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HomeMy WebLinkAboutMINUTES - 01241995 - 1.15 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA jr January 24, 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: Charles Ray Burks Jr. and Paula Greene ATTORNEY: Bruce G. Fagel JAN 12 1995 Date received COUNTYCOUNSEL ADDRESS: 445 South Beverly Drive, Suite 200 BY DELIVERY TO CLERK ON January 12. 1AIr Beverly Hills, CA 90212 BY MAIL POSTMARKED: January 10, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Januar 12 1995 VpHIL ATCHELOR, Clerk DATED: y ' BY: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (v] This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply 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: /—' /3 9s BY: I✓� Deputy County Counsel 1I1. f ROM: Clerk of the Board 70: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. 9DARD 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: JAN 2 4 1995 PHIL BATCHELOR, Clerk, By k�(;A.e1 Q�„a , Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Goverment 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 penury that I am now, and at all times herein axntioned, have been a citizen of the United States, over age 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified Copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. JAN 2 5 1995 Dated: BY: PHIL BATCHELOR by , 1M." Deputy Clerk CC: County Counsel County Administrator - - - IK A551% a a a O 4 � � � q k;•iZt 2 � U j �^ i .'•"titer �pn 441 t ��� o t h 0 U f 1 tCl - En LO e)J ,ACQ ;* UON f i rf �4 L" p 44 ( U OAU � ` flu > 44 4-) til S• ' r# O p. �4 Q u vl Qa 1 LAW OFFICES OF BRUCE G. FAGEL Bruce G. Fagel, Esquire #103674 2 445 South Beverly Drive, Suite 200 Beverly Hills, California 90212 3 Telephone: (310) 277-1288 4 Attorneys for Claimants 5 6 7 8 CLAIM FOR DAMAGES AND PERSONAL INJURY 9 10 11 CHARLES RAY BURKS JR. , a minor, ) CLAIM FOR DAMAGES AND by and through his Guardian ad ) PERSONAL INJURY SS l2 Litem PAULA GREENE; . and PAULA ) q ° GREENE, individually, ) GOVERNMENT CODE §910 � o� do13 ) � < yp Claimants, ) o 14 ) RECEIVED VS. ) w t�t1 15 ) r�^ COUNTY OF .CONTRA COSTA, dba ) AN 12 1995 X16 MERRITHEW MEMORIAL HOSPITAL, and) DOES 1 through 50, inclusive, )' CLERK BOARD OF SUPERVISORS 17 ) CONTRA COSTA CO. Respondents. ) 18 19 TO COUNTY OF CONTRA COSTA dba MERRITHEW MEMORIAL HOSPITAL, a 20 public entity and to each cf the above named entities, individuals 21 and health care providers: 22 You are hereby notified that CHARLES RAY BURKS JR. , a minor, 23 date of birth August 22 , 1994 , and PAULA GREENE, individually, 24 25 whose address is in care of their attorney, Bruce G. Fagel, 445 ! South Beverly. Drive, Suite 200, Beverly Hills, California, 90212, 26 claims damages from the above-mentioned entities in the amount, 27 computed as of the date of the presentation of this claim in 28 excess of $250, 000. 00 . 1 The claim is based on allegations that defendants negligently 2 diagnosed, treated and cared for PAULA GREENE, causing bodily 3 injury, specifically causing brain damage to her infant son at 4 delivery, date of birth August 22 , 1994 , as well as other 5 unspecified personal injuries to PAULA GREENE. 6 PAULA GREENE was present at the scene of delivery and it was 7 foreseeable that as the mother, she would suffer emotional 8 distress from any injury to her child. 9 As a result of the negligence of the above named entities, 10 and physicians and medical staff and personnel of MERRITHEW s11 MEMORIAL HOSPITAL, whose names are presently unknown, the Claimant � N012 CHARLES RAY BURKS JR. , by and through his Guardian Ad Litem, PAULA ° Z n� 13 GREENE, and PAULA GREENE, individually, claim damages for his ' ate 14 brain injury, emotional distress past and future medical 7 Y� 15 expenses, and loss of earnings and future earning capacity. 16 The said injuries and damages were caused by the negligence u 17 of the employees or agents of the above named Respondents, whose 18 names are presently unknown. 19 This claim is also based on failure to inform, lack of 20 informed consent, failure to warn and failure to adequately select 21 the medical staff and other employees, as well as to adequately 22 review their competence, and failure to maintain, operate, and 23 manage the premises and equipment at said hospital . The claim 24 against the Respondents are calculated at the presentation of this 25 claim as follows: 26 CHARLES RAY BURKS JR. , a minor, : 27 General Damages: $250, 000. 00. 28 Economic Damages: In Excess of $1, 000, 000. 00. -2- 1 Past Medical Expenses: Presently Unknown. 2 PAULA GREENE, individually: 3 General damages: $250, 000. 00. 4 Economic Damages: Presently Unknown. 5 Past Medical Expenses: Presently Unknown. 6 All notices or other communications with regard to this claim 7 should be sent to the Claimants in .care of their attorney. 8 9 Dated: January A , 1995 LAW OFF O UCE G. FAGEL 10 11 BRUCE G. o , 12 Attorney for C ants n � O � w 13 .n o oA 14 0 aw U V i uN � 15 16 h A ® � \ 17 t 18 19 20 21 22 23 24 25 o 26 27 28 -3- 0,6 1 PROOF OF SERVICE 2 State of California ) ss. 3 County of Los Angeles ) 4 I am employed in the County of Los Angeles. I am over the 5 age of 18 years and not a party to the within action. My business 6 address is 445 South Beverly Drive, Suite 200, Beverly Hills, 7 California 90212 . 8 On January 9 , 1995, I served the foregoing document. 9 described as CLAIM FOR DAMAGES AND PERSONAL INJURY on the 10 interested parties in this action by placing a true and correct 11 copy thereof encl'osed in a sealed envelope addressed as follows: o n12 VIA CERTIFIED MAIL 0 13 Executive Officer 14 Board of Supervisors, County of Contra Costa . gt; o� Administration Building U Martinez, CA 94553 15 Merrithew Memorial Hospital 16 2500 Alahambra Avenue Q� u 17 Martinez, CA . 94553 18 I deposited such envelopes in the mail at Beverly Hills, 19 California. The envelopes were mailed with postage thereon fully 20 prepaid. I declare, under penalty of perjury under the laws of the 21 State of California, that the above is true and correct. 22 23 q Executed on January `! , 1995, at Beverly Hills, California. 24 25 Diana Menzor 26 27 28 OFFICE OF COUNTY COUNSEL DEPUTIES: r. 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 February 15 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS TO: Tim Granshaw 208 Lasso Circle San Ramon, CA 94583 RE: CLAIM OF: Tim Granshaw Please find enclosed copies of Government Code sections 910 and 910 .2 per your request. It appears that the Board of Supervisors has elected to reject your claim. Your letter has been referred to the Risk Management department, which handles all cases of potential liability on the part of the county. VICTOR J. WESTMAN, County Counsel RECEIVED By: Deputy County Counsel FEB 151995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. t -1 1 ,15 • 1.�,,� •g S RECEP ":11. Tim Granshaw FEB _ 13 _ 208 Lasso Circle San Ramon, CA. 94583 CLERK 60AhU oc su;cF isoks 510 830 1678 CONTRA COSTA CO. Board of Supervisors County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553-1293 To The Board of Supervisors, PA Your response dated January 25th regarding my claim for damages sustained in a bicycle accident in July is unsatisfactory. My accident was caused by your negligence in maintaining the road surface. I remind you that I am only requesting payment for medical expenses and damage to my bite. If I do not receive a more positive response by February 18th I intend to take legal action. I will seek compensation for pain and suffering, missed bicycle races, and lost wages in addition to medical expenses and bicycle repair. Please send me copies of your initial reply and Sections 910 and 910.2 with your response to this letter. The document was missing its left edge and the copies of Section 910 and 910.2 were missing, Signed, Tim R. Granshaw a�15155 S CLAIM BOARD, OF SUPERVISM.OF CONTRA COSTA COUNTY, CALIFORNIA January 24, 1995 1&im Agsinst ilhe County, or District governed by) BOARD ACTION he Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT nd Board Action. All Section references are to ) The copy of this document mailed to you is your notice of alifornis Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code count: $2779.01 + Section 913 and 915.4. Please note all 'Ya3inPr '.AIMANT: Tim.Granshaw _ JAN 10 1995 RORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. )DRESS: 208 Lasso Circle BY DELIVERY TO CLERK ON January 9, 1995 San Ramon, CA 94583 BY MAIL POSTMARKED: January 6., 1995 FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of .the above-noted claim. IL gATCHELOR, Clerk DATED: January 10, 1995 : Deputy 1. FROM: County Counsel TO: Clerk of the Board of Supervisors (VI 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: � "�y �9S BY: a ._.. Deputy County Counsel 1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). BOARD ORDER: By unanimous vote of the Supervisors present ( XThis 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. JAN 2 4 19 i � . �� `�,�_� Deputy Clerk Dated: PHIL BATCHELOR, Clerk, By ,, YARNING (Gov. code section 913) bject to certain exceptions, you have only six (6) months from the date this notice was personally served or Posited in the avail to file a court action on this claim. See Government Code Section 945.6. u may seek the advice of an attorney of your choice in connection with this matter. If you want to consult attorney, you should do so immediately. AFFIDAVIT OF MAILING declare under penalty of perjury that I am now, and at all times herein aehioned, Have been a Citizen of the ited States, over apt 18; and that today I deposited in the United States Postal Service in Martinez, lifornia, aostage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to e claimant as Shown above. ` ted: JAIL 2 J rI BY: PHIL BATCHELOR by Deputy Clerk Loamy Counsel County Administrator i• ' l Div. 3.6 CLAIMS AND ACTIONS § 910.2 County of San Francisco (App.1941) 116 complaint for intentional tort to general P.2d 450, hearing dismissed. demurrer. Tietz v. Los Angeles Unified y School Dist. (1965) 48 Cal.Rptr. 245, 238 20. Presumptions A.C.A. 1028. Where corporation obtained a judgment Although complaint against county for sy in tort action against city, it was pre- damages to land were properly dismissed sumed that the corporation complied with on demurrer where it affirmatively showed provisions of city charter in perfecting its that claims against the county were not demand against city, since such compliance timely filed, it was an abuse of discretion was necessary to state a cause of action. to sustain demurrers without leave to Department of Water and Power of City amend to show substantial compliance of Los Angeles v. Inyo Chemical Co. with this section, if plaintiffs could allege (1941) 108 P.2d 410,16 C.2d 744, facts showing such compliance. Hum- 21. pleadings phreys v. State Dept. of Public Works (1961) 13 Cal.Rptr. 557, 192 C.A.2d 476. Where complaint by union did not allege any compliance with claims provisions of The permission given to plaintiff to file ' T the Governmental Tort Act, § 900 et seq., an amended complaint in injury action in- union could not recover monetary damages creasing demand from $50,000 to ik against city or the city's board of harbor $150,000, was not error, though claim i '! commissioners. International Broth, of filed by plaintiff against city while he was t^` Elec. Workers, AFL—CIO v. Board of still in the hospital was,for only $50,000. ;,,. Sullivan v. City & County of San Francis- ': " r, Harbor Com'rs of City of Long Beach ;,. co (1950) 214 P.2d 82,95 C.A.2d 745. g•' (1977) 137 Cal.Rptr. 372, 68 C.A.3d 556. In automobile guest's action against city yr Where claim of lien filed by subcontrac- for injuries sustained in collision on foggyIG F" for did not give irrigation district or its night with cement block foundation of officers actual notice of any impending ac- wigwag signal maintained by railroad at •: i tion against them personally and did not railroad crossing, allegation showing that mention district's failure to obtain labor �,.•; . and material bond under Civ.C. 3247 and claim was filed within 90 days after acci- dent as provided by statute and in sub- a.r did not present the district with a claim stantial compliance with city charter and " ivr for its work on public project, subcontrac- matter was referred to city attorney and 1 '' for did not have cause of action against the carefully investigated by city manager f'?I district or its officers for failure to obtain showed sufficient compliance with provi- ;Sr statutory material and labor bond. C. A. Bions relating to filing of claims. Sauds- ;q, Magistretti Co. v. Merced Irr. Dist. n• toe v. Atchison, T. & S. F. Ry. Co. (1972) 103 Ca1.Rptr. 555, 27 C.A.3d 270. ; (1938) 82 P.2d 216,28 C.A.2d 215. Failure to allege that claim had been '"�•�3 presented against school district subjected N- np 1 a § 910.2. Signature The claim shall be signed by the claimant or by some person on his behalf. Claims against local public entities for supplies, materi- als, equipment or services need not be signed by the claimant or on j his behalf if presented on a billhead or invoice regularly used in the } conduct of the business of the claimant. (Added by Stats.1963,c. 1715,p.3374, § 1.) Law Revision Commission Comment This section is the same as the second paragraph of Government Code [former] Section 711, which applies to local public entities. It will eliminate the requirement of Government Code Section 621 that claims against the State be "verified in the same manner as complaints in civil actions." Claims against local public entities are not required by existing law to be verified. 499 ref i,F I f' r DE; GOVERNMENT CODE" Note 7 § 910. Contents of claim Rett•. A claimshall be presented by the claimant or by a person acting on his or her behalf and shall show all i of the following: �(a) The name and post office address of the claimant. tice; .roj.The post office.address to which.the.person presenting.the,claim"desires notices to be sent. (c) The date, place_and other.circumstances of the occurrence or transaction which gave rise to the vices claim,asserted. )COY abtor. '(d) A general descriptionof theindebtedness,,obligation, injury,'tl ge.or loss incurred so far"as it tified may be Inown at the time of presentation of the claim. . (e).The,name:or names.of the.public employee or employees causing the injury, damage, or loss,if " epay-.. known: :... -. (f) The amount claimed if it totals less than ten thousand dollars ($10,000) asof the date of ,vhom presentation "of the claim, including the estimated amount of any prospective injury, damage,-or loss, shall insofar as it may be known at the time of the presentation'of the claim; together with the basis of Civil computation,of the amount claimed. .If the amount claimed exceeds ten:thousand'dollars ($10,000), no. dollar amount shall be included in the claim. •However,.it shall indicate whether jurisdiction over the claim would rest-in municipal or superior court.' tlocal (Amended.by Stats.1987, c.1201, §-17; Stats:1987, c. 1208, § 2.) Historical and Statutory,Notes: . 1987 Legislation thousand dollars($10,000)"after'."the'amount claimed"in subd.(fj,and adde8 the last sentence. :. Application,of Stats.1987; c."1201- §§3, 9 to 25; see '. historical-Note under C.C.P; § 877:5. Effect of amendment of seetion.by two or more acts at The 1987 siiiehdment by c.1208 required the section to' the same session of the legislature,see.Governmmt Code . show,"all of the following",added`tif it totals less,than ten § 9605. Law Review Commentaries" ds fromGrassroots..•impact Litigation:. Mass. filing of small to pay` claims., ,Andrew D; Freeman and Juli E._Farris, 26 . Mon did;'• U.S.F.L.Rev.261(1992).. . linquent d public dispute:: Library,References bystat',. California Practice Guide: Personal Injury,,Flahavan,Rea,Kelly&.Termer,see threatL Civil•Procedure Before Trial, Weil & 'Brown, see Guide's Table of Statutes for 6apter paragraph { iholding, Guide's Table.of Statutes for. chapter paragraph- number"references to paragrsplis discussing.this .ute pro ' number references to paragraphs"discussing this. aection u•eats'to section: Ikemoto Ath 444, S WESTLAW'Electronic`Research - ? See WESTLAW Electronic Research Guide following the Preface. t' Notes.of Decisions .: General description 22 City of Ontario v.Superior Court(People"ex rel.Dept.of Medical expenses 15.5 Transp.) (App. 4 Dist.1993) 16 Cal.Rptr.2d 32, 12 Cal. Place:of'filing."17.5 APp•4th 894. Summary judgement 23 5. Compliance—In general Timely filing of claim is essential element of cause of + action against public entity and failure.to allege compli- F 2. Purpose ance with.claims statute.renders complaint under Tort 1- Under the Government Tort Claims Act, purpose of Claims Act subject to general demurrer. Wood v.River- requiring the filing of claims,and of prescribing time limit side General Hosp. (App.4 Dist. 1994)31 Cal.Rptr.2d 8, frames in which such claims maybe filed,is to give public 25 Cal.AppAth 1113. entity the"opportunity to investigate the facts while evi 7, —,Sufficiency of compliance dente is fresh,"as well as to settle meritorious cases Government tort claim stating that automobile accident without the need-of litigation; furthermore,"prompt pre- was caused by"negligent maintenance and construction of sentation of claim-for money permits recipient public highway surface," and by "failure to sand and care for entity to make"appropriate physical planning decision: highway" was sufficient to support allegations of subse- Additions or changes indicated by underline; deletions by asterisks i ' 95 i. X4 ��s' 1,15 RECEIVED �m Tim Granshaw FEB - 3 208 Lasso Circle ��� San Ramon, CA. 94583 CLERK SOAi�D OF S-OP'EFt'dISORS 510 830 1678 CONTRA COSTA CO. Board of Supervisors County Administration Building 651 Pine Street, Room 106 Martinez, CA 94553-1293 To The Board of Supervisors, Your response dated January 25th regarding my claim for damages sustained in a bicycle accident in July is unsatisfactory. My accident was caused by your negligence in maintaining the road surface. I remind you that I am only requesting payment for medical expenses and damage to my bike. If I do not receive a more-positive response by February 18th I intend to take legal action. I will seek compensation for pain and suffering, missed bicycle races, and lost wages in addition to medical expenses and bicycle repair. Please send me copies of your initial reply and Sections 910 and 910.2 with your response to this letter. The document was missing its left edge and the copies of Section 910 and 910.2 were missing, Signed, Tim R. Gran --w— < `` � .� ` � l � .��, 1 ,�—� �. ,� _ �� i �, � � � r 't ,���y' N �_ f. ?"M� � � �� .:.,, .: �4 6 '�'"� ,-� �+ {�,�,., cam+ � �' � � -..� � r ''..�J x v� ,^ ,� '.. � � � o �' � 1 � �" � z � ;n 4 � � � s �� � o �, � � � d �' � � � � ���'� t � � , � � -�- � CLAIM BOARD OF SUPERVISC'RS,OF CONTRA COSTA COUNTY, CALIFORNIA January 24, 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: $2779.01 + Section 913 and 915.4. Please note all •Ye5ingp� R ��� CLAIMANT: Tim Granshaw _ JAN 10 1995 ATTORNEY: COUNTY COUNSEL Date received MARTINEZCALIF. ADDRESS: ' 208 Lasso Circle BY DELIVERY TO CLERK ON January 9, 1995 San Ramon, CA 94583 BY MAIL POSTMARKED: January 6, 1995 1. FROM: Clerk of the Board of Supervisors T0: County Counsel Attached is a copy of the above-noted claim. IL BgATCHELOR, Clerk �i 1 DATED: January 10, 1995 : Deputy 11. FROM County Counsel 70: Clerk of the Board of Supervisors (�✓") This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying 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 II1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present ( v7 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. Dated: JAN 2 4 pp n PHIL BATCHELOR, Clerk, By 11 - ( 4 , Q A a , Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the 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-.MAIL)NG 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: JAN 2 5 195 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator a� cpo n ID 10 Ir til//_✓ V 4" Ir U — �t s 0 Ola'' to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT. A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to .personal property,or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. -Claims must be filed with. the Clerk-of the .Board of Supervisors at its office in Room 106, County Administration Building,. 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one publie ,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 rim Grans 1ww ° R CEIVED ) Against the County of Contra Costa ) A 9M or ) CLERK BOARD OF SUPERVISORS , District) CONTRA COSTA CO._ Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $: 7G.d�90.6 7 and in support of this claim represents as follows: 1. When did the damage or injury occur? :(Give exact date and hour) Wednesday 744 y 13'4" 6efweu" �2' 30p�-�:30p.�•,. - 2. Where did the damage or injury occur? (Include city and county) . oufkbo,jo /0n Ph aha f 75 yards hd-w- $fore(-&-1 tk kvsec/'o�� AW o CO-" 6XII, 3. How did the damage or injury occur? (Give full details; use extra paper if required) See nofe Offa��iH� 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? hey/i pnce- in mal'n;6/n1 10 1 +he. rcaot Styr Face, D. wnat are the names of county or district officers, servants or employees causing the damage or injury? t2eVOMS 6�liYrJ ©r Caotna CBsiu [manl4 -------------------------------------------------------------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. �e,� ►�e�ct�u�h � a 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) jOpcu&7e&4tedCosf ©Fr"eC,&Ca1 covevuye. o44Vkiceti<ent C60-Foe, 6icyc4e csm�/cycVm etec.ejs&"'e-S . $. Nyames N9,2q-3024-. and addresses of witnesses, doctors and hospitals. ((I ,4 Arri&c, San .Xth hC4N►0�► -1,1007l o n�yibHu( Ecu (ec,toio1275 )eJ3S' O SF00Sar Ra Adh /,44,1gy t-00 352-MOU -------------------------------- --..----M�-M-N----MN--- 9. List the expenditures you made on account of this accident or injury: DATE ITEM S?� v►me ucl�n #� AMOUNT Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO.:_. !(=Attonne :),x .. or by some person on his behalf." Name and Address of Attorney .. . . i /Qk Claimant's Signature 206 G4ss0 C<<�l Address Telephone No. Telephone No. L/a 930--16ac ,:. 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•)I ,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. Note Attachment#1 While riding my bicycle southbound on Danville Blvd. I hit a large pothole. This pothole was practically invisible because 1)No cracking or missing road surface was apparent and 2)the pothole was deep yet narrow. As I hit the pothole my front wheel bent, at the same time my hands were knocked from the bars. When the wheel hit the front fork I flipped over my handlebars, hitting the back of my friend's bike, then the ground. Note Attachment#2 I. Injuries a. Puncture wound to the bone 1 inch below the elbow on the inside of the right arm. b. Torn muscles in right shoulder. 11. Damages a. Lemond bicycle frame. b. Scott Drop LF handlebars. c. Cinelh cork ribbon. d. 2 Omega 19 rims and bicycle spokes e. Oakley Subzero Sunglasses Note Attachment#3 I. Injury related San Ramon Emergency Physicians $324 San Ramon Valley Radiology $100 John Muir Medical Center $418 San Ramon Regional Medical Center $465.54 plus $50 co- payment Total $1327.54 11. Equipment Lemond bicycle frame and fork $1095-$1200 Scott Drop LF bars $49.95 Cinelli cork ribbon $14.95 2 Campagnolo Omega 19 rims $56.95 1115 Spokes $24.00 Oakley Subzero carbon frame sunglasses $100.00 Total(including tax) $1451.47-1563.13 , -f 4 V 1976 THANK YOU FOR SHOPPING AT LIVERMORE CYCLERY 2288 FIRST STREET LIVERMORE CA. CYCLE-CYCLE94550 v i 510-45-8090 ESTIMATE 01/02/95 13:32 TERMINAL NO. 01 B16ycles & Components INVOICE NO. 155439 CLERK: CHUCK RFCHEY 28 OAKLEY SUR ZERO IRID CHUCK RICIIEY,.' l 1 @ 100.00 100.00 T ESTIMATE SUB TOTAL 1QQ.QQ 2288 FIRST;STREET SALES TAX 8.25 IVERMORE,'CA s4's5o PURCHASE TOTAL 0,00 (510) 55-'8090 _ 1 ky Yy%�YyyyyYyvy�gvyyyy 20 • C. �S c Co, Lk5f.6 �llc� rHs 1pw` �� p NAME i� m coD -ADDRESS e ZIP 9 -SS CAm HOMWORK E PHONE v Ml fJ—/L HONE 7VJ-fM DATE Service Parts Labor Check Over 1 3 10+ CD m Comp.O'Haul 1 3 10+ -n y Install Tire F R D w Q. -- - — - - Install Tube F R m `� N ' n Install Cable FB RB FD RD -JOHN&KAREN DRIAM Adjust Hand Brake F R c r c ® (510)462-9777N True Wheel F R w D .i = p L ASAL N T 01V o LEMOND Bespoke wheel F R o R g S o BIANCHI Adjust Derail F R o MONGOOSE Adjust Hub F , 3 R CD m o SCOTT O'Haul Hub F 1 3 R 1 o o TIME + � - .... Adjust: Head Bottom Bracket I r,,, 525 MAIN STREET, PLEASANTON, CA o'Haul: Head Bottom Bracket > INSTALL � r- bO J I N ^ V y� (� "OLD;ARTSZY�ES ` PaftsA �Q KJQO ZK, Labor c MEC NIC SIGN Tax = i a TOTAL � I CO EST. AMT.A111 PICKUPD E DELIVER SUN. MON. . WED. THUR. FRI. SAT. TIME Jan, 4. 1995 7:07AM PRU-CARE OF CALIF. 415-574-3754 No. 0183 P. 2/2 10CH 942372.78159 MEOICRL CLAIM/ORRFT DETAIL .. ®1/®V95 20:4 DOC CTL: STAT : C FULLPD 88125194 1NGutb: 8711319 CLAIMANT: 573678902 03 GRRNSHRV ,TIMOTHY R RLT. C SER: M DOB: 1113817 PROUIDER: 91 91919 000 DOCTOR UNKNOWN ZIP: 94403 9=W A� MRN: 86908808088 MMPO: 621 PLRN: 97 REMARKS: NOTE NOTE ... PATT OVERRIDE: STAGE DATE: 99/25 '9 PAYEE: PROUIDER—INDIU PAT 10: 001788392 COB: KRRS : SAN RAMON REGIONAL MED CT CHECK STAT: C AS OF: 08/26+ 94 6801 MORRIS CANYON RD SERIES: 674 NO: 8032776 DRTE: SS/Z6194 SAN RAMON CH 94583 AMT: 465,54 CHK PROD TIN: 953729659-200 CODES: 272 932 BULK IND: D PE: 4 FROM/TO SNL PROC PROUIDER SP CHARGE NET PRY PND ST C 1 ) 071394 ER2 953726659-250 GP 736.46 465.54 PYD STALE 1 OF I PRYCIT WE OR WILL BE VIA BULK CHK MORE PRYLINES. - BC SEL.ECT OPTION P —= UAL I 0 OPTIONS (P,F,C,R,M,*) ------------ 0 - YOU OWE: SAID RAMON REGIONAL MEDICAL CMAKE SURE AOORESS APPEARS IN A AMOUMT DUE: 356.00 AND AKEOPAAYMENTUTO:ENVELUPE ACCOUNT NUMBER: 001700392 PATIENT: GRANSHAW9 TIMOTHY R SAKI RAMON REGIONAL MEDICAL C 6001 NORRIS CANYON ROAD SAN RAMON9 CA 94583 -'"SHOULD YOU HAVE ANY QUESTIONS REGARDING THIS ACCOUNTt CONTACT: SAN RAMON REGIONAL MEDICAL GTR AT 510/215-9200 r } i 1 SAN RAMON VALLEY RADIOLOGY i PO BOX 5111 SAN LEANDRO -CA 94577 (510)352-1900 ACCOUNT 0: 05 005867 FOR SERVICES RENDERED AT SANRAMONREGIONAL 8IW NG DATE 10/11- TIMOTHY 0/TIMOTHY GRANSHAW -•PA'ngW 208 LASSO CIR GRANgHAWo TIMOTHY SAN RAMON CA 94583 DATE OF EP"11 11-/30/72 IsEx M TE'IEPHONE ( 510T830-1678 6nlwNc _ 100. 00. blE 3 s;pc p - 00098038 TIMOTHY IM0THT R GRNNS"' AW 08/23/94 200 94,22000122 TiMIDIHY R GOANSNAW 418.0C . 1,167 AMOUNT ENCLOSED PAY THIS AMOUNT 418.0 C PLEASE REMIT YOUR PAYMENT TO- JOHN MUIR MEDICAL CENTER 1801YGNACIO VALLEY ROAD WALNUT CREEK CA 94598-3194 TIMOTHY R GRANSHAW (510)938-2400 208 LASSO CIR SAN RAT40Np CA 9-4583 CHARGE TO MY: 0 VISA 0 MASTERCARD 0 AM.EY ACC-f.NO. EXPIRATION DATE SIGNATURE AMOUNT PAID $ uburiAHGE UATE RAIIENT TYPE ACCOUNT NO. PAhEri NANIL ALXIM�S;`,-LATE 9422000122 TIMOTHY R GRANSHAW 07/13/94 07/134/94 CPA 41 08/08194 Billed Batance 418.00 Account gatance 418,00 Patient ResoonsibititY 418,00 THE BALANCE ON THIS ACCOUNT IS YOUR RESPONSISILITYo YOUR PAYMEKT IN FULL OR A CALL TO THE PATIENT ACCOUNTING DEPT TO MAKE OTHER ARRANGEMENTS IS APPREcrATE-0. THANK YOU, SUMMARY OF ACCOUNTS FOR: TIMOTHY R G R A N S H A W BALANCE FORWARD FOR ALL ACCOUNTS 418.CCI TOTAL CHARGES AND ADJUSTMENTS c.cc TOTAL INSURANCE PAYMENTS ().c() TOTAL PATIENT PAYMENTS C.C-0 JOHN MUIR MEDICAL CENTER TOTAL ACCOUNT BALANCE 418.Co 1601 YGNACIO VALLEYROAD WALNUT CREEK,CA 94598-3194 FOR BILLING INQUIRIES PLEASE GUARANTOR RESPONSIBILITY 418.00 CALL(510)938-2400 �............. - MEDICAL ORCUP , • i� WALNUT CREEK 14 596 52c37 i I44i� i KJWT 1� 4 Ppo HF�IL"t�it iiRANCE Mat SRM rim k'.+: j€ ,3 Tum "` � A�� s t+�aFsrs� i � t� e. aaAt•>'C�h�ne.+�sce�a. p7aRhi>ter'► R i ti y r T� mr 3C ©Rl PI{gH W r,,.DRDQW 3MAr44SHAW - c a�t+cr[l wTeC tmm y.tmilAur s7s+ + �^ ' .rn7rCt�# fes• zas LASSO c x f�'GLEan�m[l, tag LASSO c x;FtrLiw sexes. ATE a ;rir,3rAeus ' cA` i oto S N IRI ON aA !ON R N ZWOODE s ►.Fawo'aE(�+ Awexao o rowL Full-Tom ��,,* v4�e� X514)8�t}ib7e � *• 5 c� i 3q �� ,,. 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Mi1LtIPLF-, Lam: 1 ACC ZtICYCi-E - --- w Psytas ~T1cice" U oats" B ' tUN(t$ ra+� =a t 'vim.gUBE rn tR:w� �} Qra � 116 j 4 23 201' ,60 ,01 X 4 = 4 j T3 :7!OQ ��% , Ju x i,►,q 23 4 73.132 tic. 2 3 00 =01 XX ' 99284 + 2 _ 3 4.. . + O fl 2 X X IE M WrAL MAW 12 .nuOUM vA10 88.UL""ax ?7692U9 { 33f12UC0�'r4$C i ym ! No S 324" 44 0' 00 19, 32,4 1©0 �ruaacar,o�ermMtotymas ►a 88 O i? R S9RAL MtBiir 1vaph-vsR*ftaum a.bilisunw sae p 33 iiIS16flGmtt�E0�7taisgarptnt. t th�sus ax on amirBtetee S ty R 1.�tmN ain fiert a"�mL. MCD CTR SARMAMON EMER89NCY Pt-1YSMIAN M EMERGENCY Di.EPARTMENT P A BOX 2267 1 ;.,, RAMON CA 94583 C4ATVWORTW CA 91313 2267 95. ► N$F40689F _pw WL 94 2769209 . �` �0 "�!-il—" dQ�7G�t� ��te�i�!��1��3 �rn�.r°' ► ��a�+aa�a�ooat�++�rs� CLAIM /• 'S BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 24, 1995 Claim Agaipst 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 "Harnings" CLAIMANT: Curtis Perry, Jr. : Rebekah Patrick and Jessica Garcia D •��"` ATTORNEY: Alfred H. Buchta • J AN 12 1995 Buchta & Murphy. Date received COUNTN�ALIFL ADDRESS: P.O. Box 5026 BY DELIVERY TO CLERK ONZ�, San ramon, CA 94583 BY MAIL POSTMARKED: F.a,s1, Mgmt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OIL ATCHELOR, Clerk DATED: January 12. 1995 ' 81 : puty Il. FROM: County Counsel 70: Clerk of the Board of Supervisors This claim Complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying 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: /a/it q By &404 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. JAN 2 4 1995 p .. Dated: PHIL BATCHELOR, Clerk, By '0-4-, jq_04�. , 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 to 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: IN 2 BY: PHIL BATCHELOR by qp, , 0_11AJJA,o J Deputy Clerk CC: County Counsel County Administrator I ALFRED H. BUCHTA (Bar #60698) 2 BUCHTA & MURPHY A Legal Association RECEIVED 3 UNION BANK BUILDING 3223 Crow Canyon Road, Suite 350 '95 JAN 11 P2 :03 4 San Ramon, California 94583 (510) 866-8787 5 ;UDP (),R C0NTR0L1.F ' Attorney for Claimants: ,.U; r . 6 Curtis Perry, Rebekah Patrick and Jessica Garcia 7 'rt;," g ;,.,. :,.. . .. . 9 IN THE SUPERIOR COURT, STATE OF CALIFORNIA " COUNTY OF CONTRA COSTA 10 11 CURTIS PERRY, JR., REBEKAH PATRICK, ) GOVERNMENTAL TORT CLAIM 12 JESSICA GARCIA ) (GOVERNMENT CODE SECTION 910) 13 Claimants, ) 14 vs. ) RECEIVED 15 CITY OF ANTIOCH, CONTRA COSTA COUNTY, DEPARTMENT OF-PUBLIC ) ,)MN 1 2 1995 16 WORKS, AND DOES 1-20 ) v;,,,,; Q;,ak 17 Governmental Entities ) CLERK 80ARD OF SUPERVISORS CONTRA COSTA CO. and Employees ) 18 19 CURTIS PERRY, JR., REBEKAH PATRICK AND JESSICA GARCIA make the 20 following GOVERNMENTAL TORT CLAIM: 21 A) NAME AND POST OFFICE ADDRESS OF CLAIMANTS: 22 Curtis Perry; Jr., Rebekah Patrick, Jessica Garcia c/o ALFRED H. BUCHTA, P.O. Box 23 5026, San Ramon, CA 94583. 24 B) POST OFFICE ADDRESS TO WHICH PERSON PRESENTING CLAIM DESIRES 25 NOTICE TO BE SENT: 26 ALFRED H. BUCHTA 27 BUCHTA & MURPHY P.O. Box 5026 28 San Ramon, CA 94583 i I C) DATE, PLACE AND OTHER CIRCUMSTANCES OF OCCURRENCE: 2 On September 9, 1994 at the intersection of Hillcrest Avenue and Wildflower Drive in the 3 City of Antioch, claimants suffered serious injuries in a motor vehicle accident with another driver, 4 Hee Jueong Lin. This accident occurred in part due to the unreasonably dangerous condition of 5 said intersection, to wit: malfunctioning traffic light. The injuries suffered by claimants were 6 proximately caused by said dangerous condition and said dangerous condition created a reasonably 7. foreseeable risk of the kind of injuries which were sustained by claimants. The Traffic Accident 8 Report relating to this accident is attached for reference. 9 D) DESCRIPTION OF DAMAGES AS KNOWN AT THE TIME OF PRESENTATION 10 OF CLAIM: 11 1. CURTIS PERRY, JR.: 12 a. Forehead abrasion and scarring; b. Neck injury; 13 C. Headaches; d. Dizziness; 14 e. Nosebleeds; f. Medical bills; 15 g. Lost income; h. Emotional distress; 16 i. Loss of enjoyment of life. 17 2. REBEKAH PATRICK: 18 a. Laceration and scarring of forehead; b. Concussion; 19 C. Vomiting; d. Nausea and dizziness; 20 e. Left knee injury; £ Neck injury; 21 g. Medical bills; h. Lost income; 22 i. Emotional distress; j. Loss of enjoyment of life. i 23 3. JESSICA GARCIA: 24 a. Fractured leg; 25 b. Emotional distress; C. Loss of enjoyment of life. 26 E. NAMES OF PUBLIC EMPLOYEES CAUSING DAMAGES: 27 The City of Antioch is liable for injuries arising from the dangerous condition of 28 2 I their property. The City of Antioch and Contra Costa County are responsible for the negligent 2 actions and inactions of their employees. The Public Works Department of the City of Antioch 3 and/or the Public Works Department of Contra Costa County are responsible for the maintenance 4 of the traffic lights at said intersection. The actual names of the employees of the City of Antioch 5 and Contra Costa County that are individually responsible for the proper maintenance of the traffic 6 lights at issue in this case are unknown to claimants but are certainly known to the City of Antioch 7 and/or Contra Costa County. 8 F. AMOUNT OF CLAIM INCLUDING BASIS OF COMPUTATION: 9 The amount claimed for each claimant is within the jurisdiction of the Superior Court for 10 the County of Contra Costa. 11 12 Dated: January 9, 1995 13 ALFIgiD H. BUCHTA 14 Attorney for Claimants 15 16 17 18 19 20 21 a 22 23 24 25 26 27 28 3 STATE Or CAUPORNIA TRAFFIC COLLISION REPORT PAOE I OF SPECIAL CONDITIONS NUYeen "T&RUN CITY JUOKAAL DMTRICT LOCAL REPORT NIAie ER NEO FELONY 9 ❑ NUMBER MY t RUN COUNTY REPORTING OtsrieCT BEAT ._ I -7 Y / KILLED M140. % El LLMON OCCURRED ON .. _..__ _ _ MO. DAY YEAR TIME(]too 1 Nac a OFFICER L D. O ----------- _ MILEPOST INFORMATION ... ....: -'. OAY OF wEEK f, TOW AWAY PHOTOGRAPHS BY: ...._ -". a S M T W TvS �YE6 ❑NO -� ;'_ `` U FEET/MILES Of - -. •--G/J 0 - AT M71tSECTIONWITH .: aYE' � NO ......'..O NONE ❑�: .._ FEET/SALES Or PARTY ORNERY LICENSE NUMBER' STATE CLASS SAFETY V[lI YEAR MAKE MAKE MOOEL/COLOR ENSE NUYSER STATE sowr � /� G✓c3/Fl .PEDES- A00/tESS {,- OWNERS NAYS aSAME AS ORNER- 'J TMAM rJy '$ PARKED CITYJ STATE127r 0*1" YADDRESS ' SAYE AS ORNu s vUeGLE -�.♦ - t ✓� `j'3alJ$�T¢ / �.r yew/ '�1c J %/'� Vii.:� � r� �� ..El 1;: BK:Y•- SEX •( NAIR.:;. mEYES- Nf1oNf w60TTI {>"NIJi11RHOAlEtil- RACE 016POSITON OP VEHICLE ONOROERSOr' y-; E- DRIVER `❑DR1Vu ❑oTNER yt.t ejLI�s7r: Q/ Q� Yw:—. owr ruR � ---••,.--.- „�,.�..,�. -Q�s- may , i./`'• .- •JI-�I { � d•.s .�'f; '" --i %• F- BOTHER"' NOYi PHONE^'^ •3 r +fw^-y++-+o WSWiEfOOtNKktE .IPRIORMECNANCAL-DEFECZI. °""NONE APPARENr� >..REFERTOX&RRATIVEE]..,. USE ONLY _-__ ..'."it1ADE W DAMAGED A/tEA - OESCIYSEIIEMClE DAMAGE 04SURANC Cs..,ARRIER �. s.{ 4 - : 3y',. x.ytL,IOLICT MJWER ti" 1 MCI.E OUNIC,',.l'❑NONE; aMINOtI� 7 .. _ : YCfam Of ON STRETOR M-4WAY - _p Kx❑ "TRA ❑VE TYK ❑M04'��YAJOR J..❑iOiAL V _ - , - lam'- �L�J�Cac..� �_�� .. _ -y5 -- .. � t..,,. .CH.❑ : PARTY OAVERY LICENSE NUYSEiS STATE CLASS SAFETY va!N YEAR YAKE/YODEL/COLOR _.._ ENSENUMBER STATE OI✓T "IMM LAST). )i ,. # r ,rat --� -r kf*� .-.i, `KOES• AOORE,S "�-- v -G.�- +s�''-r -..tL f a.-�`ryy OWNER'S NAPE ❑SAYE AS ORtVEII :. Or PARKED Gt7Y/STAT£/zw-- 'T' 1-- :- -. OWNE11'8 AD011ESi- [��SAME AS ORNE/l 6j cl YCY•.. SEX.. HNR_�r -.EYE1" NEIGIFT WdOHT BIRTHDATE. MACE.; gSPOSR10N Of PENILE ON ORDERS Of•.' ��}OFFC£R RI ❑DVER 00TRER-.... . CUSY:i YO. DAY YEAR �•. _ !T.'l"1 _ _. cl *THEA, NCAL DEfECTi: PR1011 YECMANONE APPARENT� -.RFFFIITO NARRATNE❑ . ti - CHP USE ONLY SHADE W DAMAGED AREA ❑ / OESCRS£ CHICLECA.M/AE _ osSURANC£CARMER •.: POLICY NUYBEItVENCLETYK - }� �_ {�^ f t .. ❑UMC El NONE 13MMOR ` //'✓i *J_)��/',.:.: f, LA 1 ��) i _ _ Y00.``.Q MAJORcl TOTAL ORLOF JON STREET OR 1eGHWAY _.-. SPEED aCP, _ KxQPUCO CNP❑ PARTY ORNER-S LICENSE NUMBER STATE VEIL YEAR MAKE/MOOEL/COLOR LIC5NSENUMBER - _ .. STATE EOIRP. 3 py 1 . • _ DRN£R NAPE(A RST.WOOLF.LAST) _ _ •�-� 4 a •„�° •. � - KOES -TAD E . ... . Ell OWN NAY ....: „❑SAME AS DRN 1 mclm PARKED STATE/23F - QWCjERIS KESS SAME AS ORM" VENCLE _ - i - r cl SICY. SEX HAIR EYE, HEK:HT WEIGHT ...ATE RACE` q ON. Y.., ONORo£ EA ❑DRNEA ❑OTHER COST DAY t . YEAR -=-- ❑ i OTHER NOME PHONE: BUSINESS PHONE �'� - (^'� MECHANCAL'OEfEC19: 1 !: NONEAMAREM❑ REFER TONMAATNE❑ SHADE IN DAMAGED AREA PENILE TYK t,URACE CARRIER POLICY NUMBER UN " ❑INIC 1:1 HONE a MRgR f` ` 11 YOO, El MAJOR 1-1 TOTAL OM Or JONSTREETOANGHWAY SPEED PCF Icc , 3 TRAVEL Uwr PUCQ I{ CHP Q c_ ARER"S NAJAE _ DISPATCH NOTIFIED REVIEWER'S NAME c��a� y..�� JOATE REVIE/WEO !P"EP - 0YES C3 NO 0 NIA -1(..SchwI i tY-RA Y«—'1 q CNP SSS PAGE 1 (Rev 1-98) ON 042 _. - - 88 4666' STATE OF CAUPDRNIA TRAFFIC CQUISION•CODING PACE DATE Of OLUSION TLf(2/4001 _ moc NU SEh R 1.D NLMYEA _ MO. DAY � YEAR/ ,� / - OWNER'S NAM ADORESs - - MOT's OT RED PROPERTY E]YIE El No DAMAGE DExPoPT10N OF DALACE SEATING POSITION SAFETY EQUIPMENT EJECTED FROM VEHICLr_ L-AIR BAG DEPLOYED I MET 0-NOT EJECTED A-NONE IN VEHICLE M_AIR BAG NOT DEPLOYED DRIVER I-FULLY EJECTED B-UNKNOWN N-OTHER _. _. . C-LAP BELT USED P-NOT REQUIRED V-NO 2-PARTIALLY EJECTED- D-LAP BELT NOT USED -' W-YES 3-UNKNOWN ' 1-DRIVER � -...... _- 1 Z 3 2 TO 6-PASSENGERS - E-SHOULDER HARNESS USED _.,._.. PASSENGER F-SHOULDER HARNESS NOT USED CHILD RESTRAINT -' ` 4 5 6 7-.STATION WAGON REAR _._ X-NO - , G-LAP J SHOULDER HARNESS USED O-IN VEHICLE USED - 8-REAR OCG TRK OR VAN H -LAP J SHOULDER HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES ... .-- ,.> D-POSITION UNKNOWN,._ 0-OTHER S°"' .�- J-PASSIVE RESTRAINT USED - S-IN VEHICLE USE UNKNOWN- ---- . 7 K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE ;.... _ .. U-NONE IN VEHICLE _ w, ITEMS MARKED BELOW FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR MOVEMENT PRECEDING LIST NUMBER(s)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES Z 3 TYPE OF vt]ICLE 1213 AvC SECTION VIOLATED ACONTROLS FUNCTIOHING - - 77 APASSENGER CAR J STATION WAGON ASTOPPED-- r 1�%✓Z: r- B CONTROLS NOT FUNCTIONING• BPASSENGER CAR W J TRAILER B PROCEEDING STRAIGHT >;: s B OTHER IMPROPER DRIVING'' CONTROLS OBSCURED..._ RAN OFF ROAD <: 7 -. _..,. .. _ C MOTORCYCLE/SCOOTER.--. - - D NO CONTROLS PRESENT/FACTOR• DPicKUP OR PANEL TRUCK D MAKING RIGHT TURN C OTHER THAN DRIVER ` TYPE OF COL.LJSIOH E PICKUP J PANEL TRUCK W/TRAILER E MAKING LEFT TURN:t DUNIwovlrN , L• r HEAD-oN FTm=ORTRUCKTRACTORs��is z` F mmNGuTuRN__,.4_ 1 s SIDESWIPE TRUCK/TRUCK TRACTORW/TREK __ BACKlNG3 a t E. e = j _,,,� „�. REARENp -,. ,w SGWOLtiUS „ �. STOPPINGtj.� y.; SLOWING J. - .WEATHER(.MARK 7..70217EMS) ._ a_D BROADSIDE,_:- (OTHER BUS .. I PASSING OTHER VEHICLE f ACLEAR<;:. �, e. EHiTOSJECr, .: J EMERGENCY-VEHICLE CHANCING LANES,s J 1T. . s BCLOUDY.r. : >?!f •r A*•FOVF3tTURNED; : KNIGNWAYCONST-EOWPMENT KPARKING MANEUVER-* RAINING VEHICLE!PEDESTRIAN L BLICVCLE. L ENTERING 7RAFFIC:f: +`' OSNOWING OTHER { J.';- <,_. .. .-; MOTHER VEHICLE -' OTHER UNSAFE TURNING E FOG J VISIBIUTY„;- FT. MOTOR VEHICLE INVOLVED WITH- N PEDESTRIAN` XING INTO OPPOSING LANE:'s . F OTHER. w _�- F„ANON-COLLISION •.. ._ MOPED: NPAED t}. -, WINO B PEDESTRIAN a _ ING - ` ._ELING WRONG WAYOTHER MOTOR VEHICLE *ADAYUGH7 R MOTOR VEHICLE ON OTHER ROADWAY OTHLER ASSOCIATED FACTORS)B DUSK-DAWN E PARKED MOTOR VEHICLE Z 3 - (MARKITO2ITEMSy CDARK=STREETLIGHTS - vcauaoN - F TRAIN A, `"D >crrEc- �ATwN: D DARK=NO STREETJJGHTS BICYCLE _ h�Ys r, E DARK:. STREET,UGHTSNOT. RHINAL:--:-- BITSEGTIONvauTION: s _ FUNCTIorardG• ;F. _ - - z , ". �- ❑ ONO ROADWAY SURFACE flXFJ)OBJECT CvCSECTiONvquTwN: p Z 3'A DRY BPHYSICAL € #� _. ❑�. (11ARxtTO2tiEM5)_ B WET >.�. - OTHEROBJECT: -. ❑No X HAD NOT BEEN DRINKING CSNOWY-ICY-��. _:T `�._:.:. D O SLIPPERY(MUDDY.OILY EPG) ,-='. E VISION OBSCUREMENT..-; B HBO-UNDER INFLUENCE -. F INAT7ENT10N•: = HBO-NOT UNDER INFLUENCE RBD-LMPAIRMENT UNKNOWN ROADWAY CONOITION(S7 STOP i GO TRAFFIC _:.___....... PEDES7PoAN•S INVOLVED E UNDER DRUG INFLUENCE' (MARK 1 TO 2ITEMS)' .- H ENTERING/LEAVING RAMP t A NO PEDESTRIAN INVOLVED F IMPAIRMENT-PHYSICAL' r A HOLES,DEEP RUT• CROSSING IN CROSSWALK _ I���5�IH� -- - 1MPAIRMENT NOT KNOWN B LOOSE MATERIAL ON ROADWAY• B AT INTERSECTION - -UNFAMILIAR WITH ROAD NOT APPLICABLE:-- K DEFECTIYEVE�.EQUIP �D C OBSTRUCTION ON ROADWAY CROSSING IN CROSSWALK-NOT MIN I SLAY J FATIGUED D CONSTRUCTION-REPAIR ZONE AT INTERSECTION LINO SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING-NOT IN CROSSWALK L UNINVOLVED VEHICLE AHAZARDOUS MATERIAL FLOODED' IN ROAD-INCLUDES SHOULDER OTHER': - ._._._..___.. .. G OTHER•: NOT IN ROAD w D( NONE APPARENT ' 1-I NO UNUSUAL CONDITIONS—— ..-.-. APPROACHING I LEAVING SCHOOL BIDS RUNAWAY VEHICLE_ SKETCH _ MISCELLANEOUS. .. - �.G✓ =`-.'Lr!,�j_�C.r�. % ,, I�OICATL NORTN CHP SSS PAGE 2( R• 1-86 OP1042 - - - STATE OF CALIFORNA - 'N,JURED / WITNESSES / PASSEC;iERS DATE OF COLLISION TIME R PICK:NUMHfJi OFFICER LD. ^ NUMBER/� - EXTENT OF INJURY("X" ONE ) INJURED WAS ( "X" ONE)wFITIE55 vA55ENDER AGE SEX PARTY SEAT SAFeT! EJECTED ON'" ONLY NUMBER POSEOINp, FATAL SEVERE OTHERV618LE COMPL.UNT ��_ DRIVERS PASS. PEO. CYClI O wuar INJURY IwUAY Of PAIN E. El HAMELD.O.B./ADORESS / TELEPHONE ` /�- •%.. ,-/ _ � .;.'!� �% /i�_ T _ ^� / �-_ -�> - �,�.�_',.^ . - 'i.' !r•,��r, .moi-1.� (NJUREO ONLY)TRANSPORTEO BY: TAKEN TO: - _� DESCR18E INJURIES -/� 8-y .F p /❑_VICTIM OF VIOLENT W eE MAYS/O.O.B./ADDRESS PeLON INJURED ONLY)TRANSPORTED BY:^ L—/S 9-J - TAKEN TO:r_, DESCRIBE INJURIES •�,Fl�,�f�� i�a� ,f�cy-�-rte%. t o,�-�r'���sr-- �:� -'r��l ��^-J. -. - .. ❑VICTIM OF VIOLENT WYE N0rP,6 '€ - NAME/0.0.8./ADDRESS- _� TELEPHONE INJURED ONLY)TRANSPORTED BY: ` - - TAKEN TO: t TESCRIBEINJURIES - (/I j %V''✓' .i ��1.!/� r -'!�/lf' '�:� _. ��f•-� :..�,j^_�r��3� V 7.41 . VICfl1A OF VIOLENT CWAE l0T7FiE0 ;: NAME/0.0.8./ADDRESSj TELEPHONE -•� j }/ _J•:/ / 1,+�� INJURED ONLY)TRANSPORTED BY: - ,TAKEN TO: - DESCRIBE INJURIES a �r',�7i�� • >/� /. � 7�,� /� VICTIM OF VIOLENT WYE NOTIFIED ❑tt - ❑ ❑ ❑ T ❑ ❑ ❑ ❑ ❑ NAME/0.0.8./ADDRESS - __ TELEPHONE _ 17 CONJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE II.IURIES y, ❑ VICTIM OF VIOLENT CRIME NOTIFIED - cl o{AAJiJ 0.0.I.I AODRiSB r� C TELEPHONE 71 - _. `' �' fSA:/: rlf!.: �%�� �'-% '7 9�-_ •� rte.? W"URED ONLY)TRANSPORTED BY: '_ K TAEN TO: Llmbulanc� - :DESC I&JUMES ElVICTIM OF VIOLENT CRIME NOTIFIED VREP/RER'S NAME _ L4 NUMBER MO. DAY .-.YEAR REWEVIERS NAME/ DAY. YEA CHP 555-Page 3(Rev.7.87) 0131 042 87 43537 STATE OFWUFORNA _ - INJURED / WITNESSES / PASS ::;` .3ERS DATE OF COLLISION / TIME RNOONCIC N G '/ OZ C71 Z NUMBER�� �/7 Y 7 WITNESS PASSENGER EXTENT OF INJURY("X" ONE) INJURED WAS ( "X" ONE ) PARTY SEAT SAFETY ONLY ONLY AGE SEX NLAASER POS. -EQUIP, EJECTED FATAL SEVERE OTHER VISIBLE COMPLAINT DRIVER PAS$, PED. BICYCLIST OTHER a INJURY INJURY INJURY OF PAIN c�- a ❑ ❑ ❑ ❑ o� ❑ ❑ ❑ .1 - NAME/D.O.B./AOORESS rr TELEPHONE ' 16 QNJUREO ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES /J VICTIM OF VIOLENT CRIME NOTIFIED ❑ e1 3 /1711 ❑ ❑ ❑ ®" ❑ ❑ ❑ a NAME/AO.B..AODRESS _ a �g •�S/ � /^TELE PHME - (WUREOONLY)TRANSf+ORTEDBIY y - TAKEN TO: DESCRIBE WU/�/ES ❑ VICBM OF VIOLENT CRIME NOT89EO ❑tt ❑ ❑' ❑ ❑ ❑ ❑ ❑ ❑ ❑ ❑ NAME/0.0.8.I ADDRESS TELEPHONE ONJURED ONLY)TRANSPORTED BY: TAKEN TO: OESCRIBEINJURIES ❑VICTIMOFVIOLENTCRIMENOTIFIEO ❑# .: ❑ ❑ ❑ .,.-0 ❑ ❑ ❑ ❑ a . ❑ NJUAEID.OJLJ ADDRESS - TELEPHONE - ONJURED ONLY)TRANSPORTED BY: TAKEN TO: OESC UBE INJURIES - VICTIM OF VIOLENT CRIME NOTIFIED " -- ( NAME 10.0.8.1 ADDRESS � TELEPHONEE (INJURED ONLY)TRANSPORTED BY: - F V- - - TAKEN TO: OESCRI8E INJURJES ❑ VICTIM OF VIOLENT CRIME NOTIFIED ❑ ❑ ❑ ❑ �- � .j =a . _ �a ❑ 1111 ❑ ❑ NAME/0.0.1/A00RR58. - - TELEPHONE ONJURED ONLY)TRANSPORTEO BY: TAKENTO: DESCRIBE INJURIES ❑ VICTIM OF VIOLENT CRIME NOTIFIED PR ER'S NAME - - LD._NVNBER MO.= DAYYEAR REVIEVIERS NAME.'. .. ..- -. .-... MO..-: :.. DAY YEA CHP 555-Page 3(Rev.7-87)OPI 042 87 43637 STATE OF CALIFORNIA ..+ _ NARRATIVE/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page DA�VF 17EN CCURRENCE TIME tzaoo) NCIC NUMBER OFFICER I.D.NUMBER NUMaFa I 'X'ONE TYPE SUPPLEMENTAL rX-APPL/CASLE) Narrative Collision report ❑BA update ❑Fatal ❑Hit and run update ❑Supplemental ❑Other: ❑Hazardous materials ❑School bus ❑Other: CITY/COUNTY/JUDICIAL DISTRICT !REPORTING DISTR!IYSGkT CITATION NUMBER LOCATIONISUBJECT STATE HIGHWAY RELATED �oCL,/5i0.j 0,J Yes MNo 2. 3. 4. 5. _ 7-1-1 6. 9. 10. 11. 12. 14. 15. T/'�t ;7/c =ST T T E2" /f1✓ 16. 17. i . 18. ,.. . .; 19. 121. 122. 123. 125. 26. 127. ' 4 �r �. 29. - . c � L/N -/i�lTi �`�c J:' '- � � G.J 3( '� •� � 1 �Jf �^�Jam.� 1 31. PREPARER'S NAME AND I.O.NUMBER `-' DA - - REVIEWER'S NAME DATE Use previous editions until depleted. 90 57541 STATE OF CALIFORWA - NARRA'ME/SUPPLEMENTAL CHP 556(Rev 7-90)OPI 042 Page DATE OF INCIDENTIOCCURRENCE TIME r2A NCI :NUMBER OFFICER I-D.NUMBER NUMBER— "?- �-?--_7 /-; -7 o / a -", --? I % 7--? -XX',OHNE 'X'ONE TYPE SUPPLEMENTAL rX-APPECAME) L13"Narrative Collision report_ ElBA update El Fatal El Hit and run update ❑Supplemental ❑Other: -_ _ ❑Hazardous materials E]School bus ❑Other. 'CrrYt(=NTY/JUDICIAL DISTRICT,-' `` "' '"'''. REPORTING DISTRICT EAT CITATION NUMBER `t`��iC' �v�,� �'�^ `.� i�' , (/ G_ :_ ;..-J." . . LOCATION//SUBJECT STATE HIGHWAY RELATED ❑Yes' No etzLr- 4. 7. �?IaJ 10. t3... C/ e5l, ..> �'- = � _ , ? -..SLS ♦ I : 't� [L4 18. 20. 1 > r -r' 21. T 'r' / fir'✓ — / - �.. — 23. 24. 125. 26. 4 T%26. 128. j- -- �_ %r+�F' `. ''_. `:!.- ! .�. .t/T— _ 29. - - -- - 30. . .... t 7 PREPAAER'S NAME AND LD.NLNABEA GATE REVIEIYEfiS DATE `} Use previous editions until depleted `'� 57541 • DATC COtI.I S,ON 200) NCIC NVw En O�'�, .O. V ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED (SCALE L D,�ATE 0��,�1 � f aPE.cl NaaT� _ I I I _. ; ..__... ._._.. . < N �.1 06 bcbI �1 __ It — Z 71 oF�T�inJovC7; . 22� �Soc,c,� 0��1��� �'c��li,�%�F C�1 f1�J�ocu:F.E 11•�- 26 r* W,6s-A orF 4F 4i/ldec sI A46. Ag �35F�cu�.s�oF ,�asf cues i�uE�F �i11� ��•s� lbcv. DAV ONAwN •" ,.D. OE„ O. nEv,CwCRS NAr+E I NO. �4. CHP 555—Page 4 (Rev 11-85)OPI 042 1 CERTIFICATE OF SERVICE 2 CASE: Perry v. City of Antioch, et al 3 NUMBER: 4 The undersigned declares the following: 5 I am a citizen of the United States employed in Contra Costa County, California, over the age of eighteen years and I am not a part to the within action or proceeding. My business address is 6 3223 Crow Canyon Road, Suite 350, San Ramon, California 94583. 7 I served a copy of the attached: 8 Governmental Tort Claim (Government Code Section 910) 9 on the following addressee(s): 10 Contra Costa County Auditor 625 Court Street 11 Martinez, CA 94553 12 City Clerk City of Antioch 13 3rd and H Streets Antioch, CA 94509 14 by the following method(s): 15 XX BY MAIL. I placed a true copy of the above document(s) in a sealed envelope with 16 postage thereon fully prepaid for first-class mail, for collection and mailing at San Ramon, California, following ordinary business practices. I am readily familiar with the practice of Buchta 17 &Murphy for processing of correspondence, said practice being in the ordinary course of business, correspondence is deposited in the United States Postal Service the same day as it is placed for 18 processing. 19 BY PERSONAL SERVICE. I placed a true copy of the above document(s) in a sealed envelope and caused it to be delivered to the above addressee(s). 20 BY FACSIMILE TRANSMISSION. I caused the above document(s) to be transmitted by 21 facsimile to the number indicated above by the above addressee(s). 22 The above service was made on the date this declaration was executed. 23 1 declare under penalty of perjury that the foregoing is true and correct, and this declaration was executed on January 10, 1995 at San Ramon, California. 24 25 J h 26 Sheri Trimble 27 28 IM BOARD OF SUPERVISORS OF tJA TRA COSTA COUNTY, CALIFORNIA January 241 1995 ` �S 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: $1,000,000.00 Section 913 and 915.4. Please note alt V am en CLAIMANT: Carmen Salcedo JAN 0 9 1995 ATTORNEY Steven H. Henderson COUNTYCOU*SM Date received MARTINEZCAUF. ADDRESS: 3024 Railroad Avenue. BY DELIVERY. TO CLERK ON January.",-,6.11995 Pittsburg, CA 94565 BY MAII 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 9, 1995ILAP�LyLOR. Clerk ��'R ( "�„4„��CJL� tJ 11. FROM: County Counsel TO: Clerk of the Board of Supervisors {wl' 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 isnot 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: —1 i BY:'T 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). 1V. BOARD 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: JAN 2 4 1995 PHIL BATCHELOR, Clerk, By , pp.e e J , Deputy Clerk VARN1NG (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. 1'ou 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 MAIU NG 1 declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 1B; 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 Asshownabove. Dated: MIN 2 5 BY: PHIL BATCHELOR by J , edo4_j�Deputy Clerk CC: County Counsel County Administrator 4 STEVEN H. HENDERSON - SB 188620 GIVED 2 Attorney-Abogado JILL T. STERN - HENDERSON SB 1148172 s 3024 Railroad Avenue, 3 Pittsburg, CA 94565 4 510/427-1771 i Attorney for Claimant CARMEN SALCEDO � - 6 TO THE COUNTY OF CONTRA COSTA, THE CONTRA COSTA COUNTY 7 SHERIFF'S DEPARTMENT, THE CONTRA COSTA COUNTY MENTAL HEALTH SERVICES DEPARTMENT, THE CONTRA COSTA COUNTY JAIL, 8 INDIVIDUAL OFFICERS OF THE CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT AND EMPLOYEES AND REPRESENTATIVES OF THE CONTRA 9 COSTA COUNTY MENTAL HEALTH SERVICES DEPARTMENT OF THE CONTRA COSTA COUNTY JAIL 10 11 IN THE MATTER OF THE C AIN FOR DAMAGES CLAIM OF [Civil Rights, 42 U.S.C. 51983; Civil Rights, 12 CARMEN SALCEDO, Individually, MONELL; Wrongful Death, 13 and on Behalf of MARIO Code Civ.Proc. S 377; SALCEDO FERNANDEZ, Decedent, Survival Claim, Code Civ. 14 Proc. §377; Negligent Claimant. Employment; Negligent 15 . Training; Negligence; & / Attorney's Fees] 16 Claimant, CARMEN SALCEDO, as the surviving parent of 17 decedent MARIO SALCEDO FERNANDEZ, and on behalf of MARIO 18 SALCEDO FERNANDEZ, the decedent, makes and presents this claim 19 against the individual officers and employees of the Contra 20 Costa County Sheriff's Department, the Contra Costa County 21 Jail, the employees and representatives of the Contra Costa 22 County Mental Health Services Department, the Contra Costa 23 County Sheriff's Department, the Contra Costa County Mental 24 Health Services Department and the County of Contra Costa, 25 State of California, pursuant to Government Code §910 et. sea. , 26 based upon contravention of- the rights and privileges of the 27 decedent and claimant under the United States Constitution, 28 particularly the Fourth, Fifth, Eight, and Fourteenth -1- 05, 1 Amendments to the Constitution of the United States and under 2 Federal law, particularly the Civil Rights Act, Title 42 of the 3 U.S. Code, § 1983 and under State law for wrongful death, 4 medical malpractice, survival action, negligence, medical 5 malpractice, negligent employment, training and supervision of 6 employees, failure to furnish medical care, failure to .examine, 7 failure to competently and properly supervise prescription and 8 administration of drugs, failure to summons medical care, 9 deliberate indifference to the serious medical needs of a 10 prisoner, gross negligence and/or recklessness with regard to 11 the provision of and/or failure to provide medical care and 12 treatment for decedent. 13 In support hereof, claimant states as follows: 14 15 1. NAME OF CLAIMANT• Carmen Salcedo 16 2 . CLAIMANT'S ADDRESS: 17 418 Lawton Street, #11, Antioch, California, 94509 18 3 . ADDRESS FOR NOTICE RE THIS CLAIM: 19 Steven H. Henderson 3024 Railroad Avenue 20 Pittsburg, California 94565 Telephone (510) 427-1771 21 Fax (510) 427-4282 22 4. DATE, TIME AND PLACE OF INCIDENT: 23 On or about July 7, 1994, at approximately 1: 05 a.m. 24 at Merrithew Hospital, Martinez, California, MARIO SALCEDO 25 FERNANDEZ died. 26 5. NAMES OF PUBLIC EMPLOYEES RESPONSIBLE: 27 The public employees who are believed to be responsi- 28 ble include but may not be limited to Deputy Roybal, Deputy -2- 1 Elder, Salvador Morales, Doctor Gillette, Sigmund Moscovich, 2 and others whose names are not now known to the claimant. 3 6. DAMAGES CLAIMED• 4 General damages within the jurisdiction of the Superi- 5 or Court; special damages as proven; punitive damages as prov- 6 en; attorney's fees as proven. 7 7. DESCRIPTION OF CLAIM: 8 On or about July 6, 1994, at approximately 8: 17 a.m. , 9 at the main detention facility, Q module, Room 18 of the Contra 10 Costa County Jail, Martinez, California, the decedent MARIO 11 SALCEDO FERNANDEZ was found hanging by a bed sheet in his 12 cell. Thereafter he was transported to Merrithew Hospital and 13 was pronounced dead on July 7, 1994, at 1:05 a.m. The decedent 14 was a troubled individual who had received .mental health treat- 15 ment prior to his incarceration through the Contra Costa County 16 Mental Health Services Department. He suffered from serious 17 mental health disorders of which those individuals and entities 18 previously mentioned knew or should have been aware which made 19 decedent a serious potential suicide candidate. Claimant 20 believes that at the time of decedent's death that he had been 21 prescribed potent drugs by those individuals responsible for 22 his care, such drugs being the type that require medical super- 23 vision. Claimant asserts that all of the aforementioned indi- 24 viduals showed deliberate indifference to the decedent's 25 obvious, severe and immediate medical and mental health needs 26 yet failed to properly furnish medical care when these public 27 employees knew or had reason to know that the prisoner needed 28 immediate medical care, were grossly negligent and reckless in -3- 1 failing to properly supervise the administration of drugs to 2 the decedent, to supervise the decedent's mental health 3 condition, to properly, supervise decedent so as to prevent or 4 inhibit his ability to commit suicide and generally exhibited a 5 deliberate indifference to the serious medical needs of the 6 decedent. Claimant additionally asserts that the medical 7 providers committed medical malpractice by prescribing 8 incorrect medications to the decedent considering his physical, 9 emotional and situational ciircumstances, and further committed 10 medical malpractice in failing to properly supervise the taking 11 of these medications by the decedent, and further committed 12 medical malpractice in failing to adequately, properly and 13 reasonably examine and care for the decedent's mental and 14 physical condition, thereby legally causing the death of MARIO 15 SALCEDO FERNANDEZ. Furthermore, Claimant asserts 16 that the County of Contra Costa, the Contra Costa County 17 Sheriff's Department, the Contra Costa County Mental Health 18 Services Department and the Contra Costa County Jail applied 19 and enforced the customs, policies and practices of permitting, 20 encouraging and ratifying that conduct hereto aforementioned 21 and those omissions heretofore stated, therefore ratifying the 22 aforementioned practices by failing to train and inform its 23 employees and representatives of the dangers and life 24 threatening potential to those persons in the same position as 25 the decedent. As a proximate result thereof, MARIO SALCEDO 26 FERNANDEZ died. 27 Furthermore, the County of Contra Costa, the Contra Costa 28 County Sheriff's Department, the Contra Costa County Mental -4- 1 Health Services Department, the County Jail, and those 2 individuals mentioned, knew or in the exercise of reasonable 3 care, should have known, their employees and representatives 4 had the propensity for deliberate indifference to the serious 5 immediate medical needs of those prisoners in decedent's 6 position, were not providing medical care pursuant to the 7 standards in the community for individuals in the same position 8 as the decedent, and had inadequate training regarding the 9 dangers of .leaving individuals such as the decedent unattended 10 for lengthy periods of time. Said entities negligently and 11 carelessly trained, employed and retained employees and 12 representatives and assigned to them duties which allowed them 13 to imperil members of the public and to endanger the lives of 14 incarcerated individuals and to otherwise abuse their 15 authority. As a proximate result thereof, MARIO SALCEDO 16 FERNANDEZ died. 17 9. DESCRIPTION OF DAMAGES: 18 By reason of the aforedescribed acts and/or omissions 19 of those entities, agents and employees previously mentioned, 20 the decedent herein suffered shock to his nervous system, 21 physical and mental pain and anguish and was deprived of his 22 life and the enjoyment and pleasures of living. The claimant 23 herein, CARMEN SALCEDO, the mother and legal heir of the dece- 24 dent suffered the loss of love, comfort, affection, society, 25 companionship, support and pecuniary benefits of the decedent, 26 along with expenses in a sum which has not been fully ascer- 27 tained. Furthermore, the claimant was required to retain an 28 attorney to institute and present this claim and to render -5- 1 legal assistance to the claimant that she might vindicate the 2 loss and impairment of her and decedent's rights and by reason 3 thereof, claimant requests payment of reasonable attorney's 4 fees pursuant to 42 U.S.C. Section 1988. 5 10. AMOUNT OF CLAIM• 6 $1, 000,000.00 7 WHEREFORE, claimant requests damages as described herein. 8 9 Dated: January 6, 1995 10 Respectfully submitted, 11 12 S VEN H. HENDERSON 13 Attorney for Claimant 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 slr2 \ salcedo\claim . dam Amended CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January,..24, 1;995 • �� Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document sailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all •Mornings". Amount: $401,000.00 CLAIMANT: Booker T. Carloss, II D : w% ATTORNEY: - JAN 12 1995 Date received COUNTY COUNSEL ADDRESS: ANZ 800 4A7NCJ BY DELIVERY TO CLERK ON JanuarMAK1VEZMWF. 550 6th Street January 11, 1995 Oakland, CA g4bp$ BY MAIL POSTMARKED: ry 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 12, 1995 PIL LATTCHELOR. Clerk "r 11. 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 910.6). ( ) 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 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 ( v� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date JAN 2 4 1995 Dated: PHIL BATCHELOR, Clerk, By--%i A 4Deputy 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 &.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 IS; 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: JAN 2 5 BY: PHIL BATCHELOR by �_.e1_ Deputy Clerk CC: County Counsel County Administrator claim to': BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 11 /5- INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury -�o person or to per- sonal property or growing crops and which accrue on or before December 31, 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 §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 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 3 orm. o a f • • * • e • • f • • .f e e s e f e f e f e a • e s f e s e • e f • f • e e a • e RE: Claim By ) Reserved for Clerk's filing stamp ���k� �►:�r�rCUSS, IC RECEIVED gainst the County of Contra Costa ) 12 1995 or ) District) CLERCONTRAA�OSTA CO ISORS Fill in name ) The undersigned claimant hereby makes claim arainst the County of Contra Costa or the above-named District in the sum of s and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) N���►�� � Injury lqt92. mere did the damage or occur? (Inc de' city and county) Co -5LA/,9fP4aY- CCU& 3. How did the damage or injury `occur? (Give full details; use extra paper if required) --e skeet- ak64- previokst 1kr .,. kd) s coq aPK41 Coo y Me 00 Prc {a°I;5y- heo/IAA WAS rye Lr1�b(iL `l bpQ �r � _U (�� �.�-ree,� 00kl.4!:d, CH-� 016w_ wI 4. What particular �ct 'cr omission on the part of county or district officers, servants or employees caused the injury or damage? MOO 634A- Ca�� Pro 'I'D hl RDN k��s�� s �.� vs .� -fa ��►v�.s (over) i 5. What are thenamesof county or district officers, servants. oreeployees causing- the damage o:- inJury? I T1S ACV 20 r\� A-+�Ir-SOA / GA rCA 6J�;6 6CA.V'ChA 6. What damage or injuries do you claim resulted? (Give fufi extent of injuries or "l damages claimed. Attach two estimates for auto damage. �rnr�'�4`h5pr r�cow�n1�v� '�`� slevuq - 51 ` da �� `atf�' r� �0�r ca��+` , i�e�r���9«( �� � 1p0a5jbJe q0 B�e&Ml c �t14ho- t8t�, L.J/0�" C'1 r,�rn1`�'A�a -Vak ''ArJ a. reuie.W Cbufs- 7. How Vs the amount c�laime� move computed? (Includes t estimated amount of any v r u'�w�� t pn�e K-r� +� pros etive injury or damage.) 06 V,C oh we Co��f�-( io�6�l ri�l s�'t lUO 00 Abuse_ dib el011 . .. . 9 1Do, D00, od idKq( �� 1(k� OW. �a riS6K�nee v . , I!14 006LP5S LOCor"- -- ! -000 p� 8. Names and addresses--rrof witnesses, doctors and hospitals. V\ �a` r�g� KJ�t CVS 2wgi (1 1 a INS ) my , /4«�) ,t t��` ►'�C� ?� = �01��4-►0� rhe ���v�� 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT c;1 ji • a e • f e e e f e e s ;a e • eJf • e e f s e f s • e e e f f e • f f s f • f s Gov. Code Sec. 910.2 provides: 13r�i�ei The claim must be signed by the claimant SEND NOTICES T0: or by some person on his behalf." Name and Address of Attorney YPNCT C2?- Claimant s Signature 3 LE&P\b 6 Sq- Ad ss Telephone No.(2(0 +gsrBi Telephone No.(!(D) serff • �t T'�T� 1� f � • f � f • • f-e NOTICE Section 72 of the Penal Code provides: "Every person who,_with intent to defraud, presents for allowranoe 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 ($109000, or by both such imprisonment and fine. i � „ N i ca u 75� t'� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January;24,: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 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: $401,000.00 Section 913 and 915.4. please note all • • CLAIMANT: Booker T. Carloss, II �D 11199 _ ATTORNEY: JAN 12 1995 UNSSL Date received �VNNEZCALIF. ADDRESS: ANZ 800 4A7NCJ BY DELIVERY TO CLERK ON January 12, R" 550 6th Street Oakland, CA 946-4538 BY MAlt POSTMARKED: January 9, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. 8Y: DATED:— January 12, 1995 IpV,�IL BgATCHELOR, Clerk De put 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 910.6). ( ) .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). ( VI Other: d5� ArA oto C.1Aim ieje r41AD THIS DATI. . Dated: BY: �a 6Deputy County Counsel Al. FROM. Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By , 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 in 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 lnited States, over age 16; and that today 1 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 the claimant as shown above. )ated: BY: PHIL BATCHELOR by Deputy Clerk :C: County Counsel County Administrator rp L i C,5 J� U C LAIM A CA T .N3T TqE CO IV lerk- Of- +ke— Boau-d 00(lm No. 06 RECEIVED .-. AN 12 1995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO, rev\c, CA PY\ rK�e, F,4ke, / 7 W� �oss -11 06 ktr- T CCL P� o 50eldc It co Lk 01\ 61p 0 0 00 4t�red ?IA6)IA n"sen Cott T4111c, liz,ers O ce-, De�r�der Fbrel�(,O,- �ee� 5 ov�- fe-cbrAl as mu . - �f►ate. ��-� ��a� � �_ . � �� ���� ����-- � ���� r r br- i cA c ����e fir; �� ��5 1 � � ���x 7 I • �-'�5�.^.pU��t c�e�e c�c�er �v�L�l G tom. (�'rp�ra Cst U 1 ��� ��z�3 � �, � CL,jou l-d abk 4k^* s wa r- -fa�,kp. priko/^' o0er- Edi k_ Cllr yvi5 e Co 0,�- T Z"_rCeWJP2reJ k ( - �16 --kt?, Oak." ti* rlfre xd,- to It �C, rvpo 0 Odt Ym ser�ehce'z, -ik-\_ �-6MCACA . 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