Loading...
HomeMy WebLinkAboutMINUTES - 11281995 - C21 - -A. C • �f CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 1TTovembera , 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Rigoberto Adan Saenz iftimlaly� ATTORNEY: 0 C T Z Date received ADDRESS: 1761 Esmond Ave. BY DELIVERY TO CLERK ON October 24,CM UN&_ Richmond, CA 94801 ' BY MAIL POSTMARKED: Viand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim, p B _ -- DATED: October 26, 19(15 BgII Deputy OR, Clerk II. 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 2-Lo — `3 S BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. , Dated: PHIL BATCHELOR, Clerk, By kf 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. JJDated: y — / 9 9 S" BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator °Cls lo: BOARD OF SUPERVISORS OF CONTRA COSTA MUM NTY .__ =OCTIONS TO CLANLNT • A. Clai= 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 91553. C. If claim is against a district governeA- by the Board of Supervisors, rather than the County, the na-me 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 claim-, Penal Code Sec. 72 at the end of this o^v. RE: Claim B.% ) Reserved for Clerk's filing stamp RIGOBERTO ARAN SAENZ, Natural Son of RECEIVE® HAMM ISABEL SAENZ, Deceased Against the County of Contra Costa ) OCT 2 $ M or ) -SOARD F SUPERVISORS District) CLER CONTRA COSTACO.--- (Fill i n Flame"J, The undersigned claimant hereby makes claim against the County of Contra Costa or the above-nod District in the suis of $ 1,000,000.00 and in support of this claim represents as follows: ------------------------------------------------------------------------------------- 1. When did the dazage or injury occur? (Give exact date and hour) See Attachment A. -------------------------------- ----------------------------------------------- 2. Where did the derma&e or injury occur? (Include city and county) See-Attachment A. -- -------------------------------------------------------------------------------- 3. }how did the damage or injury occur? (Give full details; use extra paper if required) See Attachment A. u..r--------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attachment A. (over) �a 5, t,.� _ are the nc=,es o*•:rzty or district officers, se.Ws or employees Causiqz �• the d-ace or in u,..y? See Attachment A. E.—hr:at doge or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two es,.imates for auto dame. See Attachment A. ------ ------ 7. How wcs the anb:�:t claimed above comp--,ted? (Include the estimated amount of a.: prospective injury or damage. ) See Attachment A. ------------------------------------------------------------------------------- and at-tresses of witnesses, doctors and hospitals. See Attachment A. 9. .._s_ the exTe-:f...i es yo:� , r_e on of t.. a id .,.. or i.,ju. �.__:I ,a, •,.. :. fes►:1•n;T See Attachment Aiifir'; .. a• �' .I a O Code Sec. 910.2 provides: cla._ cis` be signed by the claimant or ty s=-? pers= on his be-=1f." Clair, :t l s S• a tu.1••e In Propria Persona. 1761 Esmond Avenue Richmond, California 94801 Telephone No. Telephone ho. (510) 284-9898 NOTICE Section 72 of the Peril Code provides: "Every person w!,o, with intent to defraud, presents for allowance or for pa}Went 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, a-ny false or fraudulent claim, bill, acco=t, 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 tho::sard ($:,00'), or by both such imprisonment and fine, or by imprison:--p-nit in the s;.a`..e pr. s---, by a fine of not exceeding tet, thousand dollars ($10,000, or by bc`..h s:cy irpriso_gin` and fine. CLAIM OF RIGOBERTO ADAN SAENZ, Attachment A Natural Son of HAYDEE ISABEL SAENZ, Deceased CLAIM FOR ONE-MILLION DOLLARS ($1, 000, 000 . 00) 1 . April 24 , 1995 (approximately 3 : 00 p.m. ) . 2 . Merrithew Memorial Hospital, Martinez, Contra Costa County. 3 . Negligent (ie. below the standard of care) treatment by CONTRA COSTA COUNTY, including, but not limited to, actions and omissions of employees and other agents of CONTRA COSTA COUNTY which caused the fall of HAYDEE ISABEL SAENZ (DOB: 10/20/49) from her bed on 04/24/95 . 4 . Failure of employees of CONTRA COSTA COUNTY and its agents to properly attend to and treat HAYDEE ISABEL SAENZ, including, but not limited to, failure to raise the left side of the bed railing of the bed in which HAYDEE ISABEL SAENZ was laying, causing her to fall from her bed and sustain trauma to her mind and body, includ- ing her head. As a proximate and reasonably foreseeable result of this incident, including the negligence of COUNTY OF ALAMEDA, HAYDEE ISABEL SAENZ died on 04/26/95 . Failure to train and/or su- pervise . 5 . One or more of persons listed under No. 8 (a) and (b) , below. 6 .' Wrongful death (including loss of financial support, contri- butions, services, society, comfort, maternal care and protection, training and advice, funeral and burial expenses, prospective gifts) , emotional distress, spoliation of evidence . 7 . Items in No. 9, 'below, including for injuries and damages indicated in No. 6, above . 8 . a. Merrithew Memorial Hospital (Martinez, CA) b. Lance Gee, M.D. ; Paul Kwok, M.D. ; Mark T. Wills, M.D. ; Robert T. Knight, M.D. ; Polly Karlin, P.T. ; Gloria Mixon, O.T.R. (#251) , and unnamed others . Discovery is continu- ing; C . Unknown female patient (Hispanic, Salvadorean, from the Fairfield, CA area, in her 70' s) . 9 . Date Item Amount 04/95 Funeral costs (in U.S . ) $4, 000 . 00 est . (U.S . ) * 04/95 Funeral costs (in El Sal . ) $6, 000 . 00 est . (E.S . ) * 04/95 Travel (to and from E.S. ) $3 , 100 . 00 (U.S. ) * 04/95 Other assoc . burial costs $3 , 000.. 00 est . (U. S. ) * * currency e C , CLAIM o28 ?` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ' November 199 ' Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: 1.,.000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Felix Adan Saenz u ATTORNEY: O C T 2 6 1995 Date received COUNTY COUNSEL ADDRESS: 1761 Esmond St. BY DELIVERY TO CLERK ON October 2gRC11V� CALIr Richmond, CA 94801 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. �dIL BATCHELOR, Clerk \ DATED: October 26, 1995 : Deputy II. 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: IC7 - 2, BY. v Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: L9 qg' 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 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. BY: PHIL BATCHELOR b Deputy Clerk Dated: /�- q�)qq� y CC: County Counsel County Administrator C aim 'to: BOARD OF SUPERVISORS OF amu COSTA OWN= AMSTRUCTIONS TO CLAIMF.h'T Wr��, �-I A. Clam 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, 1937, must be presented not later than the 100111-h 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, 1936, 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 clam 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 ags rst each public entity. E. Fraud. See penalty for fraudulent claims, Perial Code Sec. 72 at the end of this for=. * � • � � � � � � � • • � a � a � a � � faa • f � �r • * f * � a * � • • • � �r � � r Clain Bv Reserved for Clerk's filing stamp FELIX ADAN SAENZ, Legal Husband of ) HAYDEE ISABEL SAENZ, Deceased > RECEIVED Against the County of Contra Costa ) OCT 2 4 1995 or ) District) CLARK BOARD OF SUPERVISORS Fill in na_,e ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 1,000,000.00 and in support of this claim represents as follows: --------------------------- ---------------- ----- ---------------------------- 1. When did the dame or injury occur? (Give exact date and hour) See Attachment A. 2. Where did the damage or injury occur? (Include city and county) See Attachment A. ----------------------------------------------------------------------------------- 3• how did the damage or injury occur? (Give full details; use extra paper if required) See Attachment A. ----------------------------------------------------------------------------�----- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attachment A. (over) 5. Vnat are the na,es of county or district officers, se#nts or employees causir 'f ' •-• the da=ge or it ju.^y? See Attachment A. F . W:-,=t damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. See Attachment A. ------ -------------------------- 7. Hou was the am -unt claimed above cc=:-,--,ted? (Include the estimated amount of any prospective injury or dare. ) See Attachment A. �. N--e5 and att'resses of witnesses, d-_,�t:rs an, hospitals. See Attachment A. ---------------------------------------------------------------MMM------------------- s_ the on of s a ide. or i ,-u.. y See Attachment A. � la G--.%-. Code Se=. 910.2 provides: m'.:st be signed • _ g'ne by the cla:R.,�-,t S-,- 1;^7_ __ i ir.�..= —,-_cr t s^-e persten pl. his behalf." In Propria Persona. Clair nt's Enature 1761 Esmond Avenue Ad:reser Richmond, California 94801 Te:ephone No. Telephone Neo. (510) 284-9898 N O T I C E Se--tion 71 of the Penal Code provides: "Every person w':o, with intent to defraud, presents for allowance or for parmennt 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, acco,t, voucher, or uTiting, 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 thousa__ (,1,000), or by bot': such imi^ison`e.,t and fine, or by imprison:--ner.t in the state prise-., by a fine of not exceeding ter, thousand dolls.^s ($10,000, or by both suoy imrr:so_r-t ar.d fine. CLAIM OF FELIX ADAN SAENZ, Attachment A Legal Husband of HAYDEE ISABEL SAENZ, Deceased CLAIM FOR ONE-MILLION DOLLARS ($1, 000, 000 . 00) 1 . April 24, 1995 (approximately 3 : OO p.m. ) . 2 . Merrithew Memorial Hospital, Martinez, Contra Costa County. 3 . Negligent (ie . below the standard of care) treatment by CONTRA COSTA COUNTY, including, but not limited to, actions and omissions of employees and other agents of CONTRA COSTA COUNTY which caused the fall of HAYDEE ISABEL SAENZ (DOB: 10/20/49) from her bed on 04/24/95 . 4 . Failure of employees of CONTRA COSTA COUNTY and its agents to properly attend to and treat HAYDEE ISABEL SAENZ, including, but not limited to, failure to raise the left side of the bed railing of the bed in which HAYDEE ISABEL SAENZ was laying, causing her to fall from her bed and sustain trauma to her mind and body, includ- ing her head. As a proximate and reasonably foreseeable result of this incident, including the negligence of COUNTY OF ALAMEDA, HAYDEE ISABEL SAENZ died on 04/26/95 . Failure to train and/or su- pervise . S . One or more of persons listed under No. 8 (a) and (b) , below. 6.. Wrongful death (including loss of financial support, contri- butions, services, society, comfort, companionship, consortium, care and protection, training and advice, funeral and burial ex- , penses, prospective gifts) , emotional distress, spoliation of evi- dence . 7 . Items in No. 9, below, including for injuries and damages indicated in No. 6 , above . 8 : a. Merrithew Memorial Hospital (Martinez, CA) b. Lance Gee, M.D. ; Paul Kwok, M.D. ; Mark T. Wills, M.D. ; Robert T. Knight, M.D. ; Polly Karlin, P.T. ; Gloria Mixon, O.T.R. (##251) , and .unnamed others . Discovery is continu- ing; C . Unknown female patient (Hispanic, Salvadorean, from the Fairfield, CA area, in her 701s) . 9 . Date Item Amount 04/95 Funeral costs (in U. S . ) $4 , 000 . 00 est . (U.S . ) * 04/95 Funeral costs (in El Sal . ) $6, 000 . 00 est . M .S . ) * 04/95 Travel (to and from E. S. ) $3 , 100 . 00 (U. S. ) * 04/95 Other assoc . burial costs $3 , 000 . 00 est . (U.S . ) * * currency C? CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 28, 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code .Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Brittany Thompson, a minor, by Carolyn Thompson ATTORNEY: William C. Thompson, Esq. Nov 6 145 1901 Harrison St. , Ste. 1650 Date received COUNTYGOUNsCL ADDRESS: Oakland, CA 94612 BY DELIVERY TO CLERK ON nfilicFfTchFWr%F1L1F 1 Aq5 BY MAIL POSTMARKED: October 10, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �qIL BATCHELOR, Clerk DATED: November 15, 1995 : Deputy 11. FROM:: County Counsel TO: Clerk of the Board of Supervisors ( Vy 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: H(L �j BY: eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County'Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ll—,29 - / 9 9,� PHIL BATCHELOR, Clerk, By_a," 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 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:__//- A 9- /,?4y_,5- BY: PHIL BATCHELOR byJ1 (,...&,eputy Clerk CC: County Counsel County Administrator APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 14, 1995 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you isur Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Goverrzmt Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the NWATSM" below. Claimant: Brittany Thompson, a minor, by Carolyn Thompson RX 1K3 7M1D Attorney: William C. Johnson, Esq. o CT 1 3 1995 COUNSEL Address: 1901 Harriscf, St. , Ste. 1650 MARTINEZ ZCALIF. Oakland, CA 94612 MARTINEZ CAl1F. Amount: Unknown By delivery to Clerk on octnbpr 11. 1995 Date Received: October 11, 1995 By tel, postmarked on -October 10. 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: October 13, 1995 PHIL BATCI1ELOR, Clerk, HY Deputy I. FROM: County Counsel TO: Clerk of the Board of Supervisors (t.,< The Board should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Claim (Section 911.6). DATED: /o -s? •4 f VICTOR WESTMAN, County Counsel, By_ i��Deputy I. BOARD ORDER By unanimous vote of Supervisors present (Check one only) (✓) This Application is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: 71�._ 14 99 PHIL. BATCHELOR, Clerk, By Deputy WARNIW (Gov. Code 1911.8) If you wish to file a coat action an this matter, you must first petition the appropriate coat for an order relieving you from the provisions of Oovw went Code Section .945.# (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the coat within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of you choice in connection with this matter. If you want to awault an attorne should do so immediatel . V. s Clarkthe : County County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: IS-1995 PM SATCHMM I Clerk, B9 � �_,J Deputy CT V. FROM: 1 County Comm el 2 County Administrator T0: Clerk o t Boar of Supervisors Received copies of this Application and Hoard Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 1 2 CERTIFIED. MAIL - RETURN RECEIPT REQUESTED 3 RECEIVED'" NOTICE OF CLAIM FOR DAMAGES ` 4 AGAINST THE COUNTY OF CONTRA COSTA fis NOV 5 6 TO: Count of Contra Costa CLERK BOARD OF STA CO. ORS Y CONTRA COSTA CO. Board of Supervisors 7 651 Pine Street, Room 106 Martinez, California 94553 8 CLAIMANT'S NAME: BRITTANY THOMPSON, a minor, 9 by and through her Guardian, CAROLYN THOMPSON 10 CLAIMANT'S TELEPHONE 11 NUMBER: (510) 234-9521 12 CLAIMANT'S ADDRESS: 2355 Bush Street Richmond, California 94801 13 ADDRESS TO WHICH 14 NOTICES ARE TO BE SENT: WILLIAM C. JOHNSON, ESQ. 15 BENNETT, JOHNSON & GALLER 1901 Harrison Street 16 Suite 1650 Oakland, California 94612 17 AMOUNT OF CLAIM: In excess of the jurisdictional 18 limits of the Municipal Court 19 DATE CLAIM ACCRUED: October 16, 1994 20 PLACE CLAIM ACCRUED: Merrithew Memorial Hospital 2500 Alhambra Avenue 21 Martinez, California 94553 22 CIRCUMSTANCES OF CLAIM: On October 16, 1994, CAROLYN 23 THOMPSON delivered Claimant, BRITTANY THOMPSON, a minor, at 24 Merrithew Memorial Hospital . Claimant was born by vaginal 25 delivery by medical practitioners who she is informed and believes 26 were agents and employees of the County of Contra Costa. At or 1 1 during the delivery, Claimant suffered a brachial plexus injury 2 to her arm and shoulder. 3 On or about October 16, 1994, the COUNTY OF CONTRA COSTA, by and 4 through its agents, servants and employees so negligently and 5 carelessly examined, treated, tested, diagnosed, prescribed and 6 cared for Claimant' s mother, and provided medical, surgical, nursing 7 and laboratory care and treatment in a negligent and careless manner, 8 and negligently and carelessly failed to properly diagnose and 9 manage her mother' s condition and negligently and carelessly failed 14 to provide adequate pre-natal care, diagnosis, instruction or advice 11 and utilized improper, unnecessary or inadequate childbirth technique, 12 and negligently and carelessly delivered Claimant by vaginal 13 delivery and negligently failed to deliver by cesarian section when 14 the same was demanded and medically indicated; as a legal proximate 15 result of the above, Claimant suffered severe and permanent birth 16 injuries including a brachial plexus injury to her arm and 17 shoulder. 18 ITEMIZATION OF 19 INJURIES: Claimant, BRITTANY THOMPSON, suffered severe and permanent 20 injuries and damages including, but not limited to, a brachial plexus 21 injury to her arm and shoulder. 22 DATED: October 9, 1995 BE T J SON & 'GALLER 23 24 B 25 ILLI C JOHNSON Attorney for Claimant 26 , 2 CLAIM 8 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ;November 244, 1995- Claim 995Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $25,000.00 + Section 913 and 915.4. Please n ' � rn '�) . CLAIMANT: .Donald Clark KITWA ATTORNEY: Ryan & Tabor COUNTVUNSEL Allan M. Tabor Date received MART-INggLIF. ADDRESS: 11 Embarcadero West, Ste. 130 BY DELIVERY TO CLERK ON Oc oh r 25, 1995 Oakland, CA 94607 BY MAIL POSTMARKED: via: Risk Mgmt_ I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 26, 1995 JqiL Deputy OR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (yfj This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 0 — ?,u / 5 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (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: // - 2 r — 19 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 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: //- 9 - /9 9 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator 10-25-1995 09:46AM FROM GENERAL SUCS ADMIN TO 862547 P.02 RYAN & TABOR 1 ALLAN M. TABOR STATE BAR NO. 52846 2 11 Embarcadero west,. Suite 130 ���EI��® Oa land, CA 94607 3 Te ephone (510) 444-5350 4 At orneys for Plaintiff [,OCT 2 5 IM 5 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 6 7 CLAIM 8 9 DO]TALD CLARK, 10 Claimant, 11 Vs 12 COUNTY OF CONTRA CO TA, KALVIN WAYNE 13 R , 14 Respondents. 15 A. Donald Clark lives at 1815 Fifth Street, Richmond, CA 16 1 94801. 17 B. Notices in this matter are to be sent to Ryan & Tabor, 18 11 Embarcadero West, Suite 130, Oakland, CA 94607. 19 C. 'On September 23, 1995, at approximately 6:00 p.m: 20 claimant Donald Clark was a pedestrian at 6th and Market Streets, 21 City of Richmond, County of Contra Costa. At said time and place 22 a Sheriffs car backing up on Market Street struck Mr. Clark 23 w ile he was walking across the street at the corner of 6th and 24 M rket, causing the hereinafter described injuries. 25 D. Injuries : Claimant suffered injury to his head and 26 b ck. 27 E. Damages with respect to this claim. The jurisdiction 28 RYAN b TABOR 1 ATTORNETTS AT LAW DORTOCEUO SQUARE �OARGOERO WEST.SURE 170 GARLAND.CA 94M i%101 A"At10 OCT-25-1995 09:53 1 510 313 7108 97% P.02 10-25-1995 09:46AM FROM GENERAL SUCS ADMIN TO 862547 P.03 rests properly in the Superior Court and exceeds $25, 000 . 00 . 1 2 F. Names of public employees : Kalvin Wayne Rea 3 D TED: October 20, 1995 RYAN a TARO 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 2 AVORNEYS AT LAW ►OROBELLO SQUARE 1 EMBARCADERO WEST.SUITE ISO OAAMD,CA%WT (51014"-&UO OCT-25-1995 09:53 1 510 313 7108 97% P.03 10-25-1995 09:47RM FROM GENERAL SUCS ADMIN TO 862547 P.04 re,sts properly in the superior court and exceeds $25, 000 . 00 . 1 2 F. Names of public employees: Kalvin Wayne Rea 3 DATED: October 20, 1995 RYAN & 4 BX- ma?el- 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 5 TAaOR 2 ATTORNEYS AT uw . PORTOBELLO SQUARE EMBARCADERD WEST.�It1E t�0 �w ...- TOTAL P.04 OCT-25-1995 09:53 1 510 313 7109 9?% P•04 10-25-1995 09:4GAM FROM GENERAL SUCS ADMIN TO 862547 P.01 RYAN &TABOR THOMAS M.RYAN(1930-1877) ATTORNEYS AT LAW SAN FRANCISCO ALLAN M.TABOR PORTOBELLO SQUARE SANTA ROSA it EM8ARCADERO WEST MARINA VILLAGE OF COUNSEL: SUITE 130 ALAMEDA,CA RONALD P.PEROTTI OAKLAND,CALIFORNIA 9 W7 FACSIMILE; (5,0).445350 Harvey (510).44-5398 Ron 51995 p, October 20, 1995i0c�- 1� Mr. Ka in W. Rea 651 Pine Street Martin z, CA 94553 R Donald Clark v. Countv of Contra Costa, et al. Dear MI. Rea: Enclosed please find Notice and Acknowledgement of Service, and Claim in the above entitled matter. Pease }ate and sign one copy of the Nit ice Acknow�edQement and rete a it to us in the envelope we have iprmvid Please turn the other copy and the Claim over to your insura ce carriers so they may deal directly with us on this matted Triank you. Yo ruly, M. TABOR I JAMT:MC cc: CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ,November 28, 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph 1V below), given pursuant to Government Code Amount: $300.00 .. Section 913 and 915.4. Please note all "Warnings". L`% CLAIMANT: Steven Grenberg ATTORNEY: OCTI couNr`CC'UNC F' Date received ADDRESS: PO Box 805 MART IHE/, - BY DELIVERY TO CLERK ON October 21, 1995 Oakley, CA 94561 BY MAIL POSTMARKED: October 26, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. October 30 1995 QQ BaIL BATCHELOR, Clerk w DATED: : eputy II. �WThis ROM: County Counsel TO: Clerk of the Board of Supervisors 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: () ­30 �5 r BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present (d) 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: //— Igo- 19 9.5" 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 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. r Dated:_ BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Clam 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAPiLN'T 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, 1967, 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, 1986, m'.Ist be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action mast be presented not later than one year after the accraal of the cause of action. (Govt. Code §911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If clam 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 ag irst each public entity. E. Fraud. See penalty for fraudulent claim-, Penal Code Sec. 72 at the end of this for.-. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * f * * * * * * * * * * PE: Clam B, ) Reserved for Clerk's filing sta--p ) > RECEIVED ) Against. the County of Contra Costa )or )District) (Fill in n�,e; ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ n rL_ and in support of this claim represents as follows: ------ ---------------------- - ------------------------------------------ 1. When did the daTae or injury occu_^? (Give exact date and hour) ro �!i r1 the C3=&e or i T;�,uryr:C .�.2dP. C ":y sn� n��t� �5. ---������_������ ��= San�r►����__� � C.Gd v 3• How did the damage or injury occur? (Give full details; use extra paper if ..required) L o sS ---0 C&4Lk1----- � �''-�}--- - ----&-a '1__Q_T_�'�lC_�_�_�r-S- �. What particular act or omission on 4he part of county or district officers, servants or employees caused the injury or damage? Y T c) mUG lost �e- IcF� 0 n R DcJ o` U `C t o ril , S(� e e s 5 �� t'►'�O�I d +0 () S C14 ✓1 (over) Nem may-n.,.C� Gfav�( wa-s SPP"I 5. are the nates of co,--;tv or district officers, servants or e=ployees causing the damage or ice'jury? ----- E . Wnat damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. I .4-V lal----- X1 e-L1�-- 7. How was the amount claimed above comp-.:ted? (Include the estimated amount of a. prospective injury or die. ) a_nd att-esse5 of w'tnesses, r'd:�ts.^s and hospitals. ------------------------------------------------------------------------------------ G. -_ 15t the exp-enti tures y---; uc:? on. accc-.-:t of thdi-s accident or inj,,:L^-j Code Sec. 910.2 provides: !; _. P15. ".1'.•'•f°-_ '.i t(i .� c1G:= be s:gne4 by the clainant "'" 1; (r.• c. ty s=-? ers^ on his beh= f." (Claimant's Sig-at u,^e P.D . By. On .5 Aad.^esu le,ep�-cne ?;o. I ?elei^^ne 1;c. 6-/033 S� NOTICE Section 72 of the Penal Code provides: "Every person V,,o, with intent to defraud, presents for allokm_nce 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 thousa_.d (t1,OOC), or by both such imprison ent and fine, or by imprisonment in the state prisc-, by a fine of not exceeding ten- thousand dolls.^s ($10,000, or by be hsucy i�" ^ so_int and fine. ` �r- 71717, /z:H FZ F/UY at SPEEDY we care ammopuffla ek1 nWLZ �fa1'%<8 W Fax: 51"85-9075 CONTRACTOR LICENSE het 11 STATE SALES TAX # 9696 t311� � 43' ACCOUNT AGENT I PURCHASE I DATE iia-1 s-9' ! a u c3—r ta NO.: I NO.: I ORDER NO. CUSTOMER STATE TAX OR EXEMPT NO. CUSTOMER FEDERAL TAX I.D.NO. SOURCE SALESMAN I.D. ORDER TAKEN BY INSTALLED BY FEDERAL TAX I.D.NO. 10 BILL TO: ST¢+VEN* GR ENDERG SOLD TO: PROOFINSURANCE OF • INSURANCE CO. POLICY NO. INSURANCE CO. ' PHONE NO. CLAIM NO. CAUSE R POLICY NAME LOSS LOCATION AGENT NAME VERIFIED BY AGENT PHONE DATE OF LOSS DEDUCTIBLE VEHICLE INFORMATION NAME MODEL YEAR DOORS ODOMETER LICENSE VEHICLE I.D. NO. My Pa t 0 Q >: Baty Desc i taeon Unit Price Not I PCK-59 -89-H .Precision Clip Package 11. 87 11. 8-1 1 WFT 598 C Windshield Fillet, "rop 31. : 4 31. 24 •tt•�•���`•��•�•�•�••�••�•��•�•��•3s••�•�••a•3t•a���t••�•�•`�•w•�'?c��-`if•�•��•�t•�.•t�•�••s�••�7��s�••�>�a�•�•::t••�•u.•aa••�•��•�e�•;�••t��••t��••�••x••�•�c••��s.n.?i��••:� T H I S 18 N U 7 A R E i: E I P T 1D 0 irk! 0 T P A Y. •ib•k�d4•�••'s'r 3E•a`F 3F 33•sk�3r•#••!':vf••3e•:'e•33•�•h•ti$•tiS•`>Z•�•#�••+k:'#•',E3f••�•.�•3r.•;ti"•M•?3`�"•Xr•?€••#'s•3b C•C�3`;••�•••ifr�r•�•�•#••?•",•�,•�••iS-i;•.?F•'?{••::••ff•��`!••�•3r��Crt••S¢�,•9i••3t•3I•{;•�;•.S••A� WORK AUTHORIZATION I hereby authorize the above work to be done together with the necessary material, but request that you contact me if the cost of the services exceed the amount reflected on this invoice. STATE OF WINDSHIELD ❑ NOT REPAIRABLE/REPLACEMENT NECESSARY ❑ REPAIR TRIED AND REFUSED BY: ❑ DAMAGE IN CRITICAL SIGHT AREA ❑ OWNER ❑ THE REPAIRMAN ❑ REPAIRABLE— REFUSED BY OWNER AUTHORIZATION TO PAY I hereby authorize and empower the above-named insurance company 'to pay this invoice in full settlement,satisfaction and discharge of all loss under the above policy. Upon such payment,all rights I may have for claim and demand for loss and damage described above against the above named SkAbt(it e?1 280. 49 insurance company shall be thereby forever discharged. In the event.that the above named insurance ��, a company does not make timely and/or full payment of this invoice according to its terms, I hereby accept 8• u,515. T63 X 19. 84 responsibility for such payment and agree to pay all charges reflected on this invoice to Speedy Auto Glass subject to and according to all terms and conditions on the reverse side of this invoice. F11�11�1"11111!1 TERMS Ca Sh 39. 33 7PNET 30 DAYS,SERVICE CHARGE OF 11x%PER MONTH(18%PER ANNUM)WILL BE CHARGED ON OVERDUE ACCOUNTS. • $ TRANSACTION IS SUBJECT TO TERMS AND CONDITIONS ON REVERSE SIDE .2�C--' Z 02� a .-r Lei (="I21 a FR 1B M 4--.p a_.F� V 6:24 F ID a lu CD ACCOUNT AGENT PURCHASE DATE NO.: NO.: ORDER NO.: 08-14-9�� OJ1�.� I CUSTOMER STATE TAX OR EXEMPT N0. I CUSTOMER FEDERAL TAX I.D.NO. ADV.CODE SALESMAN I.D. [ORDER TAKEN BY INSTALLED BY FEDERAL TAX I.D.NO. .565--98-8723 BILL TO: SOLD TO: STEVEN GREENBERG P 0 BOX 805 OAKLEY, CA. 94561 Hm o 684--335E PROOFOF • INSURANCE CO. POLICY NO. INSURANCE CO. PHONE NO. CLAIM NO: CAUSE& POLICY NAME LOSS LOCATION AGENT NAME VERIFIED BY AGENT PHONE DATE OF LOSS DEDUCTIBLE d VEHICLE INFORMATION MAKE Toyota MODEL Pickup YEAR 1994 DOORS v ODOMETER LICENSE VEHICLE I.D. NO. Oty Part Color Kit Labor List Sell Met 1 FW598 ' Green/Plate 7. 95-1U W/Dam 3. 5 Hr, 30. 00 535. 05 197. 97 235. 92 Oty gDescri tion s Unit Price Net 1 WFT 59� C Windshield Filler Top 31. 24 31. 24 AUTHORIZATION TO PAY 7hereby authorize and empower the above-named insurance company to pay this invoice in full settlement,sat- and discharge of all loss under the above policy. Upon such payment,all rights I may have for claim mand for loss and damage described above against the above named insurance company shall be thereby forever discharged. In the event that the above named insurance company does not make timely.and/ S Lt bt o t a 1 267,16 or full payment of this invoice according to its terms,I hereby accept responsibility for such payment and agree ` 8. 25% Tax 19. 57 to pay all charges reflected on this invoice to the above named glass company subject to and according to all terms and conditions on this invoice. TERMS TOTALCheck 286.73 TERMS:PAYABLE ON THE 10TH OF THE MONTH FOLLOWING PURCHASE,SERVICE CHARGE OF 1'/x%PER MONTH(18%PER ANNUM)WILL BE CHARGED ON OVERDUE ACCOUNTS. C4 P o � 41� � G UO p �L r CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November >, 1995. Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action, All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: 1 Million Section 913 and 915.4. PIe �6_gzgs". CLAIMANT: Cindy Lea Guthrie ATTORNEY: COUNTY COUNSF Date received MARTINEZ Gi, ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON October 19, 1995 Room 423 Martinez, CA 94553 BY MAIL POSTMARKED: October 17, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 26, 1995 EVIl Dep�tyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (v'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: Dated: /b - ;t a BY: — �--- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present , (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: / - - /9 9 PHIL BATCHELOR, Clerk, By%. - ii teC_4AAJ�J44), 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: //-a2 9 - /9 9.S_ BY: PHIL BATCHELOR b eputy Clerk XV CC: County Counsel County Administrator Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. �w INSTRUCTIONS TO CLAIr'r'ILN`T 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, 1967, mast 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, 19016, 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 accrua.1 of the cause of action. (Govt. Code §911.2.) J 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. ` :F��i• -jd. see pe:a.'Ly ib.^'YYau Lile:i: s^.!..._ r� 1 .1 W—de ►9eG: (L at `i;ne Cii� O1 1J RF: Claim B;,, ) Reserved for Clerk's filing stamp ►, 1 a 10.E Cr > RECEIVED ) Agairr.,-tthe County of Contra Costa ) OCT 1 9 1995 r CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. (Fill in na_:,e, ) . The undersired claimant hereby makes claim against the County of Contra Costa or the above-nz'-ned District in the sum of $ and in support of this_claim-represents-as-follows: 3 .1. When did the damage or injury occur? (Give exact date and hour) - -- ------------ 2. her-%: die, the damaa&e L%- llQurY OCCuj ---------- ------ 3• 'How did the damage or injury occur? (Give full details; use extra paper if required) o� !� � c\�- S-a&V\Qg". 1.., --- ------------------------------------------------------------------------ 4. Wha*., par60 ticular act or omission on the part of county or distriet .officers, servants or employees caused the injury or damage? (over) 5. vast are the na=,2s of county or district officers, servants or employees causing the d=_.:.are or injury? �- ----------------------------------------------------- r E. Wn=t da:.age or injuries do you claim resulted? (Give full extent of injuries or da=ages claimed. Attach two estimates for auto damage. - d 7. Hou yrs the amount claimed above comY'.:ted? (Include the estimated amount of-ar.., prospective injury or dame.) aFIN- ; � < Nkk » _ c_®� --------------------------------- ----- and atfresses of witnesses, d:^t:^s and host:..cl s. -2u�"� �® O ` C� 9. list the y, .i =a=e o' c-�_�'�:t of th:i` accident or in.--x—y: G_v. Code Seo. 910.2 provides: be s:gned by the _�2.. �r -e• c^ `�• s.-'e ers� on his be- _f.n A_- -_,-Ess of ryn ClaiWnt.ls Sigr%ture Ad:^ess Lt_'S_5 ^ w� �e:ePn e n2. ZA. I Telephone NOTICE Section 72 of the Per,:- Code provides: "Every person with intent to defraud, presents for allour nee 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, acco:r:t, voucher, or writing, is punishable either- by impriso=ent in the county jail for a period of not more than one year, by a -fine of not exceeding one thousand (t:,0'00), or by both such im-mison ent and fine, or by imprison-pent, in the state prison, by a fine of not exceedi g ten thousand dolls.^s ($10,000, or b�y . ',-"h .�,•:� lmprao.:r?.'.. Gr.d' fide• 4 P �mF� � C LX C&O _. -AD �4 Nov A 7A-L )-ax k ATI-SNO 6 5(N PILOIQ c en ch < ;%o A t Flo w O t � (i Wool L e , t vf � t s ll - F' _ _—!J_LL--��._;`_ -`_�����:__. . �wr .�l����i-�i._Y���� __ __ w _� ���.�-..__� .�iii✓' �-�_..-`11�14— f ✓1 J /r w „ L U s� t F i c `+ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA — a _November , 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursnt to Government Code Amount: $25,275:00 .+ Section 913 and 915.4. Please CLAIMANT: Mark Hefner aka Mark Lew Krywonis OCT 2 6 1995 ATTORNEY: COUNTY COL 11V received IWARTINEZCA�SFL ADDRESS: 146 Maureen Circle BY DELIVERY TO CLERK ON �r-rnhPr ? � l AA5 Bay Point, CA 94565 BY MAIL POSTMARKED: Hand llalivorarl I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH 6g DATED: October 26, 1995 BIIL Deputy OR, Clerk II.. 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: Io -ZC. BY: 0`—� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (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: HIL 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 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: //. 9 /9 9.S BY: PHIL BATCHELOR by _,4�eputy Clerk CC: County Counsel County Administrator . - C_laim�: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be fiied agairu3t each public ea iL! y. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this RE: Claim By ) Reserved for Clerk's filing stamp ECEIVE® R 1. ew kK irlwmAjISt�urr�- Against the County of Contra Costa ) OCT 2 51995 or ) RV District) CHER CONTRACOSTA CO.ISORS Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sumo $ and in support of prA.V. this claim represents as follows: M�VN/r-;y� EXEitl�b�, ' Di¢ 5 rte. 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) F©,t6R-9.s'/L E To& 11"4t>/ (>.v/r /O 1�vc, -�4S I��,; /LID, AlArTl�Z 3. How did the damage or injury occur? (Give full details; use extra paper if required) ,�fVAJrI J&OaO j F'-I�Q�C1 Dl.9S E T1�f��tJ� 9�f�� �j�411r DC9S p�Lclslf��.'s 4r /C_ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? sG [?. SFS lE�f�i` TDt�H�tl�f1 S�ej¢ SDI� Co1�1�IN� /�� yST /MV!/'OLUEM�it�T W11N H114 VAJ r /�•V� Y-w S7-eFl Oil 7f"M�E IFn*6;1JS1C Moir,.0,1 �W1-hY G11,11T M Ott Gib>002S -b6;72z,!5/oNS op-AiD AIZE pa,&:e (9�o 14/j5F! (over) TO 111JLF4CCD 5. What are the names of county or district officers, servants or employees causing the damage or injury? PATXIC& bwY6r;�, 11061/ WIIJA�l AC7 Flin&- ^Jb Orlym- s7-AFV r 7N��v, s�� Micsr ' U�fT• .Sri OF ,qj5F- py29vix .5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. �. 4 Or TiMEf Goss© .&7A-)M0Vrre-X177-1lE, HE.V7idG A�v�u�isflj T/AvTRN-SS J _ S i �I � 1�/5 CDAIS o �___-_ --- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) , v'�qLL-'5 d� 3 H oo s r--er D,*� �T #�D ae'pw�r- 11-00rz X S-2- ` (oj2,e0 X ko 72-0 -/: )C /1�eA.) *L� naxcWL FH�,Sx.4-4 1A):59)rY 8. Names and addresses of witnesses, doctors and hospitals �Az'� qCo est'. _ G�4 9 ' _-----------_�_�__��-------------- --------- 9. List the expenditures you made on account of this accident or injury: ' 4 (fDATE IpT�EM AMOUNT f��>�gSyX/ SZ= i9 �0 z/4 PWO "t• b Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES..TOi"- ?(Attorne )�=r or b some er on, his Name and Address of`Attorney� _ s Signature 17c Address Amy Ppma, dif 41,15-65- Mel 9J 8Z, 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 ($10,0009 or by both such imprisonment and fine. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 'November fib+, 1995' Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $713.51 Section 913 and 915.4. Please note all °Warn_ings". CLAIMANT:Phil Groman for Meadow Wood Apartments ATTORNEY: OCT 2 6 1995 Date received COUNTY COUNSEL ADDRESS: 3205 Northwood Dr. , #101 BY DELIVERY TO CLERK ON 091e8N9ZN ,L1Fi995 Concord, CA 94520 BY MAIL POSTMARKED: October 18, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH BATCHELOR, DATED: October 26, 1995 BYIL Clerk II. 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 — - �/ S BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. n Dated: JZ-,L18— 199y5 PHIL BATCHELOR, Clerk, By 4dl�f„� . , , Deputy Clerk ff 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:_/J aZ 9 — /995. BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator C'1a:M -o: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this for= � * !t *y* RE: Claim By ) Reserved for Clerk's filing stamp Q✓��/`�A'L5� j RECEIVE® P G ro ria.:... Against. the _County., of .Contra.Costa. . . .) __T 1 9 1996 ,; or _ or ) CLERK BOARDOF SUPERVISORS District) CONTRA COSTA CO. Fill in name) . ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 7/ 3 . 5'/ and in support of this claim represents as follows: 1. When did the damage or injury occur? "(Give exact date and hour) U — S @ 760 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) VeIr " _ ' ly� PYT 4. What particular aet'or omission on the part of county or district officers, servants or employees caused the injury or damage? , V�.^ D. wnat are the names of county or district officers, servants or employees causing .he a -ge or injury? V Pr youliresle (Giye6, -What damage-or injuries do m of li 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.) $. Names and.-addresses of witnesses, doctors and hospitals. ;9. List the expend itures•youu: onx.account of..this,ace ident-.or,_injury: DATE- ITEM, '� AMOUN .*._*_1f �F. !F_ , m Gov. Code Sec: 910:2-prov.ides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on is behalf." : Name and Address:_of_.Attorney - Claimant's Signature A s 7 Is Telephone No. Telephone No. �r * * * * , N O T I C E Section;72 .of.the.Penal_ Code..provides: "Every person',who,'F'with.:.intent to: defraud,_,.presents for allowance. or for ;payment_to any state board..or, officer.,...or=lto-any. county, city.or .district board or ;office r, 'authorizede,to allow or_pay the_same if genuine, any,.false or fraudulent claim, ,bill' ;account, 'voucher, or writing, is punishable either by imprisonment in fthe`county jail' for a period of-not- more than. one--year,---..by. a-fine of--not exceeding. 4one thousand ($1,000), or by both""-such- imprisonment 'and'.1ine or`bye}imprisonment in the. state prison, by a" fine of not exceeding ten thousand dollars (tid,Ooo; or by both such "i:�risonment and fine' 10/17/1995 14:00 5106768163 P PAGE 01 co Estimate 1 3 a9 Sold To: MeadowWood Apt.'s `'°°"�"` " Rater Date 10/17195 3205 Northwood Dr., Ste. 101 Latest Revision 10/17/95 Concord CA 94520 Phone---(510)-676-8910 FAX: (510)-676-8163 110 2nd Ave So C-5; Pacheco; Ca. 94553-5551 Due: FAX 685.5122.Fax.._ . . _ -..__,._ _ -MeadovM*Apt`syEL.PACHECC Jobsite:` Job 685.5944 Phil 3205,Northwood Dr Ste_ 101 Office 685.5090 Ann Cogcord CA 94520 'Hi T- U54 Dull Brass LH RM ®oro QFy poor Size & Type Jamb sill Casing Type- 1'5/8 Bevel fli-unrnitred $7.841 A —._..._ i3 r C 1 b9 1 31ox618xt--314 SC PC 7-1/4 Ext f/i Kerf 170d J=5.112" $212.3 D -_._.—.... -- E F --------�- — G poor Size &_Type liamb 51tt L — N (J _ P --- Q — - - I T V _........_..__ X ------M--- �� ZI ' I; AAi --! Ad oox. oly ~-- I Re-use Exterior Trim_ r I Re-install Existing Locks Bore instructions- 6"-CL LaboQ2 Paintingm_ DIB- 2-318 6S, 2-1/8 Bare i Keyed Set=5' BS, 2.118 Bore Su4 Total $228.51 , Date. Ck No Capt Ne Cash .Tax $0.0 lobar $260.00 T. _ -:Labor-2 00 Approved Recelvee: Dal TOTAL 71$.51 CHECK THIS LIST CAREFULLY, as these are the materials.you are ordering. This list supercedes all 1 first pmt. previous lists and blueprints, No returns on special orders and machined items.Restocking charge of Rich baiance 20%will be added for all resealable iterns returned. Sun Valley Doors retains ownership of materisis listed last prnt hens untillmens in full has been eceivr�d. PLEASE READ REVERSE SIDE FOR ADDITIONAL CONDITIONS. pay balance o �v b Ilk Cl `J g J5 ,a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA ;November 28, 1995 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $50,000.00 :,.SEcti-on 4'a and 915.4. Please note all "Warnings". CLAIMANT: Dennis A. Morrill ATTORNEY: Mark A. McLaughlin, Esq. N� UNTY voisst 2211 "A" Street �eZ NEdatg recei ved ADDRESS: Antioch, CA 94509 MAFITINF"i BY DELIVERY TO CLERK ON Novemher 1 , 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. DATED:November 1, 1995 JqiL Deputy OR, Clerk d II. 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: 1� - - 5 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: //- 1X- l 9 9S' PHIL BATCHELOR, Clerk, B , Deputy Clerk MEOW 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: /�- a..9 - /cJ y,5- BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claim 3;o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. INSTRUCTIONS TO CLAIMANT A'':►_Clams relating to causes of action for death or for injury to person or to per- sonal property or gmwing crops and which accrue on or before December 31, 1957, 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, 1958, 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 §711.2. ) 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 ore public entity, separate claims must be filed agairz t each public entity. E. Fraud. See penalty for fraudulent claims, Penal Cade Sec. 72 at the end of this RE: Clair_ B ) Reserved for Clerk's fil'ng stamp DENNIS A. MORRILL ) ,p, RECEIVE® Against the County of Contra Costa ) or ) District) pil�iC SUPERVISORS (Fill i n na_.e, ) CONI COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or, the above-named District in the sum of $ 50,000.00 and in support of this claim represents as follows: 1. when did the damage or injury occur? (Give exact date and hour) May 4, 1995, at 7:55 p.m. 2. Where did the damage or injury occur? (Include city and county) On cement walkway outside 500 School Street, Pittsburg, CA 94565. Photo of scene attached --------------------------- - 3. Hoy: did the damage or injury occur? (Give full details; use extra paper if required) Claimant who was attending a class at scene exited building, walked down a small stairway, then 'he stepped on a section of cement walkway which was cracked causing him to slip and fall to the ground sustaining the injuries complained of herein. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? The County which is owner of the premises maintained a dangerous condition on public property because a section of the walkway was cracked and upraised by many inches over the adjacent section of the walkway. (over) I 5. Vast a^e .the names of couray or district officers, servants or eWployees causing"the d.an=ge or inju."'y? 1� Unknown F.1,nat da-mage or injuries do you claim resulted? (Give full extent of injuries or damages"claimed. Attach twD estimates for auto damage. Severe sprain of left ankle 7. How wrs• the amount claimed above co=p--,ted? (Include the estimated amount of a:-,-.- prospective -.•:prospective injury or da=me. ) Claim based upon medical expense, pain & suffering and residual effect of injury �,. r_es an^ aofaresGes of witnesses, doctors anf hospitals. Treatment at Kaiser Hosp' 11,Martin 4, California Sean Kriegg, !W Ce ser �ircle, Antloch CA 94509, phone 754-6604 Witnesses: Chris Luths.n, 4843 South Place, Byron, GSA 94514, phone 516-7746 Cesar De LaPapa, 773 Olivewood Drive, Pittsburg, CA 945651 phone 432-4313 G List the n- _t'�^es :--. - _ c`V. n c n15 cc ent n, r•-! exY y .:.:_ o:: a :� c. t a id or. i.:=�i ^^— IT: het T _ 3 : tS'pAA�tl}[j}�a.K6'RflA. 4Dkk4t. vx1 1 .xv..ggw:IVtCI•w.nf}'a4y�µq� 330 i?I } Code Se=. 910.2 provides: °1','BuID10VIRAOd '!,t -' c1,a:= t=��: be sig-ned b '. the c1al::�,t �cik:-=s E J ' . '� c���� s^- pers= on his be' _f. Mark A. McLaughlin, Esq. Claimant Is Jjkmx Attorney ch Street Ant Dennis Morrill, ch, CA 94509 Antioch, CA 94509 ,ed 'ress Te:ephone K:�. (510) 754-2622 Tele-)-ore ho, (510) 757-4064 # # # # # # # # # # # # # # # # # # N 0 T I C E Section 72 of the Penal Code provides: ",very person a�:o, with intent to defraud, presents for a.Ilokance or for pay=ent to any state board or officer, or to any county, city or district board or officer, authorized to allo» or pay the same if genuine, any false or fraudulent claim, bill, acct t, voucher, or uTiting, 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 (t' N`11 , or by both such imprison"ment and fine, or by imprisonaent in the state pr.-Ls--n, by a fine of not exceeding ter: thousand dolly^s ($10,000, or by bc:,h s': i+-- .,isor_-y^t :d fine. • { i I S F lQfk S' i p i �v Gk•�CTi� 4G �'����iAt i. Mme.. i lz 'i-r.: ice, ,+�'. 3 "" ;ate��+ ,•4 - . in S C , Al CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 28, 1995• Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $11,000,000.00 Section 913 and 915.4. pyftIEat s". CLAIMANT: Rick Edward Payne OCT 2 6 1995 ATTORNEY: Alexander V. Choulos, Esq. COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 1701 Franklin St. BY DELIVERY TO CLERK ON October 19, 1995 San Francisco, CA 94109 BY MAIL POSTMARKED: Interoffice Mail 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 26, 1995 JdIL Deputy OR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Vr 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). (Vk Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( } Other: Dated: I a Zc.a - BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: HIL BATCHELOR, Clerk, By Amw of Deputy Clerk fiNq 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:- BY: PHIL BATCHELOR b� PDeputy Clerk CC: County Counsel County Administrator DECEIVED TORT CLAIM AGAINST THE County of Contra Co to OCT 1919% CLERK BOARD OF SU13ERVISORS 1. CLAIMANT'S NAME: Rick Edward Payne CONTRA COSTA CO. 2 . CLAIMANT'S ADDRESS: 1281 Pine Creek Way #A, Concord, CA 94520 3 . AMOUNT OF CLAIM: $11, 000, 000. 00 HOME PHONE: (510) 827-9866 WORK PHONE: (510) 933-7670 4 . ADDRESS TO WHICH NOTICES TO BE SENT, IF DIFFERENT FROM LINES 1 AND 2 : Alexander V. Choulos, Esq. , Choulos, Choulos & Wyle, 1701 Franklin Street, San Francisco, CA 94109 5. DATE OF ACCIDENT OR LOSS: April 15, 1995 TIME OF ACCIDENT OR LOSS: 17 : 05 hours 6. LOCATION OF ACCIDENT OR LOSS: I-680 Southbound, . 5 mile(s) north of South Main Street in the City of. Walnut Creek, County of Contra Costa, California. This shall be called the "accident site" . 7 . HOW DID ACCIDENT/LOSS OCCUR: This accident occurred on the above date at or about the above time when claimant Rick Edward Payne, a tow truck driver in the course and scope of his employment, was dispatched to an accident scene at the accident site. He parked his vehicle and was in the process of removing the tow dolly when he was struck from behind pinning him between his tow truck and the left side of a fire truck owned and operated by the Contra Costa Fire District. At the time of the accident, Joe Bob Schmidt was driving an Automobile registered to Katheleen Dudgeon southbound on I-680 Due to the defective and dangerous condition of the public property at the time of the accident, driver Schmidt was caused to lose control of his vehicle and was caused to crash into the tow truck, causing multiple, permanent and severe injuries to claimant Payne as set forth more fully herein below. Claimants' injuries were legally caused by the dangerous condition of public property which existed on the date of the accident at the above mentioned location. The dangerous condition created a reasonably foreseeable risk of the kind of injury which occurred to Claimant; and the dangerous condition was created by a negligent act or wrongful act or omission of an employee the County of Contra Costa, acting within the scope of that employment. Further the County of Contra Costa had actual and/or constructive notice of the dangerous condition a sufficient time prior to the accident so that measures could have been taken to protect against the dangerous condition. Claimants are presently unaware of the exact identity of the State employees involved and therefore will name them fictitiously as DOES in the subsequent complaint. Claimants' believe that the County of Contra Costa were responsible for the design, operation, construction, repair and maintenance of the dangerous condition of public property at this location. Claimant's are unaware of the exact identity of those persons or entities who designed, operated, constructed, repaired or maintained the dangerous roadway and therefore will name them fictitiously as DOES in their subsequent complaint as well. At all relevant times, this roadway, namely I-680, constituted a public highway within the City of Walnut Creek, the County of Contra Costa and the State of California and Claimant believe that the County of Contra Costa owned, controlled and operated the roadway in question at the time of the accident and/or at all pertinent times. The dangerous condition of the roadway created a reasonably, foreseeable risk of the kind of injury which was actually sustained by claimant. The County of Contra Costa either negligently or wrongfully created this dangerous condition or had actual and or constructive notice of the dangerous condition a sufficient time prior to the injuries to have taken measures to protect against the dangerous condition or warn of the dangerous condition. Among other things, the roadway was in improperly designed and/or in disrepair and was inadequate and/or poorly maintained so that the roadway would flood to the extent that it caused drivers to lose control of their vehicles. Further, drivers on I- 680 southbound had inadequate warning of flooded conditions of the roadway. The dangerous condition consisted of improper care, maintenance, repair, and/or design of this roadway and the regulatory and warning signs thereon. . This dangerous condition created a "trap" to users of the roadway. The dangerous condition was a .con dition that created a substantial risk of injury when such property was used with due care and in a manner in which it was reasonably foreseeable it would be used. Furthermore, the County of Contra Costa negligently failed to post proper warning signs, signals, markers, etc. warning of the dangerous conditions so that a concealed trap existed on the above mentioned roadway. Furthermore, when they had actual and/or constructive notice of the dangerous condition of the roadway and the likelihood and/or possibility of serious accidents, the County of Contra Costa negligently failed to repair, ameliorate or provide adequate warning against the dangerous condition so that accidents and injuries to .motorists would not occur. All of the above acts and/or omissions directly and legally caused claimants multiple, permanent and severe injuries as set forth in this claim. The full nature and extent of claimant's injuries are presently unascertained however, they are certain to exceed the jurisdiction limits of the Superior Court of California. Further, Claimant's accident and subsequent injuries were legally caused and/or attributed to by the negligence of the Contra Costa County employees, who caused or contributed to the dangerous condition of public property as well. Such Contra Costa County employees had the authority and funds available to take other action which would not have created the dangerous condition and/or the employees had actual or constructive notice of the dangerous condition a sufficient time before the injury to take sufficient measures to protect against the dangerous condition and had the authority and duty to take such measures at public expense with funds and other means immediate available to them. Furthermore, Claimant is presently unaware of the exact identity of the State involved and therefore will name them fictitiously as DOES in his subsequent Complaint. Claimant believes that the police officers at the scene of the accident failed to act as reasonably in that they failed to adequately warn of a dangerous condition of the public roadway i.e. the previous accidents and the flooded condition of the roadway. Further, the County employees failed . to warn Joe Bob Schmidt of the previous accident which caused Claimant to be on the roadway at the time of subject accident. Further, the County employees negligently failed to properly guide and/or direct and/or control traffic on I-680 at the accident scene so that Claimant's injuries could be avoided. Further the County employees negligently failed to properly manage, direct and control the accidents scene to which Claimant responded. All of these negligent acts or omissions caused and /or contributed to claimant's accident and injuries. All of the above acts and/or omissions directly and legally caused claimant multiple, permanent and severe injuries as set forth in this claim. The full nature and extent of claimant's injuries are presently unascertained, however they are certain to exceed the jurisdictional limits of the Superior Court of California. 8. DESCRIBE INJURY/DAMAGE/LOSS: Multiple, permanent and severe injuries including, but not limited to, a fractured pelvis and puncture wound to the lower left abdominal area, and other injuries not presently diagnosed. 9 . NAME OF PUBLIC EMPLOYEE (S) CAUSING INJURY/DAMAGE/LOSS, IF KNOWN: Unknown. 10. ITEMIZATION OF CLAIM: Personal injuries, $5, 000, 000. 00 for pain and suffering. Special damages for past and future medical expenses and wage loss $ 6, 000, 000. 00. 11. SIGNED BY OR ON BEHALF OF CLAIMANT: DATED: October 13 , 1995. CHOULOS, CHOULOS & WYLE B ALEX NDER V. CHOULOS Attorney for Claimant 1 PROOF OF SERVICE 2 3 I, the undersigned, declare: 4 I am employed in the City and County of San Francisco, 5 State of California. I am over the age of 18 and not a party to 6 the within action. My business address is 1701 Franklin Street, 7 San Francisco, California. 8 On the date below I served the foregoing document 9 described as TORT CLAIM AGAINST THE STATE OF CALIFORNIA; COUNTY 10 OF CONTRA COSTA; CITY OF WALNUT CREEK in this action by placing a 11 true copy of same in a sealed envelope with the correct postage 12 thereon in the United States mail addressed as follows: 13 State Board of Control Government Claims .Program 14 P. O. Box 3035 Sacramento, CA . 95812-3035 15 City Clerk of the City of Walnut Creek 16 P. O. Box 8039 Walnut Creek, CA 94596 17 Administrator's Office 18 County of Contra Costa P. O. Box 911 19 Martinez, CA 94553 20 I declare under penalty of perjury that the foregoing 21 is true and correct and that this was executed on October 13, 22 1995 at San Francisco, California. 23 24 Marilyn usaly r' 25 26 27 28 LAW OFFICES OF GEORGELIOS .CHOULOS CHOULOS CHOULOS CHOULOS � WYLE GEORGE V.CHOULOS ) LM OYORK OFFICE C LAUDE A.WYLE ALEXANDER V.CHOULOS 1701 FRANKLIN STREET REST OUEENS BOULEVARD STEPHAN V. CHOULOS SAN FRANCISCO CALIFORNIA 94109 FORR EST HILLS,^NEW YORK 11375 JAMES V. CHOULOS I'ig5 OCT I b nTE� 124�U 1793-1331 (415) 474-7800 j"� VVV MANILA OFFICE N, 3t[{12 `8,U`P.�_F :,,kRINO BOULEVARD STPPH�,':. MALATE METRO MANILA PHILIPPINES RI RICHARD M. CREDITORt October 13 1995 CONRAOO R.AYUYOA� , - t NY 6 D.C. BAR FAX:(415) 474-073��. PHILIPPINE BAR .IV ED Administrator's Office County of Contra Costa P. 0. Box 911 OCT 191995 Martinez, CA 94553 CLERK�O N-T ARD OF COSTA Re: Rick Edward Payne Dear Sirs: Further to telephone conversations of this date, we are enclosing an original and two ocpies of TORT CLAIM AGAINST THE COUNTY OF CONTRA COSTA, with PROOF OF SERVICE. We ask that you file this claim and return a file endorsed copy to this office in the enclosed, self-addressed envelope. Should you have any questions regarding this claim, please contact this office immediately. Thank you for your assistance. Sincerely, CHOULOS, CHOULOS & WYLE f 4ar all Secretar" to Alex der V. Choul s Enclosures c . al APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COMM, CALIFORNIA _November ?0 1995 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimant: Michelle Jones Attorney: Lionel K. Hvolboll OCT 2 6 1995 COUNTy Address: 1237 Castro Street RT N��CENS ` �L Martinez, CA 94553 Amount: Unknown By delivery to Clerk on October 25, 1995 Date Received: October 25, 1995 BY mail, postmarked on - Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: October 26, 1995 PHIL BATCHELOR, Clerk, By Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). ( ✓) The Board should deny this Application to File Late Claim (Section 911.6). DATED: a - -2 c- -9 S VICTOR WESTMAN, County Counsel, By eputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( )) This Application is granted (Section 91.1.6). This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: aX- 19 4 S' PHIL BATCHELOR, Clerk, By Deputy WARNM (Gov. Code 5911.8) If you Wish to file a oourt action on this matter, you must first petition the appropriate oourt for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the oourt Within six (6) months from the date your application for leave to present a late claim Was denied. You may seek the advise of any attorney of your choice in oonnection With this matter. If you Want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Boar TO: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance With Section 29703. DATED: H- 91- /99Sr PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrate TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM LIONEL K. HVOLBOLL Attorney at Law 35372 1237 Castro Street Martinez, CA 94553 Tele: 510-228-8437 FAX 510-228-5139 RECEIVED Attorney for: Claimant, Michelle Jones , o�ln�e,ad_ fT 2510 CLERK NO AND OF SUPERVISORS CONTRA COSTA CO. CONTRA COSTA COUNTY BOARD OF SUPERVISORS In Re: ) The Claim of Michelle Jones REQUEST TO ACCEPT'LATE CLAIM a It was intended to file this claim, together with the claims of Naomi Jones, Garrett Jones and Michael Covey all together. I was informed by your clerk that inadvertently there,were two copies of the claim of Naomi Jones, which was entitled "The Claim.of Michelle Jones on behalf of Naomi Jones", for the reason that Naomi and Garrett are both minors. This was what can be termed a clerical error, and request is hereby made to accept the claim of Michelle Jones filed on her own behalf. As you can see, the correct claim was filed very shortly after the clerk . informed me of the error. Page 1 2 have just received the letter from Shirley Casillas requesting that I make this request of the Board. Her request is dated Thursday, and.I am filing this request on the following Dated- October 23, 1995 Lionel K. Hvolboll Page 2