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Home My WebLink AboutMINUTES - 10101995 - C16 CLAIM C fa BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 Cl�;T ooi�;Tst the County, or District governed by) BOARD ACTION :` S::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT arc E,<<c 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: $272.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Leona Whitten ATTORNEY: Date received ADDRESS: PO Box 361 BY DELIVERY TO CLERK ON Se=tember 21 1995 Bethel Island, CA 94511 BY MAIL POSTMARKED:_Sentember 20, 1995 1, FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg DATED: September 21, 1995 BTII DepuiyLOR, Clerk I1. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓f This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.6). ( ) 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 I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (v ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:/0 -% —/ 9S PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:—/ -- /. /99.E BY: PHIL BATCHELOR Dy ,_Q , Deputy Clerk CC: County Counsel County Administrator r j C;ha to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADAANT 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 for= � 1F !t *y* R£: Claim By } Reserved for Clerk's filing stamp LEoNA Wlgiloy RECEIVED Against the County of Contra Costa ) 2 t or ) CLERK BOARD OF SUPERAStRS District) CONTRA COSTA.CQ: Fill in name The undersigned claimant hereby makes claim against the County of Contra Costa or 2/7 the above-named District in the sum of $ - nd in support of this claim represents as follows: 1. When did the damage or injury occur? -(Give ,exact date and hour) �U�- q9. 2 2. Where did' the damage or injury occur? (Include city and county) 04).�L 3. How did the damage or injury occur? (Give Hill details; use extra paper if rewired) f-2drm � lqae� ��E�� /20 Iq u. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? & v �� i� c 71 e� - C� J� A it ,'i C-/V S 44�N� 7NC a011 wnaL are "e names oi' county or district officers, servants or employees causing the -damage or injur) 1 —_—________________w —----- 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. V cses 7. How was the amount claimed above computed? (include the estimated amount of any prospective injury or damage.) --ruio 6. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE .1-TEM AMOUNT fi Gov. Code Sec. 910.-2 provides: -0 CRAM,i'3 1, "The claim must be signed by the claimant SEND NOTICES TO: (Attorney or by sWe person on his behalf Name and Address of Attorney �t2 , (Claimant's Signature) (Address) C wcz Telephone No. Telephone No. L5Fp'�2�F'6��I�'�' 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 i.,:priso_-u,)ent1- and fine. ADDENDUM TO THE CLAIM OF 46-01VA (Print your full name) ( 1) Do you use the roadway as part of a d ily commute? Yes ( ) No ( ) ( 2) Were you aware that construction would be commencing on the roadway? Yes ( ) No ( ) ( 3) Was an alternate route available? Yes ( ) No ( ) ( 4) Did you read about the impending resurfacing in the local newspaper? Yes ( ) No ( X ( 5) Did you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( ) No ( ) ( 6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yes ( ) No ( ) (7) Did a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes ( ) No (7 (8) Did a vehicle coming from the opposite direction cause gravel to be thrown onto your car? Yes ( ) No ( ) ( 9) Was the vehicle located directly in front of you exceeding the speed advisory? Yes ( ) No ( ' ) ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No ( ) ( 11) Did you obtain the identity of the car relating to questions 6 thru 9? Yes (• ) No If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel- was thrown onto the car, along with the specific damaged parts on your vehicle. `/ (r V EL l'9�%l1/ %/1/G° 7)i(2 C-e�ria/V) W/9s 4-755 /6 - (O- Oalvry a/jez 'd ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No I declare that the above information is true and correct under the penalty of perjury. ( Signature) (Dbe) LAWRENCE VOXAM FAMILY OWNED AND OPERATED SINCE 1921 2791 N. MAIN STREET • WALNUT CREEK, CA 94596 (510) 939-3333 VOLVO GENUINE PARTS , Nothing can replace them. Notice:A handling charge of 10%will be made on all returns. No refunds after 10 days. No refunds on special order items or electrical parts or smog parts. DATE ENTERED YOUR ORDER NO. DATE SHIPPED INVOICE DATE EnTeremk 14 SEF,; 95 114 SEP 95 P.G S ACCOUNT N0. SOF 1 OF' 1 H I y- D P T T 0 0 4 TM W>LLID SHIP VIA - SLSM. BIL NO. TERMS F.O.B.POINT WAI_ NU i CHEEKY :OVANTITY PART NUMBER DESCRIPTION LIST NET 1 1 0 351.8847 .°; 4JI:Nia3)[:►ik:.1:: fiHL.r.I 31Q. 12 <Si0. i. "� s"Tt�• 1.:? 6846651. LtN'PLAC1N6 F'AR'f•-• 40* FOR ABOVE: PART-1\1 I N V O 1 C E: 0 U O 'I' . �c�:;<:,�ta:. � 7 3n 53 5- 50"- . . . . . . • . _'t SALE• . o • o . •20Y. OFF OF SUGGESTED RETAIL. . PARTS < . •FOR ALA. VOL.VO MOli}:•L S Y WAtiON OR SE:.1:1.AN SUBLET . • . • .ALL COVER COI_.ORS• . . . . FREIGHT ASK US FOR 1:1E1'Afl..S. SALES TAX ICUSTOMER'S SIGNATURE x QQ000 - - - 4 , Y 1 �.vp. .s .,x ..... ..i ..w .. . • ° 0 N r o m 0 a O . { N m N O t0 C70 `� CA tJt Ja W N to Y � Q rn z a !TI I ,�'► a rn tRf n Z r m m ? \ ° 2 a n b m • a CO c { a 1 g46 v Q r, CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 Cis<T a^1•,f�st th? County, or District governed by) BOARD ACTION `_:;; rvisors, Routing Endorsements, ) NOTICE TO CLAIMANT Q',6 ELc'0 Action. All Section references are to ) The copy of this document mailed to you is your notice of Califc-nia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,403.94 Section 913 and 915.4. Please note all •Warnings". CLAIMANT: Jacqueline Valentine ATTORNEY: Paul N. Dane Date received ADDRESS: 706 Main St. , Ste. B BY DELIVERY TO CLERK ON September 20, 1995 Martinez, CA 94553 BY MAIL POSTMARKED: September 16, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 21, 1995 lyILATCHELOR, Clerk g: Deputy 4.1,� 11.� FROM: County Counsel TO: Clerk of the Board of Supervisors ( VJ- Th--'.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 910.6). ( ) 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). ( ✓4 Other: OVK '1 l 5 • lel lJ�/� 1 Gd.2 , (!` 03e CtakAlk Dated: 'a1 `Ct S BY: �-- Deputy County Counsel I11. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Superviscrs 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:—ZQ-/D - 199.5� -PHIL BATCHELOR, Clerk, B 4A �QDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today l 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: /,0 -12 /q9 4' BY: PHIL BATCHELOR bDeputy Clerk CC: County Counsel County Administrator -TO: Jacqueline Valentine c/o Paul Dane, Esq. 706 Main Street, Suite B Martinez, CA 94553 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911.3) The claim you presented to the Board of Supervisors of , Contra Costa County, California, as governing body of the County of Contra Costa on September 20. 1995 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911.2) That is true with regard to the portions of the claim occurring in March, 1995, more than six months prior to the submission of your claim. Because the claim was not presented within the time allowed by law, no action was taken on the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code sections 911.4 to 912 .2 and 946 .6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911.6) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator By:- DegGty76lerk Dated: Enclosure NOTICE OF LATE CLAIM Page 1 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 copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. Date: By Phil Batchelor by \ l ifA, "194 Deputy lerk NOTICE OF LATE CLAIM Page 2 RECEIVED LAW OFFICES SM 2 0 Im PAUL N. DANE 706 MAIN STREET, SUITE B CLERK BOARD OF SUPERVISQAg CITY HALL BUILDING CONTRA COSTA Cp, MARTINEZ, CALIFORNIA 94553 September 14 , 1995 TELEPHONE FAX NUMBER (510)370-6359 (510)370-7285 Wendell Brunner, M. D. Director of Public Health 597 Center Avenue , Suite 200 Martinez , CA 94553 Re : Claim of Jacque 1 ;ne Va.7.ent i ne Amended. Letter Dear Dr. Brunner: I am writing to you on behalf of my client , Jacqueline Valentine, who is seeking resolution to an outstanding debt that Contra Costa County has refused to pay. She has repeatedly submitted mileage and . telephone calls to the Home Health Agency, and has sent a letter of explanation, all to no avail . My client is currently out of work and needs to be paid for this claim as soon as possible . It is my understanding that this claim dates back to March of 1995 . 'Ms . Valentine informs me that she never had any problem with her previous mileage reimbursement request, and that because she has filed a suit against the County of Contra Costa on an unrelated matter, she is now having trouble with regard to her travel payment . She feels that the County is not dealing with her in good faith, and that her claims are now being scrutinized by "auditors" . causing a long delay in payment . She realizes that her claims have been scrutinized. She has been asked to resubmit less mileage than what she actually traveled based on this scrutiny. My client refuses to perjure herself . I am asking that my client be paid for the months or March, April and May, 1995 . The March claim is for $497 . 20 ; the April claim is for $503 . 14 , and the May claim is for $403 . 60 . The total of these three claims is $1 , 403 . 94 . I am asking that this claim be paid within ten ( 10 ) days of the date of this letter or that I receive an appropriate explanation as to why they are not being paid. If this is not resolved in the next ten ( 10 ) days , I plan to file a claim against the county in a lawsuit in the appropriate forum. Further, my client was told that she would receive her hourly wage for the completion of the outstanding nursing record, and Wendell Brunner, M.D. September 14 , 1995 Page Two that she would be receive information as to the number of hours that the agency would allow for the completion of the record. To date , she has not received any information regarding this issue . I am asking that she. be provided the information along with the payment for the three above mentioned months. If you have any questions, please call the undersigned at your earliest convenience . Very truly yours , PAUL N.DANE PND: bas Attachment cc : Jacqueline Valentine Deborah Card Contra Costa County Board of Supervisors-/ . _ ..� 4-4 o e4a \ . « CL . Lo 2 2 to 4-37 � � & @ Q e Q ® $ ® � k /to \ QEgk Q . , . � w , @ \ . . , m § � 0 2 7'+ / § 5 \ \ Z = 4 CLAIM C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 [ia;T a^%i^st the County, or District governed by) BOARD ACTION `_ tervisors, Routing Endorsements, ) NOTICE TO CLAIMANT or,d 6uc,b Action, All Section references are to ) The copy .of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $500,000.00 Section 913 and 915.4. Please note all -Warnings". CLAIMANT: John J. Stice and Patricia L. Stice ATTORNEY: Date received ADDRESS: $95 Mitchell Canyon Road BY DELIVERY TO CLERK ON September 20, 1995 Clayton, CA 94517 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. September 21 1995 PPHHlI ATCHELOR, Clerk DATED: P BY: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). Other: Dated: d 1 - BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Superviscrs present (X) 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: /(j_/0 PHIL BATCHELOR, Clerk, By�, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately, * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that l 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: /Q BY: PHIL BATCHELOR b - eputy Clerk CC: County Counsel County Administrator C "7 Lr L.O i IA)Arw Vt ourr's Y 4.ri!!L� ,> INSTRUCTIONS TO CLAIMAN A. Claims relating to causes of aetior; 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, mjst be presented not later than six months after the accrual of the. cause : of action. Claims relating to any other cause of action crust 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 1060 County Administration Building, 651 Pine StreeLt. Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the nam 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 penzi ty for fraudulent claims, Penal Code Sec. 72 at the end of this T-0 W f • * . +erg • * • * * • rr +� * aaa • * aaa * * R : Clam By ) Reserved for Clerk's filing stamp John J. Stice and Patricia L. Sti)ce : } RECEIVED Against the County of Contra Cos`�a } ', 2085 or } SUPERVISORS District) CONMCOSTACO. (Fill in nazie 1 The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 500 . 0 00 .00 and in support of this claim represents as follows: _.,_--------------------- ------,.-.._ For 1 through. 4-see attachment. 1. When did the damage or injury occur? (Give exabt. date and hour) ------------------- —-------Mi--r------------i—--------Ir—MM---_—_—_ 2. Where did the damage or injury occur? (Include city and county) -----------------------------------l--s--------- i---------------- 3. How did the damage or injury occur') (Give full details; use extra paper if required) its.`. —. :f-: �r' r .. ---yi----- —i—i—X111'-- Y------it�li�.s�irYl�—�Y—i��i!!llMM--------- ' �4- What particular.act or omission on the. part, of county or, district officers, servants or employees caused the injury.:or damage? ,!, (over) • 5. Vat are the nes of co•. tY or district officers, servants or employees causing the damage or Injury? FOR 5, 6, 7 , 8 and 9 see attachment �. ..r_..._rs—_ir_.w.-__-aw_----o_w.-_--re_w_. -w__irr_----dr____w_.r� ' 6. What damage or injuries do you claim resulted? '(Give full extent of injuries or daz.-=ges claimed. Attach two estimates for'ajt6 dam3e. County gov. placed a sewage "drainage field over the'we11 on the property of Clainants making the land not saleable �.._..__..,_....�.._�.._ --------w.-----_---- _..rr---- ------ 7. How was the'amoant claimed above corp:te�?r (Iziclude .the estimated amount of an prospective injury orde. ) " It is computed in regard to carrying costs on, the land and the negligence of the County ruined a sale of the' property , It directly devalued the value of +thy- e property. No one is going to buytrj ' Stice vs. Contra Costa County, Ca. 1 . May 15, 1995--discovered about 2 :00 P.M. 2 . At claimant' s property located at Leon Way, Parcel "A" at Clayton, Ca. Contra Costa County. 3 . In 1993 Contra Costa County Servants and agents so designed constructed and maintained a drainage sewage system and field over the existing well on the property so that sewage would seep into the well used for drinking. The Co. officials failed to use and proper - plan and design and placement of the well, failed to investigate and failed to warn claimants of the danger and defect in said well and sewage system. 4 . C.C. County servants----Fran Parker, County employee was in chage of designing the sewage system and in placing it over thewell making the well useless and the property useless. The acts or ommissions were failure by Co. employees to properly install the sewage drain field so that it was not right over the well and placing it over the well at all . Further, Defendnats failed'-to warn of the condition created by the County' s neglignece. 5 . Fran Parker is the only Co. employee I know of . There were others but I do not know their names. 6 . Loss of the value of the property we value at $780, 000 . 00 . 7 . Carrying costs on land; development costs on land expenses both prior and since the discovery of the damage. 8 . Fran Parker, Co. Employee Robert Lawrence, Prudential of CAlif . Vince Cunha, Pinor Calif. Anthony BAntajello PAGE 2 9 . Road const. costw 120, 000 . 00 Comae Well Costs $60 , 000 . 00 Engineering Costs, $70 , 000 .00 7 Carrying costs, U 00 J 'D CO&e- 4v'Je-"J e "-i' Atty fees $50 , 000 .00 Septic Costs $25, 000 . 00 fl�ayMton JStie $ Patricia5 lche 1 Canyon Road, a. 94517 Dated Sept. 20 , 1995 672-5088 CLAIM C ,J (p BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 Clz4T A^!4t the County, or District governed by) BOARD ACTION `>;;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT aid 6Lc, ACti,�)n. All Section references are to ) The copy of this document mailed to you is your notice of Califcrn.ia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,523.01 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: State Farm Insurance Companies 05-6677-576 ATTORNEY: Date received ADDRESS: 6400 State Farm Drive BY DELIVERY TO CLERK ON September 20, 1995 Rohnert Park, CA 94926-0001 BY MAIL POSTMARKED: September 19, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpH gg DATED: September 21, 1995 B�1L OepuLyLOR, Clerk 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 910.8). ( } 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 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 Superviscrs present (v/) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: _PHIL BATCHELOR, Clerk, B &AJy , Deputy Clerk WARNING (Gov, code. section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personalty served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 1B; 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: BY: PHIL BATCHELOR Dy ' _ eputy Clerk CC: County Counsel County Administrator Clair. 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 aecrval of the cause of:acti°on. (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 nane 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 F Tns & A5 s� ►� ) RECEIVEp f- EV iV 148 em co vV• ) SEPAgainst the County of Contra sta z Q or CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. Fill in name ) The undersigned claimant 'hereby makes claimagainst the County of Contra Costa or. . the above-named District in the sum of $ 3 and in support of this claim represents as follows: 1. When did the damage or injury occur? '(Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 1N9__v__ 42 ,5�--T-_ i Com-, 3• How did the damage or injury occur? (Give Hill details; use extra paper if required) --------------- -- - - -- u. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? '-I'j _L 5- Y7Ar6XA�- J U L 3 1 1 OA ¢¢'''"";; K A gg ww i 5, wnaL are the na.-nes of countyor distridt officers, servants or employees causing the damage or inn jurj ? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed; Attach two estimates for auto damage. -t A14 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and.addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: 1 DATA., IT£ AMOUNT `vela'cr "`'3 / c 3 x Gov. Code Sec. 910:2 provides: M "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or bysome erson his behalf." Name and Address of Attorney Cla' s Signature Address, Telephone No. Telephone No.570-�0 3q"Z~2(Oq. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,,000,), .or by both such imprisonment and fine, or by imprisonment in the state prison, by a "fine of not exceeding ten thousand dollars ($10,000, or by both such it-priso.-unent and fine. CLAIM NO 05-6677-576 POLICY NO G066-057-05 LOSS DATE 06/28/95 DRAFT NO 1 02 948989 J PAYEE M & J BODY SHOP DATE 09/10/95 FAO EVALYN ABRAMOWITZ AMOUNT $******240. 5C 1925 EVERETT STREET ALAMEDA CA 94501-1532 COVERAGE TIN 05-942957666 COLLISION (LOMV) 400-3 $240.50 REMARKS PAYMENT FOR SUPPLEMENT REPAIRS CREATED BY William D Ervin REPRINT OF DRAFT NO 1029489881 �•� •�- STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 948989 J NORTHERN CALIFORNIA OFFICE BANK OF AME&�II,,CA-%&,,SA` 1-35/1210 ROHNERT PARK, CA CUSTOMER SE&VLCE`{4MERYC� 1233 DATE 09/10/95 INSY••NC1� Oakland 02-192 CONCORD, CA " {{,� COVERAGE Jr.- COLLISION. (LOMV) CLAIM NO 05-6677-576 POLICY NO G066-057-05 CLAIM UNIT •177 400-3 $240.50 LOSS DATE 06/28/95 OAKLAND S 0 INSURED ABRAMOWITZ, EVALYN *************************************************************EXACTLY TWO HUNDRED FORTY AND 50/100 DOLLARS *< **:? ? Pay to the M & J BODY,,-SHOP Order of.- FAO EVALYN ABRAMOWITZ 1925 EVERETT STREET 0 �h�`� '/ ALAMEDA CA 94501-1532 TIN05-94295666 AUTftS WL!�RVV IQ9 J _ APPROVED BY OSA CLA N S ,� CLAIM. NO 05-6677-576 POLICY NO G066-057-05 LOSS DATE 06/28/95 DRAFT NO 1 02 649112 J PAYEE DATE 07/08/95 EVALYN ABRAMOWITZ AMOUNT $****1, 032 . 51 558 KINGS RD ALAMEDA CA 94501-3731 OUTGDIN COVERAGE TIN COLLISION (LOMV) JUN 0 p 19S5 400-1 $1,032.51 REMARKS V OAKLAND CREATE BY Vivian Kaufman �•� �•� STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1 02 649112 J NORTHERN CALIFORNIA OFFICE BANK OF AMERICA NT & SA 11-35/1210 ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 DATE 07/08/95 INfY••NC1� Oakland 02-192 CONCORD, CA COVERAGE COLLISION (LOMV) CLAIM NO 05-6677-576 POLICY NO G066-057-05 CLAIM UNIT 177 400-1 $1,032.51 LOSS DATE 06/28/95 INSURED I ABRAMOWITZ, EVALYN ONE THOUSAND THIRTY-TWO AND 51/100 DOLLARSfdbatt* i<<„`';`' Pay to the Order of: EVALYN ABRAMOWITZ 558 KINGS RD ALAMEDA CA 94501-3731 TIN AUTH VKAUF APPROVED BY � . + � ) � z File #10173-0I'D 9656� Sl ~� o Ll||E ' GOO1- NElGHDORSTATE F�RM lS THERE � ` 7755 A PARDEE LANE OAKLAND, CA 94621 �� 6]9-270W FAX : (510) 639-2703 rn� � z SUPPLEMENT OF RECORD o HAWKINS N7/N8/95 11 :38 a. m. � � �� WILLlAM ERVIN # (51(", ) 639'£769 M< � � EVALYN ABRAMOW[TZ Claim #05-6677-576N1 Policy # �58 KTNGS RD ALAM£DA, CA 945N1 Date of Loss : 6/28/95 (5i�) 865-4525- Type of Lnss � COLLlSIOM `—� (5iWact: 6 REAR � 0 �� + � v ' Drie-In z � o ' �� > ` M� � �m > , ' n ' � License � � � M �m ` RED � o X�23�4L7553162 Lic. #: 2VGX955 CA Prod. Date : 0/0 Mi1eage � 14414 z . o Cloth seats R�cline/ iounOe seats `ketPower ste�rin� Power brakes � ' __ - �0 > ' a� s Rear defogger �Styled steel whee\ s �> 0 . Fm radic Sterpo � Eqoaltzer A/c 'bag Specisl mo1A dings Dual mirrors ` '` '` � paint ' ''-- -- ---'----------------------------------------------------------U�U K��L �E�CRIPTlON OF DAMQGE TY, COST LABOR PAIMT MISC � � _. R�f4f UNi ::j 5:, 8p 1 2 ar umppr ^ 0 �iep L REC �over w/o OSi 1 lncl �, 5 Add for C) ear Cnat i � � �m > ' 'zz �,pl �]it pact bar O,�rlap �ujnrNnn-Adj. Panei 1 Ct � o PAUEL LlD L01.4ER 1 '_-��1��6 _-0�� (D Z { Refin COVER CAR 1 5�� ~ | � Page : 1 �� (77 A Lf" FY W #1003-0094569 Sh Claim 1 , OWQS77-176%. 90 CHLY GFO STORM 2+2 30 RED %-1 . 6L-FI: --- ---- ----- --- -------------------------------------- ....... REPR/ PA RT ION OF DAMAGE UTY COST LABOR PAINT 141133 ............. .......... 2 R, Fkn TINT COKOP I -A& 13, Refin CORROSION PROTECT10i,.1 I -----------7----------------- 240. 56 3. 4 5. 7 412. 4i f. Jj Paqnz Lfj� o ' 71 Ti rn ~ 5 t @ $2l 00 119 70 SUP_'r0*l'AL_ Tax om $ 781. 26 at 8. 250N� 64. 4' �c� o _ > > z TOTAL COST OF REPA,TRG 282. 51�� o ' ADJUST�f IENTS: >00 � DeJuctible ` � � TOTA� ADJUSTWEHTS � 25N' � � g ` o � NET COBT OF REPAlRS ^ o ' - � v � ]WD BY SHOP ESTIMATE REVIEWED BY ESTIMATOR r 0T LINE FOR BODY SHOPS ONLY 510-6J9-2550. � . � RQLURF TO WSW THIS ESTIMATE TO 0E KEPAlR FACILITY PRIOR - [] V8UCiENAYREWIRE SPECIFIC W[L8U6 TO THE REPAIRS COULD RESULT IN AN ADD TDXNALCOST TO YOU! ' ?EEWENFIED BY 0EHANUFACTUffiR. on NDTOR CRASH ESTIMATING GDPE i,em- 31derived �ion the Guide DRDD90. [late �l+ as�xi�k(**) itvw� imiio�e part sxpp}ied by a supplier other tbm the :rigino\ oquipueot manofyctoreu [ZEst - A product of: CCC Information Services lnc. � m� + > p . � � � —� �.. � z . o � ± � | ----��--�-----�-----,��_----�---�—�----r-- �-- . ' BODY & PAINT SHOP 1925 EVERETT STREET ALAMEDA, CALIFORNIA 94501 BUSINESS 865-8555 August 31 , 1995 State Farm Insurance Company Evalyn Abramowitz 7755 A Pardee Lane Claim#05-6677-57601 Oakland, California 94621 90 Geo Storm Attn : Howard Hickerson Supplement to Original Replace Lt Bumper Absorber 90. 25 Replace Rt Bumper Absorber 90.25 Replace Bumper Inner Filler 38. 25 Replace Bumper Retainers . (6) 3. 42 222 . 17 Parts Total $222. 17 Sales Tax 8 . 25% 18. 33 Total Supplement �$2-450 SEP 5 Coc i Auto. Center 327 34th Street• Oakland, CA 94611 Retail Parts(510)450-6650 Business Hours• 8:00-5:30 •Monday- Friday Saturday 9:00-4:30 Toll Free Wats (Whsl. Only) (800) 781-4343 CHEVROLET GC® BUICK ITlc7OM Jeep EAGLE . I S U Z U PEUGEOT . CHRYSLER Plymouth DISCLAIMER OF WARRANTIES Any warranties on the product sold hereby are those made by the manufacturer.The seller hereby expressly disclaims all warranties, either express or implied, in- cluding any implied warranty of merchantability of fit- ness for a particular purpose, and the seller neither C 1\10 REI-LIRN(_ i WITHOUT PR I CIR Ai ITHIDR I-ZAT I CIN I assumes nor authorizes any other person to assume for L rERMS:. NET :_to DAYS, UNLE CIT HERW I:1E NCI TED it any liability in connection with the sale of said prod- ucts. RECEIVED BY X) CUSTOMER NO SOLD BY PURCHASE ORDER,NO• INVOICE DATE;,' INVOICE,NO. tt L. AIR C)8/24/9t. GMW211029 SOLD TO: SHIP TO: 111I& I BODY AND FA I N`rM«.I BODY (AND PAINT 1':25 EVERETT ,=31.REE"t1'�:_`� E VEREI—I 'E":-I REE-1- ALAMEDA CA 45C11 ALAMEDA CA 94551 Ali/'c;l`Ctt�M/DA'c:E T._I QTY - PART NUMBER -` c',, DESCRIPTION PRICE LVET TOTAL 94466.162-' ABE-;l'_IRDER— Ell C)9 o 784Cf �0 2t' 67. G'� �: 6. 1 5'44Cti7.74 F"1 LLEF1—RE I�1h�F't�I t►7;��1.. i•{. '28. 6,: 2�:. 6 414551 CLIP 0`.-%4 07 21 4 W-'v cam. ` IG tr P _, egg •.• K..ww.iwn4wi Y.F/M14w >1M+W"'I L 1' �..It f 11a l+ ryAl � � "4 .... .-�- �.l,i+ru>~n*+.a••w ,:...w., .; �i�,4k.�`r�§'' .1{r v,�k '+�.rj�"�rdr�.'�e�a.' s d�, ,� i ' 1} GHARGE .11F:; EXTENDEu:;,..,166, 65 ALL.CLAIMS AND RETURNED GOODS MUST BE ACCOMPANIED BY THIS INVOICE.. NQkREEUR S QV ELECERICAL"31: ECIAL ORDER PARTS.NO RETURNS AFTER 30 DAYS. 20%RESTOCKING CHARGE ON ALL RETURNED PARTS. r O'r p 166. 65 C CT QQ QQ��ATf��!((`�ttY.F.EES� NF�CE�SA Y TO PAID T •,a T� CW%CONDITION ON VERSE TISEl t�a PRINTED LED CI1.= 11 ::C4 A�I q ]. Cl7 STOMER COPY `�'11(►'29 SHOP C Aik it stclfe 6:3,j J `:60 el CUSTOMER'S ORDER NO. PHONE DATE NAME A ESS $fLLD-ay— C-01) CHARGE ONAC PAID OUT DESCRIPTION PRICE AMOUNT ............ ..............- ............................. .............. .......... ... ... . ....... ............. .................... ......... .. . . ........... ........... ................. .......... ............... .......... ...-...................... .................... .. ..... ......... .. ....... ..........._. .............. ....._ ........i... . .......... ............. ................. ........... ............... .......................- .................... . ............. ..........I....... ...... 7, .................... ............- ........................— .................................. .......................... .......... ............- TAX I RECEIVED BY TOTAL All claims and returned goods 10974 MUST be accompanied by this bill. 77kwk CYOU '1 1 1 � 1 +w a + got rA Of ' 11 1 1 k t Wsty� v�. 1 • � lvf_y�•§tea"'��`�'A��"�a9nk c�rJ ^ ,.l°,�'.2`r'' �3 u�rt a WG f ' - a ° f �� 'It I fir* '&° •% .L' ` "� 'S iMy `*' �, 'w+ r `ti_ A+.o i.i5r.�.t~a..F �t1fs�� POLICY NO. DATE/LOSS INSURED CLAIMANT PICTURE NO. DATE/TIME TAKEN -� BY WEATHER LOCATION AND VIEW ■ COMMENTS ADDITIONAL INFORMATION ❑OVER PICTURE NO. DATE/TIME TAKEN r 5:_ Fp ' ; BY Il lar. WEATHER i - LOCATION&VIEW r. COMMENTS r i I ADDITIONAL INFORMATION ❑OVER j OUR FILE NO. CO. CLIVI # - HAY/KMS �L! - 7 1995 SER=E CENTER S. FORM 200-2-35-X P.G.S. INDUSTRIES, P.O. BOX 1348,ASBURY PARK, NJ 07712/ 1-800-484-7419-S.C.7474/FAX 1-908-919-7319 POLICY NO. ' OAT, joss CiLICK'N STICK PHOTO STATIONER' INSURtrl-'G o CLAIMANT PICTURE NO. DATE/TIME TAKEN BY WEATHER LOCATION AND VIEW COMMENTS ADDITIONAL INFORMATION ❑OVER PICTURE NO. DATE/TIME TAKEN BY +y � WEATHER LOCATION&VIEW COMMENTS ADDITIONAL INFORMATION CIOVER OUR FILE NO. 7 P.G.S. FORM 200-2-35-X P.G.S. INDUSTRIES, P.O. BOX 1348,ASBURY PARK, NJ 07712/1-800-484-7419-S.C.7474/FAX 1-908-919-7319 • STATE FAR M State Farm Insurance Companies ®� INSURANCE Northern California Office September 15, 1995 6400 State Farm Drive Rohnert Park,California 94926-0001 Contra Costa County Board of Supervisors 651 Pine Street 6th floor Martinez, CA 94553-1290 ****IMPORTANT**** PLEASE WRITE OUR CLAIM NUMBER* ON _ YOUR REPLY OR PAYMENT _ THANK YOU RE: Claim Number: *05-6677-576 Date of Loss: June 28, 1995 Our Insured: Evalyn Abramowitz Dear Sir/Madam: State Farm Mutual Automobile Insurance Company on behalf of Subrogee, Evalyn Abramowitz hereby makes claim for $1, 523 . 01 and makes the following statements in support of claim: 1. Notices concerning this claim should be sent to: State Farm Insurance Companies 6400 State Farm Drive Rohnert Park, CA 94926-0001 2 . The date of accident occurring on June 28, 1995 at Hwy 980 12th street exit in Oakland, CA. 3 . The circumstances giving rise to this claim are as follows: Our insured stopped for a yellow light and your driver rear-ended her. 4 . The injuries reported consisted of none. 5. Our total claim is as follows: Company's Net Payment $1, 273 . 01 Insured's Deductible Interest $ 250. 00 Total Property Damage $1, 523 . 01 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 • , STATE FARM State Farm Insurance Companies ®® • Board of Supervisors INSURANCE Page 2 September 15, 1995 Northern California Office 6400 State Farm Drive NOTICE' Rohnert Park,California 94926-0001 This form is to provide notice of our claim for damages in accordance with the 120 day statute. If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. ,,�-� State Farm Mutual Automobile Insurance Dated, rnhQ�, .. 114 )qq'5 B _ 4mploy�eiNa e y Employee Ti le Empl6yee Phone Number Enc: Supporting Documents cc: Benedict 2960 09 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 wie pit t�lk ;'iii°,. ,.:.•• `�r:;s , I I'4 .�i'::fit::::.•. ..�11�'�,1 (• ::,'�i;.;,?t�4t,'i•;''ti Vii:",' ,•'�::t,SS :.. •tie�``•�.:,, e• , • C� ,'\: ;;,.,••�L;• �?ill':; �i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 the County, or District governed by) BOARD ACTION rvisors, Routing Endorsements, ) NOTICE TO CLAIMANT ord S" c .Action. All Section references are to ) The copy of this document mailed to you is your notice of Califc*ria 'Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Air*Unt: $50;.000.00 + Section 913 and 925.4. Please note allnin s" R.'S �ounse( CLAIMANT: Artemio Ramos, Diane Ramos, Art Ramos and The Estate of Suzette Lee Ramos,., g ATTORNEY: Scott A. Slomiak Date received Ictinex,CA9455 ADDRESS: p0 BOX 1290 BY DELIVERY TO CLERK ON CPpfAmhPr 99, 1905 San Mateo, CA 94401-1290 BY MAIL POSTMARKED: qpi tamhPr 91 , 1 qQ5 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PPHHIL ATCHELOR, Clerk DATED: September 22, 1995 Br: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: YDeputy County Counsel 11I. 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 Superviscrs 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: J Q HIL BATCHELOR, Clerk, By Q, , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /n — J _ / 9 9 S BY: PHIL BATCHELOR by 2Deputy Clerk CC: County Counsel County Administrator 1 KNAPP &VIOLA,P.C. LAWRENCE S.VIOLA,ESQ. SBN 130335 RECEIVED 2 SCOTT A. SLOMIAK,ESQ. SBN 148407 P.O. BOX 1290 SEP 2 Z 1995 3 SAN MATEO, CA 94401-0990 PHONE: (415) 343-6400 4 FACSIMILE: (415)342-6854 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 5 Attorneys for Claimants 6 Artemio Ramos,Diane Ramos,Art Ramos, and The Estate of Suzette Lee Ramos 7 NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA 8 (California Government Code §§ 810, et seq.) 9 In the Matter of the Claims of: 10 ARTEMIO RAMOS, DIANE RAMOS, 11 ART RAMOS, and The ESTATE of SUZETTE LEE RAMOS, 12 Claimants, 13 V. 14 CONTRA COSTA COUNTY, 15 CALIFORNIA DEPARTMENT OF TRANSPORTATION, and DOES 1 16 through 20, inclusive, 17 Respondents. 18 19 Claimants Artemio Ramos, Diane Ramos, Art Ramos, and the Estate of Suzette Lee 20 Ramos hereby make a claim against the County of Contra Costa, and the California Department 21 of Transportation pursuant to the Tort Claims Act(Government Code §§ 810, et seq.)to recover 22 23 damages for injuries suffered in an automobile accident and make the following statements in 24 support of this claim.: .25 1. The claimants' post office address is: 24242 Silva Ave #40, Hayward, CA 26 94544. 27 28 GOVNTCLM.DOC 1 1 2. All notices concerning this claim should be sent to: Scott A. Slomiak, KNAPP & 2 VIOLA, P.O. Drawer 1290, San Mateo, CA 94401-1290. 3 4 5 3. The incident giving rise to this claim occurred on March 21, 1995, on Vasco 6 Road, located in Contra Costa County, 2.0 miles North of the Alameda County line. 7 8 4. The amount of damages is unspecified at this time, but is in excess of$50,000.00 9 and within the jurisdiction of the Superior Court of the State of California. 10 11 12 5. The facts giving rise to this claim are as follows: This head on traffic collision 13 occurred on Vasco Road, approximately 2.0 miles north of the Alameda County line, in an 14 unincorporated area of Contra Costa County. At this location, Vasco Road is a two lane county 15 road with one lane in each direction(northbound and southbound). The roadway is of asphalt 16 17 construction and the traffic lanes are divided by painted solid double yellow lines, with raised 18 yellow reflectorized dots. The roadway is bordered on the east and west roadway edge by a 19 painted solid white roadway edge line and by a gravel downgrade embankment. When traveling 20 in a northerly direction at this location, Vasco Road makes a long sweeping right hand curve. At 21 the time of the accident,the roadway was wet and icy. 22 23 The claimants' vehicle was traveling northbound on Vasco Road at a speed of 24 approximately 45 miles per hour. The second vehicle involved,the Hansen vehicle, was 25 traveling southbound on Vasco Road at approximately 35 miles per hour. The vehicles 26 approached each other from opposite directions in a heavy rain and hail, with approximately 3/8 27 28 CALSTCLMBOC 2 1 inch to 1/2 inch of hail accumulated on the wet roadway. The claimants' vehicle entered a long 2 sweeping curve to the right and the Hansen vehicle entered the same curve from the opposite 3 direction. According to the claimants,the Hansen vehicle appeared to cross into the claimants' 4 vehicle's lane and the result was a head on collision. 5 6 At that time and place, Vasco Road was in a dangerous and defective condition for a 7 number of reasons, including, but not limited to the following: Hail had accumulated on the 8 roadway under circumstances where there was no warning and no precautions or remedies had 9 been taken, and although Contra Costa County and the California State Department of 10 11 Transportation had actual or constructive notice of the dangerous condition and/or the 12 accumulation to take adequate precautions,no action was taken; and, the dangerous and 13 defective curving design/condition of Vasco Road had no warnings or precautions and, 14 therefore, despite the fact that Contra Costa County and the California State Department of 15 Transportation had repeated actual notice of the dangerous and defective condition of the 16 17 roadway design/condition, and had adequate time to take sufficient precautions or effect the 18 appropriate remedy, no warning signs were in place in Contra Costa County nor any other 19 device designed to either advise the traveling public of danger or ameliorate that danger. 20 21 6. Claimant Suzette Lee Ramos suffered fatal injuries. Claimant Artemio Ramos 22 suffered numerous injuries, including but not limited to a contusion to the chest; and Claimant 23 24 Diane Ramos suffered numerous serious injuries, including but not limited to contusions and a 25 fracture of the right shoulder. Claimant Art Ramos suffered a loss of consortium due to the death 26 of his wife, Suzette Lee Ramos. 27 28 GOVNTCLM.DOC 3 1 7. The name(s) of the public entity(s), other than Contra Costa County and the 2 California State Department of Transportation, are unknown and the name(s) of the public 3 employee(s) causing claimants' injuries are currently unknown. 4 5 6 Dated: 9 S Respectfully Submitted, 7 KNAPP &VIOLA 8 A Professional Corporation 9 10 11 Scott A. Slomiak, 12 Attorney for Claimants Artemio Ramos, Diane Ramos, Art Ramos 13 and the Estate of Suzette Lee Ramos. 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 CALSTCLM.DOC 4 1 . PROOF OF SERVICE 2 [C.C.P. §1013, C.R.C. §2008, F.R.C.P. Rule 5] 3 I,the undersigned, say: I am, and was at the time of the service hereinafter mentioned, over the age of 18 4 years and not a party to the above-entitled action. I am employed in the County of San Mateo, California any my business address is 441 First Avenue, San Mateo, California, 94401-3202. 5 On September 21, 1995, I caused the following documents: 6 1. Notice of Claim Against the California State Department of Transportation 7 8 to be served on the following interested parties in the above-entitled action at the address 9 indicated: 10 State: 11 Office of Risk Management Contra Costa County 12 651 Pine Street, 6th Floor Martinez, CA 94533 13 14 BY PERSONAL DELIVERY: I caused such document(s) to be give to a commercial process server for personal service on the above-referenced individual(s). 15 BY FIRST-CLASS MAIL: I caused such document(s) to be 16 served by placing for collection and deposit in the United States mail a copy of the document(s) at Knapp & Viola, 441 First Avenue, San Mateo, County of San Mateo, California, in a sealed 17 envelope, with postage fully prepaid, addressed to each of the above-referenced individuals. I am familiar with the practice of Knapp & Viola for the collection and the processing of 18 correspondence for mailing with the United States Postal Service. In accordance with the ordinary course of business, the above-mentioned document(s) would have been deposited with 19 the United States Postal Service on the above-mentioned date, the same day on which it was placed at Knapp & Viola for deposit. I understand that, upon motion of a party served, service 20 pursuant to C.C.P. § 1013a(3) shall be presumed invalid if the postal cancellation date or postage meter date on the envelope is more than one day after the date of deposit for mailing contained in 21 the affidavit. [C.C.P. §1013a(3).] 22 BY EXPRESS MAIL: I caused such document(s) to be served by depositing a copy of the document(s) in a post office, mailbox, sub-post office, substation, mail 23 chute or other like facility regularly maintained by the U.S. Postal Service for receipt of Express Mail, in a sealed envelope, with Express Mail postage paid, addressed to the above-referenced 24 individual(s). [C.C.P. § 1013(c).] 25 xxxxxxxxxxxx BY OVERNIGHT DELIVERY: I caused such document(s) to be served by depositing a copy of the document(s) in a box or other facility regularly maintained by 26 the express service carrier, or delivered to an authorized courier or driver authorized by the express service carrier to receive documents, in an envelope or package designated by the 27 express service carrier with delivery fees paid or provided for, addressed to the above-referenced individual. [C.C.P. § 1013(C)] 28 PRFSERV.DOC 1 1 BY FACSIMILE TRANSMISSION:I caused such document(s) to be served at approximately m. on the above-referenced individual(s) by facsimile 2 transmission pursuant to Rule 2008 of the California Rules of Court. The telephone number of the sending facsimile machine was 415-342-6854, and the telephone number of the receiving 3 facsimile was . A transmission report, which is attached to this proof of service, was properly issued by the sending facsimile machine, and the transmission was reported as complete 4 and without error. [C.R.C. Rule 2008] 5 1 declare under penalty of perjury under the law of the State of California that the foregoing is true and correct, and that this declaration was executed in San Mateo, County of San Mateo, 6 California on September 21, 1995. 7 Name: Nancy Olsen Signature AAA 8 9 10 11 12 13 14 15 16 .17 18 19 20 21 22 23 24 25 26 27 28 PRFSERV.DOC ® 2 LAW OFFICES OF KNAPP & VIOLA A PROFESSIONAL CORPORATION LAWRENCE S.VIOLA 441 FIRST AVENUE TELEPHONE(415)343-6400 ELISA LOWY CIRILLO* POST OFFICE DRAWER 1290 FACSIMILE(415)342-6854 CAMILLA J.AMOROSO SAN MATEO,CALIFORNIA 94401-0990 SCOTT A.SLOMIAK 'ALSO ADM[TTED M THE pp��/� STATE OF NEW YORK RIF6E EIVED September 21, 1995 ii SEP zam Office of Risk Management BOARD OF SUPE WAAS Contra Costa County CLERKCONTRA COSTA 00. 651 Pine Street, 6th Floor Martinez, CA 94553 RE: Claim Against Government Entitv Our File#: 3021 Dear Sir or Madam; I have enclosed a claim on behalf of Artemio Ramos, Diane Ramos, Art Ramos and the Estate of Suzette Lee Ramos in connection with a head on collision which occurred on March 21, 1995 on Vasco Road, Contra Costa County 2.0 miles north of the Alameda County line. As the claim indicates,please send all notices regarding this matter to my attention. Thank you for your cooperation. Very Truly Yours, KNAPP &VIOLA A Professional Corporation Scott A. Slomiak SAS/njo { 7033955213 -: a �Y � k � 4� � � d 6, d �! � 0✓ j V I�!r . i' 9 100 cc;003205 5229+x' �-219511b0-1120-4 X. Scott A. Slomiak ------- _1_5-34 3- -- 1y-343-640 VIOLA - 1 T T AVENUE t ,.❑ ;•;; �t It.'. ,,SJI AVENUC X tA Tile # 30.21 __ X. _F -- !ix 1 1 t-, 1 Office. of Risk Manaemen,t 510 646-29.26___ —_.. -- --- ------ ---g— X Contra Costs County - 651 Pine Street 6th Floor Martinez CA x94333 I:F 7 O 3 3 9 5 5 2 1 3 - -' 194 ® STANDARD OVERNIGHT FRI ,� emp# 85796 21SEP95 15:07 AA . Trk# 703 3955 213 LETTER OAK 94553-OA-US CLAIM BOARD OF SUPERVISORS.OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 Ci?<M a^"^st the County, or District governed by) BOARD ACTION ,ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT or,d Sur•c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $25,000.00 + Section 913 and 915.4. Please note all OUrd�r�ggr.s" Ci®lIFlSeI CLAIMANT: Harriet Davis �•. ; ATTORNEY: Allan M. Tabor z Martine Date received ,CA 9455 ADDRESS: 11 Embarcadero West, Ste. 130 BY DELIVERY TO CLERK ON September 15, 1995 Oakland, CA 94607 BY MAIL POSTMARKED: September 15, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 22, 1995 sa'L DeputylOR, Clerk \ ,� aA I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `Z — 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 Superviscrs 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: /p_/a-/9gjf PHIL BATCHELOR, Clerk, B 5� , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I an now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited 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. e Dated: o� % BY: PHIL BATCHELOR byLAd��eputy Clerk CC: County Counsel County Administrator RECEIVE® RYAN & TABOR 1510 1 ALLAN M. TABOR STATE BAR NO. 52846 2 11 Embarcadero West, Suite 130 aim OFSUPERViSORS CONTRA COSTA CO. Oakland, CA 94607 3 Telephone (510) 444-5350 4 Attorneys for Claimant 5 6 7 CLAIM 8 HARRIET DAVIS, 9 Claimant, 10 VS. 11 CITY OF RICHMOND, 12 COUNTY OF CONTRA COSTA, 13 Respondents. 14 A. HARRIET DAVIS lives at 11780 San Pablo Avenue, No. 103, 15 E1 Cerrito, CA. 16 B. Notices in this matter are to be sent to Ryan & Tabor, 17 11 Embarcadero West, Suite 130, Oakland, CA 94607 . 18 C. On July 17, 1995 claimant was an invitee at defendant's 19 clinic at 38th & Bissell Streets, City of Richmond, County of 20 Contra Costa, State of California. At said time and place she was 21 caused to slip and fall on a ramp on the outside of said clinic. 22 Said ramp was a dangerous condition of public property. It was 23 defective in its design, manufacture, inspection and maintenance 24 and furthermore, it was covered with debris, and the lighting was 25 poor. 26 D. Injuries: Claimant sustained injury to her left knee, 27 left foot, and back. Exact medical bills are unknown to date. 28 RYAN&TABOR E. Damages with respect to this claim. The jurisdiction ATTORNEYS AT LAW PORTOBELLO SQUARE 11 EMBARCADERO WEST,SUITE 130 OAKLAND,CA 91807 (810)114-5350 rests properly in the Superior Court and exceeds $25,000.00. 1 F. Names of public employees unknown. 2 DATED: September 15, 1995 RYAN &TABOR 3 4 BY ALLAN M. TABOR 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 RYAN&TABOR ATTORNEYS AT LAW PORTOBELLO SQUARE 11 EMBARCADERO WEST,SUITE 130 OAKLAND,CA 90507 (510)044-5350 n • `` pA ' C's y K .o b. t,a v 0 a as r W 03a�`�g �r N0 o. OZS2WWW g • CLAIM Cr (0 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 Ci?:T bri�^st the County, or District governed by) BOARD ACTION _ :`, `_::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT ord 6Lc•c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $4416.03 Section 913 and 915.4. Please note all "Warnings". CLAIMANT, James and Susan Edwards ATTORNEY: Date received ADDRESS: 1075 Laurel Ave. BY DELIVERY TO CLERK ON September 26, 1995 Reddsport, Or. 97467 BY MAIL POSTMARKED: Hand Delivered 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 27, 199.5_ Jy1L DepuiyLOR, Clerk //// U 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (+f This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( Other: LX rW,, g �U � r1 -1 .o - ,� caMta r Dated: �( " Z$ ^ 9 S 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. BOAR:. ORDER: By unanimous vote of the Superviscrs 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: /p --/p- 199.!� 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 mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you Should do so immediately. * For Additional Warning See Reverse Side Of This Notice. . AFFIDAVIT OF MAILING 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 1B; 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: Y, Ijg, �, / BY: PHIL BATCHELOR by �' eputy Clerk :C: County Counsel County Administrator TO: James and Susan Edwards 1075 Laurel Avenue Reedsport, Oregon 97467 NOTICE TO CLAIMANT (Of Late-Filed Claim) (Government Code Section 911 .3) The claim you presented to the Board of Supervisors of Contra Costa County, California, as governing body of the County of Contra Costa on September 26 . 1995 has been reviewed by County Counsel and is being returned to you herewith because: Your claim for an injury to person or personal property which arose on or after January 1, 1988 was not presented within six months of the event or occurrence as required by law. (See Government Code sections 901 and 911.2) Your claim was delivered on September 26, 1995. It is not timely as to all injuries or damages incurred prior to March 26, 1995 (more than six months prior to filing. ) . In order to protect your legal rights, you must apply for leave to present a late claim as to those injuries or damages occurring prior to March 26, 1995. However, your claim will be considered as to those injuries or damages occurring on and after March 26, 1996 . As to those injuries or damages occurring on or after March 26, 1995, the claim is timely. Because the claim was not presented within the time allowed by law, no action was taken on the late portion of the claim. Your only recourse at this time is to apply without delay for leave to present a late claim. (See Government Code sections 911 .4 to 912 .2 and 946 . 6) Under some circumstances leave to present a late claim will be granted. (See Government Code section 911.6) You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. PHIL BATCHELOR, Clerk of the Board of Supervisors and County Administrator /J By: D uty Clerk Dated: Z2.?y Enclosure NOTICE OF LATE CLAIM Page 1 r 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 copy of the above Notice to Claimant (of Late Submitted Claim) , addressed to the claimant as shown above. Date: 9'x9 -/99.5 By Phil Batchelor by Deputy erk NOTICE OF LATE CLAIM Page 2 Clato: 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 5911.2.) 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 ) 2629 or ) istrict) BOARD OF SUPERVISORS NTRA Fill in name DCOCOSTA CO.) The undersigned claimant hereby.makes claim against the County of Contra Costa or the above-named District in the sum of and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) W-Av --�2 tt� q C1 2. Where did the damage or injury occur? (Include city and county) • use exEra r if —Tw the damage or injur occur. (Giv full details, paper required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �. wnat; are the n---nes of county or district officers, servants or employees causing the cam:ge or injury? . 5.- What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) B. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT rc dov. Code Sec. 910:2 provides: n ;,The claim must be signed by theclaimant SEND NOTICES TO: (At Or�as.�c.r, . or b some person on his behalf." Name and Address of Attorney F 6ALaCL Ez (Claimant's Signat Ol Address. Telephone No. , Telephone No. s N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonrsent and fine. o 10?5 Laurel Avenue r Reedsport, "Or. 97467 May 2, 1995 Board of Supervisors 0 Room 106, Co. Admin. " Bldg. 651 Pine Street Martinez, Ca. 94553 Dear Board Members : Following is a description of the events which pr;dmpted this action against the County of Contra Costa:, Line 3 from claim- form: How did the damage occur? On March 3, 1995, our son, Jesso Daniel Carey, was stopped for a traffic violation in Eugene , Oregon. As a result of that he was "f. ound to have a warrant for his arrest from Contra Costa; California, He was arrested and charged with being a fugitive from justice. He called us from jail and we began investigating the charge to find out why he was being held. We were informed that he was being charged with drug trafficking and conspiracy to sell automatic weapons , . and we were told, personally, by Hal Jewitt , that without a doubt " Jesse wasthe :r ,man! " Our son, Jesse, insisted that he knew nothing of what triese charges were(�,about, and due to the dates involved with these charges , we believed his innocence. Our son had just started a new job in the Eugene area and had worked one week before he was arrested. Consequently he had no money to deal with the expense of this false arrest, or support his family during this crisis . We ,also, had no money to deal Stith this unpleasant and demeaning situation because we live on a fixed income due to blindness . We have putro`.�urselves into financial debt to help him. We bailed him out and took him to California to fa.ce" .his charges and prove his innocense. After 5 minutes in the court room, before court began, Jesse was , indeed, found to be the wrong man after all. Since he was so very simply proven innocent and Mr Jewitt made a very serious and costly mistake by assuming that he had the right man, we feel we should at the very least be reimbursed. for our expenses in dealing with this very traumatic matter. Line 4 from claim form: Also explained in above account. Line 5 " " " Hal Jewitt Line 6 " " Financial damages Line 7 " " " Actual cost . Itemized on attached list. Q List of Expenses due to False Charges line 7 and, q from claim form March 3 , 1995.. . : Arrest telephone. . . . . . . . 11. 98 4, Trip to Eugene to get car and Jess ' belongings tele. . . . . . . . . . . . . 3. 69 gas . . . . .. . . . . . . 18. 00 meals . . . : . . . . . . . 15. 00 March 5, tele. . . . . . . 1.95 61 . . . : Arraignment. Trip to Eugene to see about bail. Found out about warrant and$10, 000. 00 bail. tele. .. 1.34. gas . . . . . . . . . . . . . . 18. 00 meals . . . . . . . . . 15. 00 o March 7, . . . Numerous calls to Calif, including Hal Jewitt, to try to understand charges. tele. . . , . , . . . . .23.57 ,. 8, Continued calling; Hal Jewitt, lawyers , etc. in _both Calif. -and Qregon. tele. . . . . . . . : . . . . 23.88 9, Numerous telephone calls . Overnight trip to Eugene for legal help, in person, due to frustration via tele. Motel in Junction City and Creswell, Or. to talk. to Jess ' employer. a tele. . . . . . . . . . . . 29'. 14 motel::':-. . ... . . . . . .38.00 meal-s r.. o .. . . . . . . . 20.00 o gas 22.00 March .10, Eugene trip ( con' t) . Ta'lked. to attorney. Went to loan companies . tele: . . . . . . . . . . . .32.62 gas. . . . . . . . . . . . 15.00 meals. . . . . . 15:`00 Trip to Florence to see about loan. gas . . . . . . . . . . . . . . 8�90� 129 Telephone calls , tele. . . . . . . ... .. . . 1,.9.4 . . . . ... tele. . . . . . . . . . . . . 2.127 139 Telephone calls concerning bail, etc. tele.... . . . . . . . . . . .4.6.60 141 Title Co. Trip to Florence. Put deed- to house , up to secure loan for bail. o gas . . . . . * 0 . ... . . . . 8000 o tele. . . . . ... . . . . . . 5.4.0 152 Telephone. Legal info, etc, teie. ... . . . . . . . . 9.36 161 Telephone. tele . . . . . . . . . . . . . 5.61 171 . . . : Trio to Florence to .get money ( check) for bail. Telephone, gas . . . . . . 8.00 tele. . . . , .. : . . ..:. 4. 58 181 Telephone. tele. . . . . . . . . . . . . 4.80 191 Telephone. tele. . . . . . . . . . . . . 1.40 March 20, Trip to Eugene with bail check. very complicated and tiring procedure. . .Lawyers . . .Custody Ref. Visited Jess . (overnight trip) gas. . . . . . . . . . . . . . 14.00 tele.. . . . . . . . . . . . 4:59 motel. . , ... . . . . . . . 38.00 meals. . . . . . . . . . . . 15.00 r March 21, 1995. . . : Overnight trip to Eugene (con' t) . No banks in Eugene would cash check. Had to go back to Florence, then back to Eugene to pay bail. tele. . . . . . . . . . . 2.95 gas: . . . . . . . . . . . 22. 00 meals. . . . . . . . . . 15 00 22, Telephone tele. . . . . . . . . .4 .36 23 .. . tele. . .. . . . . . . . . 17.73 24, ° tele. . . . . . . . . . . 7. 11 251 Trip to Calif. to prove innocense, gas , . . . , . . . . .80.00 food. . . . . . . , . . 100. 00 261 Met with attorney gas. . . . . . . . . . . . 15. 00 food. . : . . . . . . . .4.0.00 27, . . . : Waited gas . . . . . . . . . . . . 10:00 food. . . . . .. . . . . . 25.00 289 Court in Richmond. Jess o immediately found to be the Wrong Man ! Before court even began he was exonerated. tele. . . 1-70 gas. . . : : :.: * : : *. : 10.00. . , , . . 10.00 meals:. . . . . . . . . 15.00 299 Talked to attorney in Concord about the hardship of these false charges with no evidence and no effort to properly identify suspect. gas . . . . . .'. '. . . 20.00 food. . . . . . .'. . . .25,00' 30 , to Trip home gas. . . . . . . . :. . . 60.00 April 2 food. . . . ..'. . . . . . 85-00 motle. . . . . . . . . .40.00 3 Trip to Eugene. Talked to custody ref.. and D.A. about bail. gas . . . . . . . . . . . 18.00 food 10.00 Summery of Expenses : Fam. support, gas , food. $1086.03 Lawyers Fee 1500.00 loan for Bail 1130.00 Loss of rent 00.00 tot'd-7%. . . . 94416-03 . o CLAIM C„t(,a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 . . Cl,<T A:!�^st the County, or District governed by) BOARD ACTION _ �.::;' rvisors, Routing Endorsements, ) NOTICE TO CLAIMANT or,c Suc-c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10,000.00 + Section 913 and 915.4. Please note all Sheryl S. Hayworth •Waref" h' CLAIMANT: S ��•' Counsel f.4 f` ATTORNEY: Lisa V. Heilbron, Esq. Martinez, Date received Se tember 22 199SCa94553 ADDRESS: PO Box 2084 BY DELIVERY TO CLERK ON p Oakland, CA 94604-2084 Hand Delivered BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PP gg .. DATED: September 22, 1995 8dil DepuLylOR, Clerk 1I. 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 910.8). ( ) 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: ZS— 9 S 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. BOAR:, ORDER: By unanimous vote of the Superviscrs 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:_fO-/D - LJ ZS- PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury ttat I an now, and at all times herein mentioned, have been a citizen of the United States, over age 1B; 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: /D - 13 -- /9 9S7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator CLAIM TO: BOARD OF SUPERVISORS OF CONTRA C1197_4Tnq% )1applicationto: Instructions to ClaimantC!erk of the Board Martinez,California 94553 A. Claims relating to causes of action for death or for injury to person or to personal. property or growing crops must be presented not later than the 100th day 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. (Sec. 911. 2, Govt. Code) 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 , California 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 end oT this form. RE: Claim by ) Reserved for Clerk' s filing stamps Sheryl S. Hayworth ) RECEIVE® ) Against the COUNTY OF CONTRA COSTA) 2 2 FA or 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 $Within Superior Court Jurisdiction. and in support of this claim represents. as follows : ------------------------------------------------------------------------ 1. When did the damage or in]ury occur? (Give exact date and hour) Injury occurred on January 10, 1995, when claimant noted tree on her property was sinking. Injury continued through and including March 22, 1995, when greatest flooding occurred. -----------T----------- -------------------------------------------- --- 2. Where did the damage or--injury occur? (Include city and county) 528 Moraga Way, Orinda, Contra Costa County, California. 3 How did the damage or injury occur? (Give full details, use extra sheets if required) Improper maintenance of drainage culvert led to blockage and flooding of claimant's property. Subsidence on claimant's property was also caused by improper drainage conditions. - ------------- ---lar----acto-----r--omission-------------------------------------------- 4 . What part-icuon the part of county or district officers , servants or employees caused the injury or damage? County's failure to properly maintain drainage culvert. (over) 1 5. What are the names of county or district officers , servants or employees causing the damage or injury? Unknown. ------------------------------------------------------------------------- 6. What damage or injuries do you- claim resulted? (Give full extent of injuries or damages claimed. Attach ,two estimates for auto damage) Blockage of culvert and improper drainage caused flooding of claimant's property and subsidence of soil which necessitated pumping of standing water and excavation work. ------------t------=----------------------------------------------------- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) According to estimates obtained from contractors and receipts for excavation work and pump rentals. Total damage estimated to fall within jurisdictional limit of Superior Court. ------------------------------------------------------------------------- 8. Names and addresses of witnesses , doctors and hospitals. Leo Sid, 528 Moraga Way, Orinda, CA. Nelly Russell, 534 Moraga Way,Orinda, CA. , Katalin E Charles Tobias, 526 Moraga Way, Orinda, CA. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 3/22'/95 „ ,; Excavation $2,000.00 `3/22795- Pumping Water $4,000.00 i• �i � 4 i"t M x.<?Igpd Govt. Code Sec. 910.2 provides : "The claim signed by the claimant SEND NOTICES TO: (Attorney) or by some person on h�iQs behalf. " Name and Address of Attorney' 6"" Lisa V. Heilbron, Esq. Climant' s Signature Crosby, Heafey, Roach E May, P.C. 1999 Harrison Street . A dress P.O. Box 2084 Orinda, CA 94536 e�eddp-hbne 0604 -208510) 763-2000 Telephone No. (510) 376-3393 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, town, city district, ward or village board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is guilty of a felony. "" CLAIM .. , BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA C . � October 10, 1995 Cla4- Ar!ii st the County, or District governed by) BOARD ACTION :::-t-;' _:;,envisors, Routing Endorsements, ) NOTICE TO CLAIMANT grid 6La,c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califcrnia Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $72,89 Section 913 and 915.4. Please note all 'Warnings". CLAIMANT: P.J. Jordan, Jr. ATTORNEY: Date received ADDRESS: 322 Rock Oak Rd. BY DELIVERY TO CLERK ON September 27, 1995 Walnut Creek, CA 94598 Hand Delivered via: Risk M t. BY MAIL POSTMARKED: � 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PpHHIL BATCHELOR, Clerk DATED: September 27, 1995 BY: Deputyi__� 11. FROM:: County Counsel TO: Clerk of the Board of Supervisors (1,0< This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: "( 'Z J 8Y: 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. BOAR:, ORDER: By unanimous vote of the Superviscrs present ( V�This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /0_/0 — /99,57PHIL BATCHELOR, Clerk, By J Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Earning See Reverse Side Of This Notice. 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 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. Dated:�Z)� �g 9S 8Y: PHIL BATCHELOR byc� eputy Clerk CC: County Counsel County Administrator Cla :.o* BOAP0 OF SUPERVISORS OF CONTRA COSTA COUNTY • INSTRUCTIONS TO CLAIMANT A. Ciai:.s gelating 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.}. e 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 nage 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 f or=. R£: By, ) Reserved for Clerk's filing stamp " RECEIVED Against the County of Contra Costa ) 0 ,27 or ) VLa ;JCLERK B D OF S8 WA, cciT0 District) COSTA ill in name ) The undersigned claimant fiereby`makes `claim"against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 47-o 0 2. Where the damage or injury occur? (Include city and county) -7, C � y V e- 6 -- 3• How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, se-rvants or employees caused the injury or damage? • :,v� 5. wnat are t.ne nares o1' county or district officers, servants or employees causing r the ua merge or injury? � > 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ..,,z ___..�.� � - 7. How was reamount claimed above computed? (include the estimated amount of any prospective injury or damage.) Names and address az of witnesses;. do^tors. anal.hospitals. . 9. List the expenditures you made on account of this accident or injury: DATE IT£M AMOUNT' rr^F.xvrrtwvt9.6'aVfW.aR!4�.G'7y:'.Y.iB.W!.'.'+tixt�Gh 'rf. . :.fix a 4:a'Y..1?.»MairntStlPAs!. ' 7f � � F if � � � 1C� � 7f 1};75 -�'•7f.� � � � R � � � � if if 1[ if � � � � � � iS � R Q Gov. Code Sec. 910;2 provides: The claim must be signed,_by-.the•,.cla.bant SEND NOTICES or by some person on his behalf:" Name and Address of Attorney Cla' t ;s Signat Address. Telephone No. Telephone No, �t 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. �7oZ538 ; 'o a VAN MW 5 BLLVm 94553 CUSTOMER'S ORDER NO. DEPT. NAME I ADDRESS_ �f SOLD 6Y. GASH C.O.D. CHARGE ON ACCT:., MDSE.REfD. PAID OUr AUAN ,a DESCRIPTION; PRICE ,AMOUNT 4 '- 9 -�- 9 o t }�e RECD BY A M 1 oon I shoot tot the M you MISS, 1° othe stars pei r r 1 r, to ` s X46 Ll 41 � a C.J co O -�a0 cv ' Q^�G 1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 10, 1995 C1?4T Ar!'4 st the County, or District governed by) BOARD ACTION : " _ n,`*.::;ervisors, Routing Endorsements, ) NOTICE TO CLAIMANT o",d Sic-c Action. All Section references are to ) The copy of this document mailed to you is your notice of Califc«is Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount. $3,000.00 + Section 913 and 915.4. Please note all •Warnings". CLAIMANT: Richard A. and Paula M. Kerr ATTORNEY: Deborah Kerr, Esq. P.O. Box 9728 Date received ADDRESS: So. Lake Tahoe, CA 96158 BY DELIVERY TO CLERK ON September 26, 1995 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH g DATED: September 27, 1995 BYIL DeputyLOR' Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( U+4"'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 no'%ifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �� 2-1 " 1 S_ BY: Deputy County Counsel 111. F;OM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOAR:, ORDER: By unanimous vote of the Superviscrs 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: 9,3,6- PHIL BATCHELOR, Clerk, By J , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 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 1B; 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: /6) 9� BY: PHIL BATCHELOR by � 4�eputy Clerk CC: County Counsel County Administrator Claim 3•o: BOARD OF SUPERVISORS OF CONTRA COSTA CO= INSTRUCTIONS TO CLAD- N'T A. Claim-- 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, 1957, mus'!! 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 Vnich accrue on or after January 1, 1986, 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 o W. RF: Claim B.% ) Reserved for Clerk's filing stain �.a1-,ojvt A /14. /54 pt- RECEIVED > 2 61996 Against the County of Contra Costa ) or ) D-OF SUPERVISORS CONTRA COSTA CO. District) (Fill in na ,e, ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the s= of $ 3, O D O Cc, sTS and in support of this claim represents as follows: ---------------------------------------- 1. When did the damage or injury occu.^? (Give exact date and hour) In g;,c'h R g, � 9 9.9 - -------------------------- ------- —-----— — 2. Where did the damn&e or injury occur? (Include city and county) NCW7':r,'2zI COh7YA CoSTaCc�c�rrTy ------------------------------------ ------ ------------------- 3. How did the damage or injury occur? (Give full details; use extra paper if requir'ed) �, aC •/e ?v T: o h L/, oard o u cr v. l a • % t/al,Prcvcd ,E,' on �• T:oh #y Wo.s ho 7' Ce3 b�57Y:e�� /t®�S !e-9 . I,•ce Jc+�v:ces )'es ohs.Ye ° f" e-'01- ¢a/ NL ?he Sal saf�4tiT f++ondnocnr To Tie f'o ��Lt_ / ZZ_h/�s�z 4 w_5=--1Q�_ t-:__-?y Y aJ-P on s e_ �. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? _ o C oht:rt �c-) 76 o.SSeI'Ta /'e v= /�¢h1 aS a C Ute,,/�/"'' • Uk 7'67e a�>�'r•o va d C y Z hG a f e� �p d•sT�':cr Aff „ � for h�H' SUhc��v:S: qhs r-- Q • o. O✓l�� n?••or► �h 40l nJ� iS NOT ,be- �P�YD✓a t� F•YMa�. TjS:,t G Oh C GUI1T^%hS 17oLa,w o4h�%7' c,9clS o.h �Overh�rQhl Sir"%ces T� 4)_51 IA ZST� The G oh %r � anayr 1-w T T'a cx,'sJ;byv�^� i/ypo hT •� 'X,V':l D�fzaS ho �-ie�'�S 7�o i/�, e � �/�e�urn vh c �hSl'i vT� u r►�../. - 1 5. wns t are the na=,es of county or district officers, servants or employees causing the damage or V.�, VL OSseY : vccs 7 7-Ae /� � � Carr�rNantr�. / v'r/o�h,�nT �TAc' CounTy C0UAIf•'/ 7 �'I l'w^�'c� Oc/^t,'h;sicr•', The do /1cy �,.':�h duT c.�'/'^YanT ac v:ce TO �-Ao 1-?vcp1 ?ha.T ?he fro /-'cy ,"� C.ur7k&P� ✓✓ to 4uw dl,age or injuries do you claim resulted? (Give full extent of injuries or domes claimed• Attach two estimate for ,oto dam4a e. T�� O�(?h Lo Ts o ,� Y div,'// �1v jecT To � vao ee /ev:a�✓ county or, rhe.r',407 ownar•. ?- /;go :A"C) V 9erT:n 4Ih�-/�/:�9r��-rYr, , •Gqs@ � os� rhe ��--- .. : aime., aSovE co_p aed? (In:lude the estimated aa�un. prospective i:-' ^ or le E. ) %he Y.�/v �se Th�e4 .[ 0 9s, Gha way o1, nHaTh¢V l+as ya�h '� �1 �;D o 0. F. N_es and at�'resses of w.tnesses, d:_tsrs a^,'_' hosr:tals `VI-4 G List the of this a�'^.ident or in'� r'j )w 1 3 Grv. Code Se_. 910.2 provides: cla._ be signed by the clamant c 1; 7-175 T- (r ,.._.�.•` cr ty s=--e pers= on his behalf." 1.=: ant h.."ESS c-" �0km/' If'a Clai�,�.n 's Sigra„u^e �P- 6v on 97 2 8 T-►hoe ,C•, .7 /s 1790 E//.'s S7. f d:L,, s C UhCord ,5%-) qo.5;2-a Te:epho ne N; . _ Telephone hc. # # �S/U) S 7- 0 a # # # NOTICE / Section 72 of the Peril Code provides: "Every person �, ,o, with intent to defraud, presents for allow- nee or for pa}ment to any state board or officer, or to any county, city or district boa-rd or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, acco:r•.t, voucher, or uTiting, is punishable either by imprisonment in the county jail for a period of not more than one year, by aline of not exceeding cne thousand (:1,000) , or by both su:h imprisonment and fine, .or by imprison-jent in the state prise::, by a fine of not excee�ing ter: ,thousand dollars ($10,000, or by ir� isc:int a..a fine. •r r -