHT His PARTS Bmpr . I - Fndr BmprReforce Bar_ I Fndr. • Bmpr Impact Strip Bmpr Brkt Fndr ShId Bmpr Gd Fndr Shld Bmpr Tip R L Fndr Mldg Bmpr Botts & Shims Fndr Mldg - Bmpr Filler Hdlmp Valance Grvl Shld Hdlmp Door Prk Lite Hdlmp Sealed Beam t Sys t _ Hdlmp Door Cowl—Post rame Door (Fri) + Mbr Sealed Beam / Cowl-Post Door Hinge Wheel n Door (Fri) Hub Cap Door Mldg Door Hinge Hub & Drum Door Lock 'Door Mldg. Knuckle - Ctr Post Door Lock Up Cont Arm Door (Rear) Cir Post Lr Cont Arm Door Mldg Door—(Rear) Shock - cker Pnl Door li ockr Mldg Tie Rod Ends - Floor Rocker Pnl Qtr. Pnl Grille Rockr Mldg Grille Panel Floor Qtr. Pnl - Qtr Mldg Park Lights R L - Qtr Mldg Qtr Ext Qtr Ext Lock Plate Lr Whl Hsg Whl Hsg Lock Plate Up MISC. REAR Fri Seat Hood - Bmpr Rear Seat Hood Hinge Bmpr Brkt Wndshld _ Hood Mldg Bmpr Impact Strip Bmpr Gd Wndshld Kit Bmpr Filler Hding Rad. Sup Back Up Lite Top _ Rad. Core - Lwr Body Pnl Tire % Worn Coolant Batt Bad Hoses & Clamps Tail Lite R L Paint&Mat. Fan Shroud - Paint Stripping Fan Blade Trnk Lid/Gate AUTHORIZATION FOR REPAIRS Water Pump Trnk Lid Hinge You are hereby authorized to make the above repairs. A/C Core Trnk Lfd Mldg Rechrg A/C Floor Signed 1 - Frame `Mbr LABOR HRS Mir Mts Gas Tnk PARTS Tai Ipipe —Mif Ir � Trans Linkage TTail SUBLET Spring f TOWI G ARGE Hub & Drum Wheel ALES T / Antenna Valance GRAND T CODE: A—Al i gn — Ex & X — Exchange N —New — OH — Over haul — P—Pai nt ` R-Repair —S•Straighten—U-Usetl All Materials Are Subject To Price Change At Time Of Invoice. Deductible Must Be Paid Before Car Will Be Released `i ►�^- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA - -'February 28, 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 6overnment Code Amount: Unknown Section 913 and 915.4. Please note all ow&mi� { r CLAIMANT: Ann Fitzgerald ATTORNEY: Sanders, Dodson, Rives & Canciamill'a FEB 0 _7 1995 Date received COUNTYCOUNSEL MARTINEZ CALIF. ADDRESS: 2211 Railroad Ave. BY DELIVERY TO CLERK ON !'February 3, 1995 Pittsburg CA 94565 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. OIL gATCHELOR, Clerk DATED: F hp�Ye 7, 19g5 : Deputy 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: t-6 BY Deputy County Counsel I13. FROM: Clerk of the Board T0: 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: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. o �� FEB 2 Dated: PHIL BATCHELOR, Clerk, B . 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 sail 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 limes 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 Martinet. California, postage fully prepaid a certified copy of this Board Order and Notice to Cltimant, addressed to the claimant FEBsshown above. Dated: FEB 2819 BY: PHIL BATCHELOR b puty Clerk CC: County Counsel County Administrator ED RE 4 - 3 1995 CLERK BOARD OF Sl1PERVISORS CONTRA COSTA CO. CLAIM AGAINST PUBLIC ENTITY (Gov. Code §§ 905, 905.2 , 910, 910.2) TO: COUNTY OF CONTRA COSTA ANN FITZGERALD hereby makes claim against the County of Contra Costa and makes the following statements in support of the claim: 1. Claimant's post office address is: C/o Stanley K. Dodson SANDERS, DODSON, RIVES & CANCIAMILLA ' Attorneys at Law 2211 Railroad Avenue Pittsburg, CA 94565 2 . Notices concerning the claim should be sent to: Stanley K. Dodson SANDERS, DODSON, RIVES & CANCIAMILLA Attorneys at Law 2211 Railroad Avenue Pittsburg, CA 94565 3 . The date and place of the occurrence giving rise to this claim are: November 17, 1994, on Cowell Road at Ygnacio Valley Road, Walnut Creek Judicial District. 4 . The circumstances giving rise to this claim are: The intersection, during reconstruction, repaving and remarking, was negligently and dangerously layed out so as to confuse and mislead traffic entering Ygnacio Valley Road from Cowell Road, causing claimant to enter from Cowell Road onto Ygnacio Valley Road on a green light to drive her vehicle in the path of a vehicle traveling along Ygnacio Valley Road, also with a green light. e � 5. Claimant suffered property damage to her vehicle and suffered injuries to her head, neck, back and abdomen. She has also suffered a loss of wages. 6. The names of the public employees causing claimant' s injuries: Unknown. 7 . My claim as of the date of this claim is in an amount that would place it .in the jurisdiction of the superior court. Dated: February 1, 1995. SANDERS, DODSON, RIVES & CANCIAMILLA By: STANLEY K. DODSON Attorney for Claimant, ANN FITZGERALD Amended CLAIM BOARD.OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 28, 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: $8,500.00 Section 913 and 915.4. Please note all •YD iIan" _ CLAIMANT: Booker T. Carloss ANZ800 4A7 NCJ J A H 3 0 1995 ATTORNEY: Date received COUNTYCOLINSEL MARTINEZ CALIF. 550 6th Street ADDRESS: BY DELIVERY TO CLERK ON January 30, 1995 Oakland CA 94607 BY MAIL POSTMARKED: Not Legible 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. IVIL1L gATCHELOR, Clerk , DATED: January 30, 1995 Deput �./L�•_��� ll. FROM: County Counsel 70: 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 910.6). ( ) 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 owl,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: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:_FE-8 2 8 19M PHIL BATCHELOR, Clerk, By-au , 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. 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 7 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States. over age 16; and that today I deposited in the United States Postal Service in Martinet, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. �- FEB 2 8 1995 Dated: BY: PHIL BATCHELOR by ,e,8eputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: 'j. CONTRA COSTA COUNTY PHILLIP S. ALTHOFF f SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY o VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTORJ.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 30, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Booker T. Carloss ANZ800 4A7 NCJ 550 6th Street Oakland, CA 94607 RE: CLAIM OF: Booker T. Carloss 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. [] 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 . [x] 7 . Other: We must treat your letter of January 26, 1995 as an amended claim against the County. In that regard, it is insufficient for the above-noted reason(s) . Please also be advised that the statement "This claim substantially complies with Sections 910 and 910 . 2" is not a comment on the merits of the claim. It is merely a statement that the claim contains all of the necessary information so that it may be processed by the Board of Supervisors . I believe the Board rejected the claim on the merits . The Office of County Counsel has no authority to advise the Probation Department to release a "hold" on a probationer. VICTOR J. WESTMAN, County Counsel By:Ar< _.... Deputy County ounsel 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 30, 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) 5 � w M ' ``) ID V C-d s c-� Tyr RECEIVED hoard .64 S� r%1&f'5 _ � JAN 3 01995 Coup%+- Adw*(Kisiict�ioi, "P(A ldi + y l CLERK BOARD OF SUPERVISORS CONTFtA COSTA CO. C14 R� SS:3- �2F'3 -RE Bo6t'-er T CGL(loss, C(Gi►�. ' )6floAi0�) iMr or�er- +�dgj - T 6iS5'.L4?yve-1 5� hc�. Vie_ O�e�invl\,?4. Codes��-�C-4 CA MO Uv& was e}cborbilar�— v . W, ��. tAkl'scc ov\ Co k\&�o v-,- arra(( y YO Mow- v r6I�-tor Je p e v. - � +�. k nh(. A- Ldp +� /A 0Wb1d,5- '%- cite �,; W l I I Gp pew i h Oao,� tjVVI r\dfl�'-edf. P oe A+kkc-�On' Y�kmloe Is �5 SgperUjso, is 11�r. �sjoja (Sto) 3f3 -.gOod, U �Ave_ k\07L- ft"ed CA vt, CotUY4 d(44Vs )K `f ke, Past Wt\- "? Wa5►�'-f KUkYlber. \ w, 'tkls cotes via( a pev-5t) I txr-u C 16;m 2), D S0.d 2i hi auSci�nO� U� v�dl� 01011a (A Gym -��e. C���_ J� KCere Mt 6506Q-4i (s1 o) 763',GS39' CLAIM • -- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 28,1995 Claim Against the County. or District governed by) BOAR_ D ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document sailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (paragraph IV below), given pursuant to Government Code Amount: $9,923.43 Section 913 and 915.4. Please note all 'warnings". � Fz }'10�� ;r CLAIMANT: Henry Christopher Verga �,• ATTORNEY: FEB 0 7 1915 Date received COUNTYCOUNSEL ADDRESS: 2520 Ryan Rd. , Apt. 43 BY DELIVERY TO CLERK ON February 3, 19 T1NEZCAL1F. .Concord CA 94518 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. February 7 1 IL gATCHELOR, Clerk , DATED: rY , 995 BY; Deputy 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: 1i S BY:T AV. Deputy County Counsel 111. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD 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 2 8 SM . Dated: PHIL BATCHELOR, Clerk, B , Deputy Clerk 41ARNING (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 sail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of on attorney of your choice in connection with this matter. If you want to consult on attorney, you should do so immediately. AFFIDAVIT OF MAILING I .detlare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the Onited States, over age 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. )aced: BY: PHIL BATCHELOR b, Deputy Clerk :C: . County Counsel County Administrator Clain.. to: - BOAP.D OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Clams relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual. of the cause of action.. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,. must be presented not later than six months after the accrual Of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed With the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form � * � ii' � � * � if * iN< >il � * ♦� * * � � ♦1} # * * iE * iE * � � iE * � i� * * * * � * ♦E � ii; � RE: Claim By ) Reserved for Clerk's fl ing stamp -Henry Chrisiopher Verga ) RECEIVED Against the County of Contra Costa ) FB 3 1995 or ) 3: `tSP.rn . District) gpippp OF SUPERVISORS Fill in name ) -- MRA COSTA Co. The undersigned claimant hereby makes claim attaint the County-of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: X9,923.43 1. When did the damage or injury occur? (Give exact date and hour) a ugusi n, 1994 at approximately 11:15 am 2. Where did the damage or injury occur? (Include city and county) N�e.ar•the Intersection of Highland Road and Camino Tass.sjar•a,,an Raison,Contra Costa Couniy,CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) (See miac:ired) 4. What particular act or'omission on the part of county or district officers, servants or employees caused the injury or damage? 1) Lack of warning of defective nature of roadway 1) Failure to observe and correct roadway defect in an area that is immediately adjacea l is a couAtty construction zone. ;Ove^) �. wnat are the na_rnes of county or district officers, servants or employees causing the darn-age or injury? Unknoum 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Fracture of right clavicle,cuts and abrasions on right arm and right leg Damage to bicycle 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Amount of medicals/property damage listed below plus 59 000 for pain& suffering 3. Names and addresses of witnesses, doctors ars }+�+�•+�*�ia- Doctors-ValleFCare Medical Center,5555 W. LasPositas Blvd., Pleasonton,CA 94588 Dr.Cynthia Penn-Duecker,3600 Sisk Rd.,Suite 1-A,Modesto,CA 95356 Dr.Dennis Gustafson,2123 Ygnacio Valley Rd.,K-100,Walnut Creek,CA 94598 Witnesses-Unknown y. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT (See attached) Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney Fla' 's Signature) Ad ess Telephone No. Telephone No. N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such impriso.-went and fine. I was riding a bicycle westbound on Highland,approaching the intersection wi11i Camino Tassajara. I was just east of a small brid-e on the road when I struck a defect in the roadway which 1 did not see. Without anv warning,my bicycle event doom,causing me to strike.the ground and suffer serious lttjuty. The nature of the defect is an irregular shaped strip of concrete that is bonded to the road. It is approximately 10'in ieng1h,1'in width and between 2"and 1/2" high off the road. It is highest in its most eastbound section where the wheel of my bicycle struck it Medical Expenditures ValleyCare Medical Center $491.05 Dr.Cynthia Penn-Duecker 199.00 Dr.Dennis Gustafson 65.00 Economy Medical 18.84 Livermore Valley Radiology 29.00 Perscription 5._15 5808.84 Bike Repairs Encina Bicycle Center 5 59.39 Performance Bicycle .55.20 5114.59 1401 NORTH BROADWAY WALNUT CREEK, CA 94596 (510) 937-7723 SALE "A518650 01802 36762 0018 08129194 04=58 PM 1 8130660000002 NOSE 1 P 50.99 50.99 8.25: TAX 4.21 TOTAL $55.20 BANK CARDS 5.20 HENRY UERGA ACCOUNT NUMBER 5396820024895320 EXPIRATION DATE 05/96 AUTHORIZATION NUMBER 077869 THANK YOU GOR SHOPPING AT PERFORMANCE! KEEP CYCLING... THANK YOU FOR SHOPPING AT PERFORMANCE! Economy Medical 1935 Diamond Blvd. Concord, California 94520 (510) 686-3323 (800) 439-3323 CUSTOMER'S ORDER NO. PHONE DATE NAME ADDRESS 801.,D RY CASH C.O.D. CHARGE ON ACCT. MDSE.RETD. PAID OUT ..� O Y. Y DESCRRIIPTIONj,�'' ,_. PRICE AMOUNT �u t C I i I I I I I I I TAX I RECEIVED BY 6 TOTAL IO I54IJ All claims and returned goods 18434 MUST be accompanied by this bill.PRDDJCT C� 610 ate. M . .' �rl Jog: S A �• ? r7!* J m; ;sits m Oe1= L z f Ffi � x NOW w CD gp, O � aw , nRR CD �4, Z; s ry� 0. im Z z'. n ws Z`O; "sz j � . z 9� ?z 4w,�^e �a a •' nC G) sga S m ND = ,�l y r C,: • Y 0,0 m ^�^ , m y • Y 1 € K; r•. N'rVALLEYCAKE Valley Memorial Hospital ❑ ValleyCare Medical Center Pleasanton CA 94588 Livermore, CA 94550 - H E Phone (510) 447-7000 SYSTEM I.R.S. 94-1429628 I.R.S. 94-3097094 PATIENT NAME - - ACCOUNT NO. ' ' ROOM NO. ADM.DATE - DISC.DATE PAGE VERGA* HENRY C 7392194 0000— 8/06/94 8/06/94 1 INSURANCE NAME BILLING DATE VERGAE HENRY C 171318 NO INSURANCE COVER 8/31/94 2520 RYAN RD #43 CONCORD CA 945180000 GROUPNO. TYPE FiNCL POLICY NO. 02 ER 00 RE—FULL DATE CHARGE DESCRIPTION SERVICE CODE STANDARD PRICE ESTIMATED ESTIMATED ESTIMATED PATIENT JF - INS.COVERAGE INS.COVERAGE INS.COVERAGE CHARGE SERVICE _ CPT4 CODE RVSI# REE LAB ***2.50 PHARMACY 8/06 DIP—TET TOX-ADULT 2132525 1 45.05 ** UB82 TOTAL ** 45.05 ***270 MEDICAL SURGICAL SUP 8/06 CLAVICLE STRAP LG 4050652 1 74.00 8/06 SLING ARM LG 4051210 1 34.2.5 8/06 CLAVICLE STRAP LG 4050652 1 74.000 ** UB82 TOTAL ** 34.25 ***320 RADIOLOGY — DIAG. IM 8/06 CLAVICLE 3073000 1 73000 73000 222.75 #* U882 TOTAL ** 222.75 ***450 EMERGENCY ROOM 8/06 LEVEL CHARGE 8 7010035 1 123.0,0 8/06 INJECTION 70303.14 1 22.00 8/06 WOUND PREP MINOR 7030144 1 12001 22.00 8/06 ORTHO APPLICATION 7030064 2 44.00 8/06 WOUND PREP MINOR 7030144 1 12001 22.00C ** UB82 TOTAL ** 189.00 Please Note: The total above is the amount due the hospital. If you have insurance coverage your CONTfNUE_. insurance company will be billed as a courtesy to you. However, the responsibility for payment of this statement rests with the guarantor. You will be advised of any payments,charges or credits not presently in the business office by subsequent statements. This statement does not include fees for your physician,anesthesiologist or private duty nurse. A&FORM 04095(10/91) PATIENT COPY PLEASE PAY THIS AMOUNT y ❑ Valley Memorial Hospital ❑ ValleyCare Medical Center BARE r� Livermore, CA 94550 Pleasanton, CA 94588 Phone (510)447-7000 SYSTEM I.R.S. 94-1429628 I.R.S. 94-3097094 4TIENT NAME ACCOUNT NO. ROOM NO. ADM.DATE DISC.DATE PAGE VERGA* HENRY C 7392194 0000— 8/06/94 8/06/94 2 INSURANCE NAME BILLING DATE VEsRGA, HENRY C 17.1318 N4 IINSURANCE COVER 8/31/94 2520 RYAN RD #43 CONCORD CA 9451800010 GROUP NO. TYPE FNCL POLICY NO. 02 ER 00 .c—BILL NTE CHARGE DESCRIPTION SERVICE CODE STANDARD PRICE ESTIMATED ESTIMATED ESTIMATED PATIENT INS.COVERAGE INS.COVERAGE INS.COVERAGE CHARGE RVICE CPT4 CODE RVS# REF LAS SUMMARY OF CHARGES 250 PHARMACY 45.05 270 MEDICAL SURGICAL .SUP 34.25 320 RADIOLOGY — DIAG. IM 222.75 450 EMERGENCY ROOM 189.00 TOTAL CHARGES 491.05 RAIL PAYMENTS TO: PO BOX 39000 DEPT# 05438 S.F. CA 94139-5438 �.� c ase Note: The total above is the amount due the hospital. If you have insurance coverage your urance company will be billed as a courtesy to you. However, the responsibility for payment of this Cement rests with the guarantor. You will be advised of any payments,charges or credits not presently 491.05 the business office by subsequent statements. ,is statement does not include fees for your physician,anesthesiologist or private duty nurse. S W 04095(10191) PLEASE PAY THIS AMOUNT PATIENT COPY / l : t-G t- SS DRUGS 48 CASTR s VL'T CASTRO VALLEY CA RX 5. 55 ICE TEA 79 ' AF I VOT 4. 19 TAX 1 15 AMT DIE 10. `.a CHRG CRU 10. 88 CHANGE 0 0$r'06/94 15 :15 312991 08 THRNK; WAR ENCINA. BICYCLE CENTER 0 20 2901 Ygnacio Valley Road ' abut Creek, 598 Phone: -9200 CD [10 NAME C_/4' 7 116 XC4" W m Un z ADDRESS ZIP m HOME WORK -7 HONE DATE 'L PHONE Se ice Parts Labor e7:0v1 3 10+ m N Comp.O'Haul 1 3 10+ m nstall'Tir R Gx+ D o Install Tube F R 3 0 Install Cable FB NB FD RD Adjust Hand Brake R c oc m 0B True W F R 0 � :c.spoke'W F R —-� 1 m T 0 Q. Adjust Derail F a, 0 Adjust HOb F 1 3 R 'Cr m O'Haul Hub F 1 3 R Adjust: Head Bottom Brack O'Haul: Head Bottom Bracket K n INSTALL (J �� m O N PA's o D SAVE OLD PARTS YES❑ NO❑ m La or 0 O MECHANIC OFF X ax p x 00 TA EST. o EST.B !�. AMT. O13�1 IC DATE�� A� DELIVER SUN. MON. TUES. WE . THUR. FRI. TIME mG)nvommK (3 z, ; m_z Ch C TQPA t Cs © OOOr m' ZfT bf M N m V1, Tt -4 N -C \ m- ,jy rr C� H rl .p "..lT.r N A m ba m cn si d m o' m zn �s ao v+ cn m N 7T1 A .d W c W m. ,a f7i. M 2� CT m 3 *� M f11 Ri tIS,Q- i j•` Q n`2b. O D A vs r0 r m r av a •a +-+ Z ❑ rm fTi.X7 lTs \ m D. . v M} .; Z D m Gf+ C z ., N G1 LD fTt N c� rn a A le rn •Its -i - O 2 Cl Z S Z 4F Q CQ O i F v a M 4P fno : t C� m' N 71' a' C? i.d•m 0 0 cn m m ...�_ n � � rri air . ._� D N ►.� b t = O Z C]. i11 tY1 t/1 m tr D Cl) m Q+ a Wza Q o "' O o --i;R D mm ,0 "U O -moi ( o O =' t7 7D. '" 3' ;K 0 O m `4.v Q D fTi,lS i ►r Z cn Z CN - rhtli O Fn . D C o 0 CA 00 rn-i D z ,,f -Di j• D: t' L z m ^� p m fT r �p O Z t-+ D . �in CLAIM t ' `u BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA February 28, 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: Unknown Section 913 and 915.4. Please note all •M in n CLAIMANT: Denise Loomis FEB o 7 1995 ATTORNEY Sanders, Dodson, Rives & Canciamilla COUNTY COUNSEL Date received �pRTINEZCALIF. ADDRESS: 2211 Railroad Ave. BY DELIVERY TO CLERK ON February 3, 145 Pittsburg CA 94565 BY MAIL POSTMARKED: Land Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. c llATCHELOR. Clerk DATED: February 7, 1995 : puty 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( %,)00070his 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: $'�{ S BY: Deputy County Counsel 111. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.Dated: FEB6PHIL BATCHELOR, Clerk. By r 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. 1f you want to consult an attorney, you should do so immediately. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the united States, over age 18; and that today I deposited in.the United States Postal Service in Martinez. California. postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. ated: FEB 2 8 sm BY: PHIL BATCHELOR by puty Clerk County Counsel County Administrator � . - - RECEIVE® i FEB - 31995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CLAIM AGAINST PUBLIC ENTITY (Gov. Code && 905, 905.2 , 910, 910.2) TO: COUNTY OF CONTRA COSTA DENISE LOOMIS hereby makes claim against the County of Contra Costa and makes the following statements in support of the claim: 1. Claimant's post office address is: c/o Ronald P. Rives SANDERS, DODSON, RIVES & CANCIAMILLA Attorneys at Law 2211 Railroad Avenue Pittsburg, CA 94565 2 . Notices concerning the claim should be sent to: Ronald P. Rives SANDERS, DODSON, RIVES & CANCIAMILLA Attorneys at Law 2211 Railroad Avenue Pittsburg, CA 94565 3 . The date and place of the occurrence giving rise to this claim are: November 15, 1994, on Cowell Road at Ygnacio Valley Road, Walnut Creek Judicial District. 4 . The circumstances giving rise to this claim are: The intersection, during reconstruction, repaving and remarking, was negligently and dangerously layed out so as to confuse and mislead traffic entering Ygnacio Valley Road from Cowell Road, causing claimant to enter from Cowell Road onto Ygnacio Valley Road on a green light to drive her vehicle in the path of a vehicle traveling along Ygnacio Valley Road, also with a green light. 4 1 5. Claimant suffered property damage to her vehicle and suffered injuries to her neck and back. 6. The names of the public employees causing claimant's injuries: Unknown. 7. My claim as of the date of this claim is in an amount that would place it in the jurisdiction of the municipal court. Dated: February 1, 1995. SANDERS, OD ON, RI S & CANCIAMILLA By: RON LD P. RI ES Att rney for Claimant, DENISE LOOMIS CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA •February 28, 1995 _.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 Government Code Iimount: not more than $10,000.00 Section 913 and 915.4. Please note all -Warnings". CLAIMANT:David Laird ATTORNEY: James D. Rode, Inc. _ ' JAN 2 7 1995 Date received COUNTYCov NIEL ADDRESS: 165 No. Redwood Dr. , Ste. 110 BY DELIVERY TO CLERK ON January 27, 1995AAAR* 7._4 San Rafael, CA 94903 BY MAIL POSTMARKED: TPS &x - Day Ai r ( no natal 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. _ pp��IL ATCHELOR, Clerk C -Q.c_JCJC�A,o DATED: January 27, 1995 61 : Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( s 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: I "?j V — � _ BY: uty County Counsel 111. FROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present wf`uis 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 PHIL BATCHELOR, Clerk, BkAj pe A r , 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 shcown above. Dated: �; o 19 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Clai- to: BOAM OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not . later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form RE: Claim By ) Reserved for Clerk's filing stamp DAVID LAIRD ) RECEIVED Against the County of Contra Costa ) or ) JAN 2 71995 District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigried -claimaiit hereby makes -claim against the County of Contra Costa or the above-named District in the sum of $not more than $10,000 and in support of this claim represents as follows: Their share. of clean up costs discussed below. 1. When did the damage or injury occur? (Give exact date and hour) In August, 1994 - exact date andtime unknown. 2. Where did the damage or injury occur? (Include city and county) 2701-A Goodrich Ave. , Richmond, CA, Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required) Contractor for County dumped debris on the property without consent or premission of owner . and/or tenant.. It now needs to be cleared off. -------------------- -- ------ -------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See 3 above. We believe the debris came from the County job at Point Pinole and that the contractor was O.C. Jones , 4920 C Street, San Francisco, .CA... `Ovnr JAMEs D. RoHDE A PROFESSIONAL CORPORATION ATTORNEY AT LAW 165 NORTH REDWOOD DRIVE, SUITE 110 SAN RAFAEL, CALIFORNIA 94903 TELEPHONE: (415) 472-4140 FAX: (415) 479-5948 January 26, 1995 City of Board of Supervisors County Administration Bldg. 651 Pine Street, Rm. 106 Martinez, CA 94553 Dear Clerk: Enclosed is an original and one copy of a Claim form., Please file stamp and return an endorsed copy to me in the enclosed envelope. Your assistance in this matter will be appreciated. Very truly yours, JAMES D. ROHDE, INC. Tami Hinchman, Secretary to James D. Rohde :tlh r a , -77 says v In r FI G N I cP r T �.• mm O f1 «7 Fj IT trJ n O n M x 5 E • N N �' I-h 1 �� m W . g f7 c M co O22Mc) o n MO g (D N fi t7"Eli M a fG aft O �� H y, m Z . F, Om 3 7 • w . x,.. 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