HomeMy WebLinkAboutMINUTES - 12101996 - C.6-C.8 0 .�
CLAIM
BOAR: Or SUFER�iSCFS 0' CON-":: S'A COUNT, CALIFORN:A December 10, 1996
Claim Against the County, or District governed by) BOAR: A:71ON
the Board C' Supervisors, Routing Endorsement$, ) NOTICE TO 4 AIMANT
and Boa-: A:tion. All Section references are to ) The copy of this document mailed to you is your notice of
Califorrii Government Codes. ) the action taken on your claim by t r +�
(Paragraph IV below), given pursuanoYFr�imenC
Amount: $20,000.00 Section 913 and 915.1. Please note all ^Yarnsqs^
Nov 0 V 1996
CLAIMANT: Bich Phuong COUNTY COUNSEL
MARTINEZ CALIF.
ATiORNEr: Law Offices of Walter R. Huff
Date received
and Associates November 1, 1996
ADDRESS: 1215 W. Imperial Highway, Ste. 2258r DELIVERY t0 CLERK ON
Brea, CA 92621 BY NAIL POSTMARICEO: October 29, 1996
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED:
November 4, 1996 V}l LATpuVyLOR , Clerk
11. FROM: County Counsel TO: Clerk of the Bard o1 Supervisors
C>,I 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 Bard cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clerk should return claim on ground that it as filed late and send
warning of claimant's right to apply for leave to present It late claim (Section 911.3).
( ) Other:
Dated: / �!� BY: iLC G(l �/ Deputy County Counsel
111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(�) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this date. y
loud: DEC 10 1996 PHIL BATCHELOR. Clerk, B)—��a R �/1 O . Deputy Clark
YARNING (Gov. code section 913)
Subject to Certain exceptions, you Mve only six (6) =nth& from the data this notice was personally served or
deposited in the mail to file A court actiah 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 ant to Consult
an attorney, you should do so immediately. + For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF 101AILING
I declare under penalty of perjury that i am now, shd at all times herein mentioned, have been A citiyen of the
United Stites, over age 18, and that today I deposited in the United States Postal Service in Martinet,
Glifornia, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to
the claimant as shhorn above. (( 4q (�
Dated: KC It
p 1t BY: PHIL BATCHELOR by�Jya v Deputy Clerk
�—z
CC: Crunty Cc,,se Court) Admim strator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
Clair_ to; BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY C"
INSTRUCTIONS TO CLADIANT
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. Claim 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.
RE: Claim By ) Reserved for Clerk's filing stamp
BICH PHUONG ) RECEIVED
)
Against the County of Contra Costa j NOV 11996
District) CLERK BOAR0 OF SUPERVISORS
Fill in Tame ) CONTRA COSTA CO. _
The tmdersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 20 ,000 00 _ and in support of
this claim represents as follows: medical special damages and general_damasBs
1. When did the damage or injury occur? (Give exact date and hour)
July 2 , 1996 at about 10 :05 a.m.
2. Where did the damage or injury occur? (Include city and county)
City of Pleasant Hill, Contra Costa County
I-680 freeway north-bound approx. .35 miles north of Monument Blvd.
3• How did the damage or injury occur? (Give Hall details; use extra paper if
required)
See attached Traffic Collision Report No. 7-17
4. What particular act or omission on-the part of county or district officers,
servants or employees caused the injury or damage?
Violation of California Vehicle Code Section 21658 (a)
d
,., ,. ,_ - �s,w•... �v S �"�.����s�;•+;'fit' �rkttixk»
y
5. wnat are the names of county or district officers, servants or employees causing
th-2 ca:-.age or injury?
Charles Henry Jackson
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Injuries to spine and surrounding musculature. Medical expenses not
determined to date. Treatment on-going.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$ 20 , 000 .00 . This figure represents claimant' s good-faith estimate
of total damages including medical expenses, pain and suffering,
anxiet emotional distresses and other esultina dama9Pa _
S. Names and addresses of witnesses, doctors and hospitals.
Mt. Diablo Medical Center - 2540 East Street, Concord, CA 94520
Mt. Diablo ER PHYS/FM Concord - P.O. Box 39000/Dept. 05074 , San Francisco
9• List the expenditures you made on account of this accident or injury:
DATE ITEM ANfOUNT
No medical expenses have been aid to date.
Gcv: Code Sec. 910:2 provides:
"The clim be ed by the claimant
SEND NOTICES T0: (Attorney)
or s er n o is behalf."
Name and Address of AttorneyATTORNEY IN FACT
LAW OFFICES OF WALTER R. HUFF
,i AND ASSOCIATES Cla i tore
1215 W. Imperial Highway, Suite 22
Brea, CA 92621 ES
HUFF & ASSOCIA
12,115 W. IMPERIAL HWY., #225
BREA, CA 92821
Telephone No. (714 ) 525-5595 Telephone No.
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 ^'i Lr,�ri
STATE OF C','IFORNIA
TRAklk COLLISION CODING6ju a�, C 1 P,GE OF
Z
DATE OF ORIGINAL INCIDENT TIME'24001 '� NCIC NUMBER OFFICER I.D. A'4�-� NUMBER A
07 - 02 - 96 1005 9320 009318 076U6721
OWNERS NAMEADDRESS _ p�j NOTIFlED
STATI'OF CAI IFORNIA AML
TRA'FPIC COLLISION REPORT cE GT
SPECIAL CONDITIONS NO INI NhR FEL D14 IAL DISTRICT NUMBER
4 1 [ ] PLEASANT HILL MT. DIABLO
NO KILL I HAR MISD COUNTY DIST BEAT ^• —/ A
0 CONTRA COSTA 682 C-st. s: oTE9E 21 '
COLLISION OCCURRED ON: NO DAY YEAR TIMEQ4M NCICI OFFICER
L I-680 N/B 07102196 1005 9320 009318
C
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY:
T
0 .35 mile (s) N of MP 680 CC 17 . 70 TUESDAY pg YES NO
N I I AT INTERSECTION WITH: STATE HWV REL
OR: . 35 mile s N of MONUMENT BLVD. DQ YES f 1 NO NONE
PARTY DRIVER'S LICENSE NUMBER STATE I CLASS SAFETY VEA YR MAKE/MODEL COLOR LICENSE NUMBER STATE
1 A9408764 CA C G 89 MAZDA MPV VAN SILVER3ESF125 CA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE,LASn
PCI VIET HAN PHUONG
FEDES- STREET ADDRESS - OWNER'S NAME [ ] SAME AS DRIVER
TRff 4603 GUNDRY AVE . BICH PHUONG
PARKED CTTY/STATETLIP OWNER'S ADDRESS [{] SAME AS DRIVER
VErTL LONG BEACH CA 90807
BICY. SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [] OFFICER KI DRIVER []OTHER
M BLK BRN 5-05 1i 1 i2 25 ' 74 SL.�0:•T': T0:4 ) 9 T
r) I (510, 3_ -122_
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT P{] REFER TO NARRATIVE [ ]
[] (310) 595-0979 ( ) NONE CEP CLEONLTYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER I []UNK [ ]NONE []MINOR
N. I . P 22 [ )MOD.PI MAJOR [ ]TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N I-680 65
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY YEN YR MAKE/MODEL/COLOR LICENSE NUMBER STATE
2 D0408553 CA C G 93 GMC VAN SAFARI WHITE E294371 CA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE.LAM
F{] CHARLES HENRY JACKSON
PEDES STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER
TRrp. 178 TIVOLI LN. CONTRA COSTA COUNTY #5849
PARKED CITY/STATE/LIP OWNER'S ADDRESS [I SAME AS DRIVER
VETT' DANVILLE CA 94506 1801 SHELL AVE. , MARTINEZ, CA 94553
BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE AACE DISPO OF VEHICLE ON ORDERS OF: [] OFFlCER {] DRIVER []OTHER
C`� M BLK BRN 6-02 198 11106135 DRIVEN 1y�
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT!AI REFER TO NARRATIVE[ ]
[] (510) 736-3757 (510) 646-4821 CEHICLE TYPE DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER [ JUNK [ ]NONE jq MINOR
N. Z . P. 22 I [ IMOI)j ]MAIOR [ ]TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N T-680 65 21658 A VC
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VIM YR 'MAKE/MODELICOLOR LICENSE NUMBER STATE
3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE.LAST)
[ I
PEDES STREET ADDRESS OWNER'S NAME [ ] SAME AS DRIVER
TR ff
PARKED COY/STATEMP OWNER'S ADDRESS [ ] SAME AS DRIVER
VErTL
BICY- SEX HAIR EYES I HEIGIFF WEIGIIT BIRTIIDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ ] OFFICER [ I DRIVER []OTHER
C11
ODIHR HOME PHONE BIISINE&S PIIONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[ ] REFER TO NARRATIVE [ ]
I I CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
VEHICLE TYPE -
INSUPANCE CARRIER POLICY NUMBER I [ ]MOD.[ I MANOR [ ]TOTAL
DIR TRV ON STREET OR{IIGIIWAI' PD LMT PCF
STATE OF CALIFORNIA 7 Q
INJURED/WnWESSES/PASSENGERS %, PAM �7 OF U
DATE OF COLLISION TIMEQ,W) 4y:+ NCIC NUMBER OFFICER I.D. ; NUMBER
07 - 02 - 96 1005 1 9320 009318 076U6721 �� 7
EXTENT OF INJURY ('XONE) INJURED WAS ('X' ONE)
WITNESS PASSENGER AGE SEX PARTY SEAT SAFETY EJECTED
ONLY ONLY FATAL I SEVERE I OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER
70 M X X 3 G 0
NAME/D.O.B./ADDRESS TELEPHONE
BICH PHUONG 04-29-26
H-SAME AS P-2, , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
LACERATION TO R/HAND, COMPLAINT OF NECK, SHOULDER AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
21 M I I I I X I X I I I I 1 1 1 1 G 0
NAME/D.O.B./ADDRESS TELEPHONE
VIET HAN PHUONG 12-25-74
H-4603 GUNDRY AVE . , LONG BEACH, CA, 90807 (310) 595-0979
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
N/A N/A
DESC IBE INJURIES:
COMPLAINT OF NECK PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
27 F I I I I X I X I I I I ( 1 4 1 G 0
NAME/D.O.B./ADDRESS TELEPHONE
MAI PHUONG 04-24-69
H-203 NICHOLSON, MONTEREY PARK, CA, 91754 (818) 288-9918
ON)URED ONLY)TRANSPORTED BY: TAKENTO:
N/A N/A
DESC IBE INJURIES:
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF mLENT CRIME NOITFIED
60 F I I I I X I X I I I I 1 1 5 1 G 1 0
NAME/D.O.B./ADDRESS TELEPHONE
CHAU VUONG 01-02-36
H-SAME AS P-2 , , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME LD NUMBERMO. DAY YR. REVIEWER'SNAME M0. DAY YR.
PASSALAC UA D 009318 07-03-96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE 4
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 1 -17
1 FACTS:
2
3
4 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance
5 responding at 1010 hours. I responded from WB S.R. 4 at Solano Way and arrived on scene at
6 1016 hours. All times, speeds and measurements in this investigation are approximate.
7 Measurements were taken by Officer Dalecki # 8521 by pacing, except where otherwise
8 indicated.
9
10
11 SCENE: At the scene of this collision, I-680 is a northbound/southbound freeway consisting
12 of four lanes in each direction. The roadway is straight and level. The surface is composed
13 primarily of concrete, the N-I In in partially asphalt surfaced along with the center median and
14 right shoulder. See diagram.
15
16
17 PARTIES:
18
19 Party # 1 (Phuong) was located at the scene standing near the Ufront of V-1 upon my arrival.
20 Party Phuong was identified by a valid California driver's license. Phuong was placed as a
21 party by the following items:
22
23 - personal statements
24
25 Mazda MPV Van, Driver# 1's vehicle, was located on its wheels as shown on the diagram.
26 V-1 sustained major damage to the left side ,front end (hood, bumper& grill), right rear side
27 and windshield.
28
29
30 Party # 2 (Jackson) was located at the scene upon my arrival. Party Jackson was identified by
31 a valid California driver's license. Jackson was placed as a party by the following items:
32
33 - personal statements
34
35 GMC Safari Van, Driver# 2's vehicle, was located on its wheels as shown on the diagram.
36 V-2 sustained very minor damage to the left rear bumper.
37
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
• STATE OF CALIFORNIA �`'�'` C
NARRATIVE/SUPPLEMENTAL PAGE TTT
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 7��
1
2 PHYSICAL EVIDENCE: Skidmarks and vehicle debris. See diagram.
3
4
5
6 STATEMENTS:
7
8 Party # I (Phuong) related that he had been traveling NB I-680 in the N-I In. at approx. 75
9 mph. when he saw V-2 in the N-3 In. change Ins. toward his vehicle. P-I related that P-2 as he
to got alongside him continued into his In. P-1 braked but was hit by V-2 and knocked into the
11 center divider.
12 Q- Do you know what the speed limit is here? A- Yeah, 70.
13 Q-But you were going 75 ? A-yes.
14
15 PaM # 2 (Jackson) related that he had entered I-680 NB from Monument Blvd. and had
16 moved into the N-3 In. at approx. 25-30 mph. P-2 further related he turned on his blinker and
17 thought P-2 saw him so he (P-2) continued over into the N-1 In. P-2 felt P-1 hit his vehicle (V-
18 2)on the 1/rear fender. P-2 looked in his mirror and saw P-1 out of control and hit the wall.
19
20
21
22 OPINIONS AND CONCLUSIONS
23
24 SUMMARY:
25
26 Party #1 (P-1, Phuong) was traveling NB 1-680 in the N-1 In. at approx. 75 mph. Party #2 (P-
27 2, Jackson) had entered NB 1-680 from Monument Blvd. and was moving to his left at approx.
28 25-30 mph. accelerating into traffic. P-2 had his tum signal on and thinking P-2 saw him
29 continued changing Ins. to his left entering the N-I In. However due to P-2's speed he was
30 unable to slow sufficiently as P-I moved into his In. and struck the I/rear bumper causing his
31 vehicle (V-2) to go out of control and strike the center divider jersey wall.
32
33
34 AREA OF IMPACT:
35
36 P.O.I. established by physical evidence to be approx. .35 mi. N/of Monument Blvd. and approx.
37 10 feet E/of the W/edge of the N-I In. of 1-680.
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 CAUSE:
2
3 Party #2 (Jackson) caused this collision due to his unsafe lane change in violation of 21658 A
4 VC. Party #1 (Phuong) is an associated factor due to his exceeding the maximum speed limit
5 of 65 mph. in violation of 22349 A VC.
6
7 RECOMMENDATIONS
8
9 None.
10
PREPAREWS NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA /7 1 lA
NARRATIVE/SUPPLEMENTAL PAGE / Y
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 "� 7
1
DIAGRAM 1-680 N/B
RIR 2' E/OF W/EDGE#1 LN. V-1
R/F ON W/EDGE#1 LN. Aqj
1111
lA1A
1
50'
I
A=48' A
SKIDMARK
91'
8=89' BI
SKIDMARK
21'
C= 117'
SKIDMARK
117'
C
12'-+x-12' 12' 8'
z 1z' N-2 N-3 N-4
.35 MI.
N1
TO JERSEY WALL
MONUMENT BLVD. RAISED ASPHALT CURB
PREPARER'S NAME I.U.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
• V •STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 17 ,11
1
2
3
1=680 NIB Q
SKETCH
v_2
V-1
N-1 N-2 N-3 N-4
JERSEY WALL RAISED ASPHALT CURB
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
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CLAIM
BOA;: Or Su%ERA:S.;S Or CON';- :CS-A COuNTr, CALIFORN:A December 10, 1996
Claim A;ainst the County, or District governed by) BOA;: ACTION
the Board c' Supervisors, Routing Endorsements, ) NOTICE To CLAIMANT
and Boa,., A:tion. All Section references are to ) The copy of this document mailed to you is your notice of
Califo^ria Gorerhmert Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph iV below), given pursuant„ " r'r ,qa�a� pph-�
Amount: $20,000.00 Section 913 and 915.1. Please note Arn� int gs�'
CLAIMANT: Viet Han Phuong NOV 0 4 1996
COUNTY COUNSEL
ATiDRNEr: Law Offices of Walter R. Huff MARTINEZCALIF.
and Associates Date received November 1 1996
ADDRESS: 1215 W. Imperial Highway, Ste. 225 BY DELIVERY TO CLERK ON
Brea, CA 92621 BY FAIL POSTMARKED: October 29, 1996
1. FROM: Clerk of the baro of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 4, 1996 OIL PpCYyLOR, Clerk
11. FROM: County Counsel TO: Clerk of the bard of supervisors
(k) 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 910.1).
( ) 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.,Z BY:�c/!/(/ Deputy County Counsel
111. FROM: Clerk of the Bard 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
(X) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the bard's Order entered in its minutes for
this ate. f� �I
Dated: 11LC 1l o ►Hll BATCHELOR, Clerk, iy—Jrit Deputy Clerk
YARNING (Gov. cede section 913)
Subject to certain exceptions, you have only xis (6) months from the ate this notice was personally served or
deposited in the mail to file a court action on this Claim. Sea 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 FAILING
I declare under penalty of perjury that I as now, and at all times herein mentioned, have been a citizen of the
United States, over age 11; and that today I deposited in the United States Postal service in Martinez.
California, postage fully prepaid A Certified copy of this bard Order and Notice to Claimant, addressed to
the claimant as shown above. C
Dated: K4 2 p� BY: PHIL BATCHELORjv e �'- uty Clerk
CC: Cour•ty Curse County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
Clair- to: BOAPJ) OF SJPERVISORS OF CONTRA COSTA COUNTY
INSTRUCTIONS TO CLAIMANT
A. Clai:s relating to causes of action for death or for injury to person or to per-
sonal property or growing crops and which accrue on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating to causes of action for death or for injury to person
or to personal property or growing crops and which accrue on or after January 1,
1988, must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (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
• • tk �F f !F If f M IF 1F # iE M f 1F ! f / ! • • 1F R 1F ■ 1t 1F 1k It N IF if 1F f ! 1F ■ ■ ■ 1E f 1F
R£: Claim By ) Reserved for Clerk's filing stamp
VIET HAN PHUONG RECEIVED
)
Against the County of Contra Costa NOV - I
District) CLERK BOARD OF SUPERVISORS
Fill in name ) CONTRA COSTA CO. ,
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ 20 .000 .00 — and in support of
this claim represents as follaws: medical special damages and general damagQ.s
1. When did the damage or injury occur? (Give exact date and hour)
July 2 , 1996 at about 10 :05 a.m.
2. Where did the damage or injury occur? (Include city and county)
City of Pleasant Hill, Contra Costa County
I-680 freeway north-bound approx. .35 miles north of Monument Blvd_
3. How did the &-mage or injury occur? (Give full details; use extra paper if
required)
See attached Traffic Collision Report No. 7-17
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage?
Violation of California Vehivle- Code Section 21658 (a)
4/ ,(4
5. anac are the Mmes of councv or district officers, servants or employees causing
the da:»ne or Injury?
Charles Henry Jackson
5. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Injuries to spine and surrounding musculature. Medical expenses not
determined to date. Treatment on-going.
7. How, was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$ 20,000 .00 . This figure represents claimant' s good-faith estimate
of total damages including medical expenses, pain and suffering,
anxietyernotional distress , and other re� y�lg dap�aGps__
$. Names and addresses of witnesses, doctors and hospitals.
Mt. Diablo Medical Center - 2540 East Street, Concord, CA 94520
Mt. Diablo ER PHYS/FM Concord - P.O. Box 39000/Dept. 05074, San Francisco
i rn
9. List the expenditures you made on account of this accident or injury:
DATE ITEM: AMOUNT
No medical expenses have been paid to date.
Gov. Code Sec. 910.2 provides:
"Thec aim t be igned by the claimant
SEND NOTICES TO: (Attorney) or b o n his behalf."
Name and Address of AttorneyATTORNEY IN FACT
LAW OFFICES OF WALTER R. HUFF
AND ASSOCIATES (Cla S s gnature)
1215 W_ Imperial Highway, Suite 22 LAW OFFICES
Brea, CA 92621
1215 . L HWY., #225
BREA, CA 92821
Telephone No. (714 ) 525-5595 Telephone No.
* * * * * * *
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in
the stag prison, by a fine of not exceeding, ten thousand dollars ($10,000, or by
both
STATE OF 61IFORNIA
:i]W- lC COLLISION CODING �' "CF Z OF
DATE OF ORIGINAL INCIDENT TIMERHDI NCIC NUMBER OFFICER I.D. NUMBER [�
07 - 02 - 96 1005 9320 009318 076U6721
___ WNERSNAMEADDRESS _ _ _ �Byy(tj'pp NOTIFIED
STATI'UF CAI IFORNIA I�yO
TR:kYT C COLLISION REPORT P.cF OF
SPECIAL CONDITIONS NO IN) HkR FEL DIJ .�_ IAL DISTRICTrNUMBE,R4 [ PLEASANT HILL MT. DIABLONOKILL H&RMISDCOUNTY DIST BEAT0 CONTRA COSTA 682Co- .: 07EDET21. '
COLLISION OCCURRED ON: MO DAY YEAR TIME04" "mc/ OFFICER I. 1
0 I-680 N/B 07102196 1005 9320 00931'8 ,
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY:
0 e
.35 mils) N of MP 680 CC 17 . 70 TUESDAY Pq YES NO
N I I AT INTERSECTION WITH: STATE HWY REL
__&M:. .35 mile (s) N of MONUMENT BLVD. YES I I No D9 NONE
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEX YR MAKEMODELCOLOR LICENSE NUMBER STATE
1 A9408764 CA C G 89 MAZDA MPV VAN SILVER 3ESF125 CA
. . . . . . . . . . . . . .
DRNER NAMETFlRST,MIDDLE.LA517
19 VIET HAN PHUONG
PEDES- STREET ADDRESS OWNER'S NAME [ ) SAME AS DRIVER
E
4603 GUNDRY AVE. BICH PHUONG
PARKED CTTYJSTATE/LIP OWNER'S ADDRESS tq SAME AS DRIVER
YEff` LONG BEACH CA 90807
BICY. SEX HAIR I EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ OFFICER Pl DRIVER [)OTHER
``['] M BLK BRN 5-OS 117 ii 151 14 B�
SL.�0'VrN TO:: (510) 933-1221
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONEAPTARENTKI REFERTONARRATIVE
] (310) 595-0979 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
[ l NONE [IMINOR
INSURANCE
TYPE [1
AURANCE CARRIER POLICY NUMBER I JUNK
N. I .P 2 2 [ )MOD.M MAJOR [ TOTAL
DIR TRV ON STREET OR HIGHWAYPD LMT PCF
N I-680 65
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAM M
Y VER YR MAKEODELCOLOR LICENSE NUMBER STATE
2 D0408553 CA C G 93 GMC VAN SAFARI WHITE E294371 CA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE.LAST)
jq CHARLES HENRY JACKSON
PEDES STREET ADDRESS OWNER'$NAME [ SAME AS DRIVER
TR ' 178 TIVOLI LN. CONTRA COSTA COUNTY #5849
PARKED CTTYISTATE2IP OWNER'S ADDRESS [] SAME AS DRIVER
lErfLI DANVILLE CA 94506 1801 SHELL AVE. , MARTINEZ, CA 94553
BICE. SE% HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE D6PO OF VEHICLE ON ORDERS OF: [ ) OFFICER jq DRIVER [)OTHER
M BL BRN 6-02 198 11 06 35 DRIVENCLM RP1
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPAREPPT M REFER TO NARRATIVE
[ (510) 736-3757 (510) 646-4821 CHP USE ONLY DESCRME VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE [ UNK [ JNONE jqMINOR
N. I . P. 22 I )MOD.[ MNOR )TOTAL
OR TRV ON STREET OR HIGHWAY LMT PCF
RT T-6e0 65 21658 A VC
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEN YRS MAKIUMODEL/COLOR LICENSE NUMBER STATE
3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE.LAST)
( )
PEDES- STREET ADDRESS OWNER'S NAME [ ) SAME AS DRIVER
TR
PARKED CITYISTATEaIP OWNER'S ADDRESS [ ) SAME AS DRIVER
V ISL
BICY• SEX HAIR EYES I HEIGHT WEIGIITBIRTIIDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ ) OFFICER [ ) DRIVER [ )OTHER
CLn
IFTHER HOME PIWNE BUSINESS PHONE: PRIOR MECHANICAL DEFERS. NONE APPARENT REFER TO NARRATIVE
( I CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
VEHICLE TYPE
INSURANCE CARRIER POLICY NUMBER [ UNK [ )NONE [ )MINOR
[ )
MOD.( )MAJOR [ TOTAL
DIR TRV ON STREET OR HIGHWAY PDLMT KF
STATE OF{pLIFORNIA I,, Q
INR REDIWITNESSES/PASSENGERS 51f?( C 'w PAM \77 w U
DATE OF COLLISION TIME04001 ���' NCIC NUMBER OFFICER LD. ' NUMBER
07 - 02 - 96 1005 9320 009318 076U6721
EXTENT OF INJURY ('X' ONE) INJURED WAS('X' ONE
WITNESS PASSENGER ACE SEX PARTY SEAT SAFETY ECTED
ONLY ONLY FATAL SEVERE OTHER VLSIBLE COMPLAINT NUMBE0. FOS. ECRM.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OMER
70 MX X 3 1 G 0
NAME/D.O.S./ADDRESS TELEPHONE
BICH PHUONG 04-29-26
H-SAME AS P-2, , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INIURIES:
LACERATION TO R/HAND, COMPLAINT OF NECK, SHOULDER AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
21 M I I I I X I X I I I I 1 1 1 G 0
NAME/D.03./ADDRESS TELEPHONE
VIET HAN PHUONG 12-25-74
H-4603 GUNDRY AVE. , LONG BEACH, CA, 90807 (310) 595-0979
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DE A N/A
DE RUURIES:
COMPLAINT OF NECK PAIN
VICTIM OF VIOLENT CRIME N MMD
27 F I I I I X I X I I I I 1 1 4 1 G 1 0
NAME/D.O.B./ADDRESS TELEPHONE
MAI PHUONG 04-24-69
H-203 NICHOLSON, MONTEREY PARK, CA, 91754 (818) 288-9918
(INJURED ONLY)TRANSPORTED BY: TAKEN TO
T7/A
0E RUURIES: N/A
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CIUME NOTIFIED
60 F I I I I X I X I I I I 1 1 5 1 G 1 0
NAMGD.O.BJADDRESS TELEPHONE
CHAU VUONG 01-02-36
H-SAME AS P-2, ,
(POURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INNRIES:
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VALENT CRIME I10fiF1ED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
] VKTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME LDHUMBER18 MREVIEWER'SNAME
PASSALAC UA D 0093MO. DAT YR.
• • STATE OF CALIFORNIA 1� \1 W
NARRATIVE/SUPPLEMENTAL PAGE 7
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 FACTS:
2
3
4 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance
5 responding at 1010 hours. I responded from WB S.R. 4 at Solano Way and arrived on scene at
6 1016 hours. All times, speeds and measurements in this investigation are approximate.
7 Measurements were taken by Officer Dalecki # 8521 by pacing, except where otherwise
8 indicated.
9
l0
I t SCENE: At the scene of this collision, I-680 is a northbound/southbound freeway consisting
12 of four lanes in each direction. The roadway is straight and level. The surface is composed
13 primarily of concrete, the N-1 in in partially asphalt surfaced along with the center median and
14 right shoulder. See diagram.
15
16
17 PARTIES:
18
19 PaIn # 1 (Phuong) was located at the scene standing near the Ufront of V-I upon my arrival.
20 Party Phuong was identified by a valid California drivers license. Phuong was placed as a
21 party by the following items:
22
23 - personal statements
24
25 Mazda MPV Van, Driver# 1's vehicle, was located on its wheels as shown on the diagram.
26 V-1 sustained major damage to the left side ,front end (hood, bumper& grill), right rear side
27 and windshield.
28
29
30 PaM # 2 (Jackson) was located at the scene upon my arrival. Party Jackson was identified by
31 a valid California drivers license. Jackson was placed as a party by the following items:
32
33 - personal statements
34
35 GMC Safari Van, Driver#2's vehicle, was located on its wheels as shown on the diagram.
36 V-2 sustained very minor damage to the left rear bumper.
37
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
• STATE OF CALIFORNIA �S'.` "' 4 _
NARRATIVE/SUPPLEMENTAL PAQF
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER h
07/02/96 1005 9320 009318 076U6721
1
2 PHYSICAL EVIDENCE: Skidmarks and vehicle debris. See diagram.
3
4
5
6 STATEMENTS:
7
8 PaM # 1 (Phuong)related that he had been traveling NB I-680 in the N-1 In. at approx. 75
9 mph. when he saw V-2 in the N-3 In. change Ins. toward his vehicle. P-1 related that P-2 as he
10 got alongside him continued into his In. P-1 braked but was hit by V-2 and knocked into the
I; center divider.
12 Q-Do you know what the speed limit is here? A- Yeah, 70.
13 Q-But you were going 75 ? A-yes.
14
15 PaM# 2 (Jackson) related that he had entered I-680 NB from Monument Blvd. and had
16 moved into the N-3 In. at approx. 25-30 mph. P-2 further related he turned on his blinker and
17 thought P-2 saw him so he (P-2)continued over into the N-1 In. P-2 felt P-1 hit his vehicle (V-
18 2)on the Urear fender. P-2 looked in his mirror and saw P-1 out of control and hit the wall.
19
20
21
22 OPINIONS AND CONCLUSIONS
23
24 SUMMARY:
25
26 Party #1 (P-1, Phuong) was traveling NB 1-680 in the N-I In. at approx. 75 mph. Party #2 (P-
27 2, Jackson) had entered NB I-680 from Monument Blvd. and was moving to his left at approx.
28 25-30 mph. accelerating into traffic. P-2 had his turn signal on and thinking P-2 saw him
29 continued changing Ins. to his left entering the N-1 In. However due to P-2's speed he was
30 unable to slow sufficiently as P-I moved into his In. and struck the I/rear bumper causing his
31 vehicle(V-2) to go out of control and strike the center divider jersey wall.
32
33
34 AREA OF IMPACT:
35
36 P.O.I. established by physical evidence to be approx. .35 mi. N/of Monument Blvd. and approx.
37 10 feet E/of the W/edge of the N-I In. of 1.680.
38
39
40
PREPARER'SNAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
(✓' to
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 CAUSE:
2
3 Party#2 (Jackson) caused this collision due to his unsafe lane change in violation of 21658 A
4 VC. Party #1 (Phuong) is an associated factor due to his exceeding the maximum speed limit
5 of 65 mph. in violation of 22349 A VC.
6
7 RECOMMENDATIONS
8
9 None.
10
PREPARER'SNAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1
DIAGRAM I=680 NIB Q
R/R 2' E/OF W/EDGE#1 LN. V
RIF ON WEDGE#1 LN.
50'
A=48' A
SKIDMARK \
91'
B=89' BI
SKIDMARK
i
21'
C= 117'
SKIDMARK
117'
C
1r�Ir17e•
z' 1z
N-2 N_3 N-4
.35 MI.
1
TO 'JERSEY WALL
MONUMENT BLVD. RAISED ASPHALT CURB
PREPARER'SNAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
•STATE OF CALIFORNIA 4 \ @S G .0
NARRATIVE/SUPPLEMENTAL PAGE (j u
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1
2
3
1=680 NIB Q
SKETCH
I
V_2
V_1
:JERSEYWALL
N-2 � N-3N-4
RAISED ASPHALT CURB
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
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C' I
i
111
CLAIM
BDA;' Or SURERi:S:rS Or CON--' C^SA COUNTY, CA;IPORN!A December 10, 1996
Clair Against the County, or District governed by) BOAR: ACTION
the Board c' Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Boa-, action. All Section references are to The Copy of this document mailed to you is your notice of
Califorria Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Mount: $20,000.00 Section 913 and 915.1. Please note 11MMUd Efnl
CLAIMANT: Mai Ngoc Phuong NOV 0 4 1996
ATTORNEY: Law Offices of Walter R. Huff COUNTY COUNSEL
and Associates Date received MARTINEZ CALIF.
ADDRESS: 1215 W. Imperial Highway, Ste. 225 BY DELIVERY TO CLERK ON November 1 . 1996
Brea, CA 92621 IT MAIL POSTMARKED: October 29, 1996
1. FROM: Clerk of the bard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim,
DATED: November 4. 1996 JV}L LATpCu�iyl0ll, Clerk
11. FROM: County Counsel T0: clerk of the turd of Supervisors
(K) This claim complies substantially with Sections 910 and 910.1.
( ) This claim FAILS to comply substantially with Sections 910 and 910.1, and we are to notifying
claimant. The Lard cannot act for IS days (Section BID,$).
( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( ) Other:
Dated: BY: Deputy County Counsel
III. FROM: Clerk of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 911.7).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
K) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Surd's Order entered in its minutes for
this :tate.
1996
Dated: DEC 10 ►Illi 9ATCNELOR, Clerk, tyL�f-�-'. Deputy Clerk
WARNING (Gov. code section 917)
Subject to certain esteptions, you MVS only tis (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 ant to consult
an attorney, you should do so immediately. m For Additional Hauling See Reverse Side Of This Notice.
AFFIDAVIT OF NAILING
1 declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the
United Stotts, over age 18; and that today I deposited in 100 United Stat&S Postal Service in Martinez,
plifornia, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to
the claimant as Showabo
" above,
4
Dated: DEC 12 6 % BY: PHIL BATCHELOR b-j_ t-� �� Deputy Clerk
CC: County Cc..•Se County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims act.
Clair_ to.: BOARD OF ,SUPERVISORS OF CONTRA COSTA comr" C ,
INSTRUCTIONS TO CLADiAf f
A. Clai=s relating to causes of action for death or for injury to person or to per-
sonal property ar 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,
3.988, must be presented not later than .six months after the accrual of the cause y
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 nape 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=
! /1E ■ f IF M {E f N !f ! R [ M f 3.F ! M * ■ N R rF • 3.E • {E !F M R M M A }F IE f3. ! M 3.E 3.E fE A M
RE: Claim By ) Reserved for Clerk's filing stamp
MAI NGOC PHUONG } RECEIVED 1
} r
Against the County of Contra Costa )
or }
CLERK HOARpp Of SUPERVISO° .:;
District) CONTI7A COSTA CO,,,_,. ;
Fill in name }
The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-naux•d District in the sum of $ 20 ,000 .00 and in support of
this claim represents as follo'as: medical special damages and one
1. When did the damage or injury occur? (Give exact date and hour)
July 2 , 1996 at about 10 .05 a.m.
2. Where did the damage or injury occur? (Include city and county)
City of Pleasant Hill, Contra Costa County
I-680 freeway north-bound approx. .35 miles north of Monument Blvd.
3. How did the damage or injury occur? (Give full details; use extra paper if -
required)
See attached Traffic Collision Report No. 7-171
4. What particular act or emission on:the part of county ordistrictofficers,
-
servants or employees caused the injury or damage?
Violation of California Vehicle Code Section 21658(a )
4 �
i
4
... .. .,.
�. wnat are -.ne nz•Des of councv or district officers, servants or employees causing
the ca,-„,je or ,n jury?
Charles Henry Jackson
6. 'What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Injuries to spine and surrounding musculature. Medical expenses not
determined to date. Treatment on-going.
7. How was the amountclaimedabove computed? (Include the estimated amount of any
prospective injury or damage.)
$ 20,000 .00. This figure represents claimant' s good-faith estimate
of total damages including medical expenses , pain and suffering,
anxzet emotional distress., and other resno damaa�,__
9. Names and addresses of witnesses, doctors and hospitals.
Mt. Diablo Medical Center - 2540 East Street, Concord, CA 94520
Mt. Diablo ER PHYS/FM Concord - P.O. Box 39000/Dept. 05074 , San Francisco
9. List the expenditures you made on q000unt of this accident or injury:
DATE ITF4 :_ _ ,.) - ! AMOUNT
No medical expenses ";, iMve bean °pard to date.
* ■ * ar a * A rt * * � � � * t �r �f�l. � x * ft � rt a rt ■ it � • � r rt • * � +t « �
Gov. Code Sec. 910.2 provides:
"The c3 im must be si ed by the claimant
SEND NOTICES TO: (Attorney) or by scime cer*% on YA behalf.”
Name and Address of Attorney
LAW OFFICES OF WALTER R. HUFFATTORNEY IN FACT
AND ASSOCIATES Cla:mant , i ure)
1215 W. Imperial Highway, Suite 22 VgyypFFICES
Brea, CA 92621
Ad TER R. HU ATE8
1215 W IMPERIAL HWY., #225
BREA, CA 92821
Telephone No. (714 ) 525-5595 1 Telephone No.
+� * * * e +t
N 0 T I C E
Section 72 of the Penal Code provides:
"Every person who, with intent to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, authorized to allow or pay the same if genuine, any false or fraudulent
claim, bill, account, voucher, or writing, is punishable either by imprisonment in
the county jail for a period of not more than one year, by a fine of not exceeding
one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
JOth -C�l I"F.�rit3O t'Y . X,I filly_
STATE OF ZALIFORNIA 1_
TRArOC COLLISION CODING C • P Pace z OFDATE OF ORIGINAL INCIDENT TIME04001 NCIC NUMBER OFFICER LD. ?F,_ NUM9E0.
. 07 - 02 - 96 1005 9320 009318 076U6721 9
OWNERS NAME/ADDRESS
___._____. ___._.._._... _ NOTIFIED
5TATr OF CAI IFORNIA �"`� i
-,MC COLLISION REPORT cF OF
SPECIAL CONDITIONS NO INF H&R FEL 'D It —.IAL DISTRICT NUMBER
4 (] PLEASANT HILL MT. DIABLO
NO KILL H&R MISD COUNTY DIST BEAT
0 CONTRA COSTA 682 rseirs_ oTsysTZL '
COLLISION OCCURRED ON: MO DAY YEAR TIME(24M) NCIC/ OFFICER 1 1
I-680 N/B 07 02 96 1005 9320 009318
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOG0.A PHS BY:
D
. 35 mile (s) N of MP 680 CC 17 . 70 TUESDAY (XJ YES
No
N (I AT INTERSECTION WITH: STATE HW Y REL
Pq OR: . 35 mile s) N of MONUMENT BLVD. rEs NO NONE
PARTY DRIVER'S LICENSE NUMBER STATE CLA55 SAFETY VEH YR MAKEAMODEVCOLOR LICENSE NUMBER STATE
1 A9408764 CA C G 89 MAZDA MPV VAN SILVER 3ESF125 . . CA
. . . . . . . .
DRIVER NAME(FIRST,MIDDLE.LAS'D
t9 VIET RAN PHUONG
TRIAS! STREET ADDRESS - OWNER'S NAME ( ] SAME AS DRIVER
" 4603 GUNDRY AVE. BICH PHUONG
PARKED CITY/STATE2IP OWNER'S ADDRESS
SAME AS DRIVER
VErTL LONG BEACH CA 90807
BICIY-- SEX HAIR EYES HEIGHT WEIGH BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: ( ] OFFICER p{] DRIVER ( ]OTHER
c` M BLK BRN 5-05 i27 i2 25 74 SLiv'DO:'7i: T0.4 1 9 T
n 1 (510, 3_ -122_
OTHER HOME PHONE BUSINESS PHONE PRIOR MEC14ANICAL DEFECTS: NONE APPARENT t] REFER TO NARRATIVE ( ]
( ] (310) 595-0979 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
VEHICLE TYPE
INSURANCEPCARRIER POLICY NUMBER 2 2 I ( ]MOD.Pq MAJOR (]TOTAL
DI 1
DR TRV ON STREET OR HIGHWAY PD LMT PCF
N I-680 65
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODELJCOLOR LICENSE NUMBER STATE
2 D0408553 CA C G 93 GMC VAN SAFARI WHITEE294371 CA
. . . . . . . . . .
DRIVER NAME(FIRST,MIDOLE.LAST)
P CHARLES HENRY JACKSON
PEDES STREET ADDRESS OWNER'S NAME (] SAME AS DRIVER
TRrf 178 TIVOLI LN. CONTRA COSTA COUNTY #5849
PARRK1ED CRYISTATEZP OWNER'S ADDRESS ( ] SAME AS DRIVER
VE�IICL DANVILLE CA 94506 1801 SHELL AVE . , MARTINEZ, CA 94553
BICIY-1 SEX HAIR EYFU HEIGHT wE1GH BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: ( ] OFFICER KI DRIVER []OTHER
cL�rS M BL K BRN 6-02 198 11106135 DRIVEN
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT K] REFER TO NARRATIVE( ]
( ] (510) 736-3757 (510) 646-4821 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER
VEHICLE TYPEI ( JUNK [ ]NONE P{]MINOR
N. I . P. 22 ( ]MOD.( ]MA OR ( ]TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N 1-680 65 21658 A VC
PARTY DRIVER'S LICENSE NUMBER STATE CLASS .SAFETY YEN YR MAKENODEIJCOLOR LICENSE NUMBER STATE
3
DRIVER NAME(FIRST.MIDDLE.LASD
t
PEDES- STREET ADDRESS OWNER'S NAME ( ] SAME AS DRIVER
TRA{
PARKED CITY/STATEaIP OWNER'S ADDRESS ( ] SAME AS DRIVER
VE�f1�L
f`CY�I SEX HAIR EYES IIEIGIIT WEIGIR DIRTIIDATE RACE DISPO OF VEHICLEON ORDERS OF: ( 1 OFFICER ( ] DRIVER [ ]OTHER
U'I'HFR HOME PHONE BUSINESS PHONE, PRIOR MECHANICAL DEFECTS: NONE APPARENT ( ] REFER TO NARRATIVE( 1
CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
VEHICLE TYPE
INSURANCECARRIER POLICY NUMBER UNK NONE MINOR
I � ]MUDMAJOR ( ]TOTAL
DIR TRV ON STREET OR IIIGIIWAI' SI'D LMT PCF
STATE OF'yLIFORNIA /��J
fNdURED/WITNESSES/PASSENGERS $ C PAGE 3 OF t
DATE OF COLLISION TIMEQ400) NCIC NUMBER OFFICER I.D. NUMBER
07 - 02 - 96 1005 9320 009318 076U6721 -1
EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE)
WITNESS PASSENGER AGE SEX PA0.I SEAT SAFETY EJECTED
ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP.
INIURY INIURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER
70 M X X 1 3 G 0
NAME/D.O.B./ADDRESS TELEPHONE
BICH PHUONG 04-29-26
H-SAME AS P-2, , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
LACERATION TO R/HAND, COMPLAINT OF NECK, SHOULDER AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
21 M I I X X 1 1 1 G 0
NAME/D.O.B./ADDRESS TELEPHONE
VIET HAN PHUONG 12-25-74
H-4603 GUNDRY AVE . , LONG BEACH, CA, 90807 (310) 595-0979
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
N/A N/A
DEC IBE INJURIES:
COMPLAINT OF NECK PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
27 F I I I I X I X I I I I 1 1 4 1 G 1 0
NAME/D.O.B./ADDRESS TELEPHONE
MAI PHUONG 04-24-69
H-203 NICHOLSON, MONTEREY PARK, CA, 91754 (818) 288-9918
(INJURED ONLY)TRANSPORTED BY: TAKEN T0:
DESNCRIBIE INJURIES: N/A
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
60 F I I I X X 5 G 0
NAME/D.O.B./ADDRESS TELEPHONE
CHAU VUONG 01-02-36
H-SAME AS P-2 , , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
PREPARERS NAME LD NUMBER MO. DAY YR, REVIEWER'S NAME MO. DAY YR.
PASSALAC UA D 009318 07-03-96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 .17
i FACTS:
2
3
4 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance
5 responding at 1010 hours. I responded from WB S.R. 4 at Solano Way and arrived on scene at
6 1016 hours. All times, speeds and measurements in this investigation are approximate.
7 Measurements were taken by Officer Dalecki # 8521 by pacing, except where otherwise
8 indicated.
9
10
I 1 SCEP At the scene of this collision, I-680 is a northbound/southbound freeway consisting
12 of four lanes in each direction. The roadway is straight and level. The surface is composed
13 primarily of concrete, the N-I In in partially asphalt surfaced along with the center median and
14 right shoulder. See diagram.
15
16
17 PARTIES:
18
19 PaM # 1 (Phuone) was located at the scene standing near the Ufront of V-I upon my arrival.
20 Party Phuong was identified by a valid California driver's license. Phuong was placed as a
21 party by the following items:
22
23 - personal statements
24
25 Mazda MPV Van, Driver# 1's vehicle, was located on its wheels as shown on the diagram.
26 V-1 sustained major damage to the left side ,front end (hood, bumper& grill), right rear side
27 and windshield.
28
29
30 P_ arty # ?. acksgn) was located at the scene upon my arrival. Party Jackson was identified by
31 a valid California driver's license. Jackson was placed as a party by the following items:
32
33 - personal statements
34
35 GMC Safari Van, Driver # 2's vehicle, was located on its wheels as shown on the diagram.
36 V-2 sustained very minor damage to the left rear bumper.
37
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER h
07/02/96 1005 9320 009318 076U6721
1
2 PHYSICAL EVIDENCE: Skidmarks and vehicle debris. See diagram.
3
4
5
6 STATEMENTS:
7
8 Party # 1 (Phuong) related that he had been traveling NB I-680 in the N-1 In. at approx. 75
9 mph. when he saw V-2 in the N-3 In. change Ins. toward his vehicle. P-I related that P-2 as he
10 got alongside him continued into his In. P-I braked but was hit by V-2 and knocked into the
Ill center divider.
12 Q- Do you know what the speed limit is here? A- Yeah, 70.
13 Q-But you were going 75 ? A-yes.
14
15 PaM # 2 (Jackson) related that he had entered I-680 NB from Monument Blvd. and had
16 moved into the N-3 In. at approx. 25-30 mph. P-2 further related he turned on his blinker and
17 thought P-2 saw him so he (P-2) continued over into the N-1 In. P-2 felt P-1 hit his vehicle (V-
18 2)on the 1/rear fender. P-2 looked in his minor and saw P-1 out of control and hit the wall.
19
20
21
22 OPINIONS AND CONCLUSIONS
23
24 SUMMARY:
25
26 Party #1 (P-1, Phuong) was traveling NB I-680 in the N-1 In. at approx. 75 mph. Patty #2 (P-
27 2, Jackson) had entered NB I-680 from Monument Blvd. and was moving to his left at approx.
28 25-30 mph. accelerating into traffic. P-2 had his tum signal on and thinking P-2 saw him
29 continued changing Ins. to his left entering the N-1 In. However due to P-2's speed he was
30 UP.able to slow sufficiently as P-I moved into his In. and struck the 1/rear bumper causing his
31 vehicle (V-2) to go out of control and strike the center divider jersey wall.
32
33
34 AREA OF IMPACT:
35
36 P.O.I. established by physical evidence to be approx. .35 mi. N/of Monument Blvd. and approx.
37 10 feet E/of the Wedge of the N-I In. of I-680.
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 CAUSE:
2
3 Party #2 (Jackson) caused this collision due to his unsafe lane change in violation of 21658 A
4 VC. Party #1 (Phuong) is an associated factor due to his exceeding the maximum speed limit
5 of 65 mph. in violation of 22349 A VC.
6
7 RECOMMENDATIONS
8
9 None.
10
PRE-PARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA f W
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 7. 7
' 1
DIAGRAM 1-680 N/B
R/R 2' E/OF W/EDGE#1 LN.
V-1
R/F ON WEDGE#1 LN. a"j
Alo
50'
I
A= 48' A
SKIDMARK
91,
Dg1
SKTDMAMARK
21'
C= 117'
SKIDMARK
117'
IF 12' 12' 8'
2' 12' N_2 N-3 N-4
.35 MI.
N1
TO JERSEY WALL
MONUMENT BLVD. RAISED ASPHALT CURB
PREPARER'S NAME LD.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
_S±a YJ .+tV -'•[a'iR.l!'.. �,.tip, 3. ._ ,�.lt....__... �. ••>TOGtLOHI�xc
•STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1
2
3
1-680 N/B
SKETCH
V-2
V-1
I
N-1 N-2 I N-3 N-4
JERSEY WALL RAISED ASPHALT CURB
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
C� �P
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t*
CLAN'.
BOA;: Or SURER�:S^RS Or CON-,. :Oc;A COUNTY, CALIFORNIA December 10, 1996
Claim Aga'nst the County, or District governed by) BOAR: ACTION
the Board c' Supervisors, Routing Endorsements, ) NOTICE To CLAIMANT
and Boa-e A:tion, All Section references are to The copy of this document mailed to you is your notice of
Califorrii Govt-mmert Codes. ) the action taken on your claim by the Board of Superviso•S
(Paragraph IV below), given pursuantQSIRIf�
Mhount: $20,000.00 Section 913 and 915.4. please note at�u�yarnings�," � )
CLAIMANT: NOV 0 4 1996
Chau Diem Phuong COUNTY COUNSEL
MORK': MARTINEZ CALIF.
Law Offices Of Walter R. Huff Date received
and Associates November 1 1996
ADDRESS: 1215 W. Imperial Highway, Ste. 225 BY DELIVERY TO CLERK ON
Brea, CA 92621 BY FAIL POSTMARKED: October 29, 1996
1. FROM: Clerk of the Bard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim,
DATED: November 4, 1996 F!L LATpCuvyLOR, Clerk �jtz� Q ` j
11. FROM: County Counsel T0: Clerk of the Bard 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 bard 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 U present a late Claim (Section 911.3).
( ) Other:
Dated: l I/Y/14 BY: /i(/,ititit. .li(/I/ Deputy County Counsel
111. FROM: Clerk of the Bard 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
YX ) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this date.
Dated: DEC 10 1996 ►MIL IATCNELOR. Clark, By �/ Lv A "'�^T— . Deputy Clark
WANING NOV. code section 913)
Subject to certain exceptions, you have only six (6) mdnths from the data this hotiCe Ms personally served Or
deposited in the mail to file a court action on this claim. See Government Code section 946.6.
you may seek the advice of an attorney Of your choice in connection with this matter. If you ant to Consult
an attorney, you should do so immediately. + For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF 04AILING
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 19; and that today I deposited in the United States Postal Service in Martinez.
California, postage fully prepaid a Certified copy of this Bard Order and Notice to Claimant, addressed to
the claimant as Showne above. y_
Dated' ` BY: PHIL BATCHELOR byv/ -� Deputy Clerk
CC: Co•Jr•ty Cc.'se County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
Claic tom 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, 1981,
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 an 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=
* f * * N * * 4 M N * ■ R M i * * * f M R * * * R II R 4 M 4 N R * R IE * ■ M 4 i * a *.
R£: Claim By ) Reserved for Clerk's filing stamp
CHAU DIEM PHUONG )
RECEIVED
Against the County of Contra Costa ) .
or ) - I
District)
Fill in name ) CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO. _
The undersigned claimant hereby makes claim agai e County of Contra Costa or
the above-named District in the sum of $ 20 .000 00 and in support of
this claim represents as follo'as: medical special damages and cLeneral damaa s
1. When did the damage or injury occur? (Give exact date and hour)
July 2 , 1996 at about 10 :05 a.m.
2. Where did the damage or injury occur? (Include city and county)
City of Pleasant Hill, Contra Costa County
I-680 freeway north-bound approx. .35 miles north of Monument Blvd.
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
See attached Traffic Collision Report No. 7-17
4. What particular act or omission on:the part of county or district officers,
servants or employees caused the injury or damage?
Violation of California Vehicle Code Section 21658 (a)
s
«-
.u...: l Y �I 7 ^S R #A �-
Q-,
5. wnaL are ane names of county or district officers, servants or employees causing
the daaage or ;njury?
Charles Henry Jackson
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage.
Injuries to spine and surrounding musculature. Medical expenses not
determined to date. Treatment on-going.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
$ 20,000 .00 . This figure represents claimant' s good-faith estimate
of total damages including medical expenses, pain and suffering,
anxiety. emotional distress and other 1 ina damajaeZ ___ _
6. *lames and addresses of witnesses, doctors and hospitals.
Mt. Diablo Medical Center - 2540 East Street, Concord, CA 94520
Mt. Diablo ER PHYSJFM Concord - P.O. Box 39000/Dept. 05074 , San Francisco
9. List the expenditures you made on account of this accident or injury:
DATE ITEM ANrMW
No medical expenses have been'lpaid to date.
■ tf if 14 IF M N If iF .* k If !! IE IF ■- M R -IC i4 :tF M 1f iF R R * R If ■ 1F 1F M 1f IF K 1f iF K R If tE
Gov. Ide Uec, 10Yhrij
ovidesbeed by the claimant
SEND NOTICES TO: (Attorney) or n f."
Name and Address of Attorney ATTORNEY IN FACT
LAW OFFICES OF WALTER R. HUFF
AND ASSOCIATES Claimant' gnature� -�
1215 W. Imperial Highway, Suite 22i LAW OFFICES
Brea, CA 92621 Add TE$
1215 W. IMPEIAL HWY., #226R
BREA, CA 92821
Telephone No. (714 ) 525-5595 1 Telephone No.
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 211ow 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 i fine of not exceeding ten thousand dollars ($10,000, or by
STATE OF CAI IFORNIA l.�
7RAi''I11C COLLISION CODING �yS��y (4Q P,GE Z DF O
DATE OF ORIGINAL INCIDENT TIME(1400) NCIC NUMBER OFFICER I.D. i' NUMBER A
07 - 02 - 96 1005 9320 009318 07606721
OWNER$NAME/ADDRESS
_—__..
STATT OF CAI IFORNIA
TR k IC COLLISION REPORT _ .GF OF
SPECIAL CONDITIONS NO INH HAR FELD I� SIAL DISTRICT NUMBER
4 (] PLEASANT HILL MT. DIABLO
NOKILL H&RMISD COUNTY DIST BEAT -(
0I CONTRA COSTA 682 L St <m: 07 21 '
COLLISION OCCURRED ON: MO DAY YEAR TIMEQ4001 NCIC/ OFFICER L� 1
0 I-680 N/B 07102196 1005 9320 00931'6
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY:
0 . 35 mile (s) N of MP 680 CC 17 . 70 TUESDAY PQYES NO
N I J AT INTERSECTION WITH: STATE HWY REL
OR: .35 mile s N of MONUMENT BLVD. DQ YES f 1 No D9 NONE
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE
1 A9408764 CA C G 89 MAZDA MPV VAN SILVER 3ESF125 CA
. . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE,LAM
P9 VIET HAN PHUONG
PEDES- STREET ADDRESS OWNER'S NAME ( ] SAME AS DRIVER
TRf' 4603 GUNDRY AVE . BICH PHUONG
PERKED CITY/STATE2IP OWNER'S ADDRESS �(] SAMEASDRIVER
`}1 LONG BEACH CA 90807
BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ ] OFFICER P] DRIVER (]OTHER
G` M BLK BRN 5-OS i2 / 12 25174 SL^.iOWN TO," I 933-1221 ,
Cl I RTT(510,
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT E'1 REFER TO NARRATIVE [ ]
[ ] (3 1 0) 595-0979 ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER
[ ]MO [ ]NONE []MINOR
DI. I . P 22
VEHICLE TYPE I [ )MOD.(�MAIOR [)TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N I-680 65
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODELICOLOR LICENSE NUMBER STATE
2 D0408553 CA C G 93 GMC VAN SAFARI WHITE 2294371 CA
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE,LAST)
PC] CHARLES HENRY JACKSON
PRDE4 STREET ADDRESS OWNER'S NAME [] SAME AS DRIVER
178 TIVOLI LN. CONTRA COSTA COUNTY #5849
PARKED CFTY/STATEMP OWNER'S ADDRESS [] SAME ASDRIVER
'TT'l DANVILLE CA 94506 1801 SHELL AVE. , MARTINEZ, CA 94553
CLY- SE% HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DLSPO OF VEHICLE ON ORDERS OF: [ ] OFFICER K] DRIVER []OTHER
��5�)' M BL BRN 6-02 198 11 06 35 DRIVEN
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT f{] REFUTE)NARRATIVE[]
[] (510) 736-3757 (510) 646-4821 CHP USE ONLYDESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE
[]UNK [ ]NONE MINOR
N. I . P. 22 [ ]MOD.[ ]MAJOR [ ]TOTAL
DIR TAV ON STREET OR HIGHWAYPD LMT PCF
N T-680 65 21658 A VC _
PARTY DRIVER'S LICENSE NUMBER STATE CLSSS SAFETY VEH YR 'MAKEIMODEL/COLOR LICENSE NUMBER STATE
3
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
DRIVER NAME(FIRST,MIDDLE,LAM
I
PEDFS- STREET ADDRESS OWNER'S NAME ( ] SAME AS DRIVER
TR"
PARKED CFTY/STATEIZIP OWNER'S ADDRESS ( ] SAME ASDRIVER
VErfL
BICY. SEX
HAIR EYES HEIGHT I WEICHT BIRTIIDATE I RACE DISPO OF VEHICLE ON ORDERS OF: ( ) OFFICER ( ] DRIVER ( ]OTHER CLpR HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT O REFER TO NARRATIVE ( I
[ I CHP USEVEHICLEiYPONLE Y DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER I [ )MOD.( )MAJOR [ )TOTAL
DIR TRV ON STREET OR HIGHWAY IS PD LMT i'CF
STATE OF CALIFORNIA r- 7 Q
INJURED/WPCNESSES/PASSENGERS PAaB \7 of U
DATE OF COLLISION TIME0400) NCIC NUMBER OFFICER I.D. NUMBER -,
07 - 02 - 96 1005 9320 009318 076U6721
EXTENT OF INJURY(A ONE) INJURED WAS ('X' ONE)
WRNESS PASSENGER AGE SEX PARTY SEAT SAFETY EJECTED
ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT BER POSEQUIP.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER .
70 M X X 3 G 0
NAME/D.O.B./ADDRESS TELEPHONE
BICH PHUONG 04-29-26
H-SAME AS P-2 , , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
LACERATION TO R/HAND, COMPLAINT OF NECK, SHOULDER AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
21 M X X 1 1 G 0
NAME/D.O.B./ADDRESS TELEPHONE
VIET RAN PHUONG 12-2S-74
H-4603 GUNDRY AVE. , LONG BEACH, CA, 90807 (310) 595-0979
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
N/A N/A
DESCRIBE INJURIES:
COMPLAINT OF NECK PAIN
VICTIM OF MLENT CRIME NOTIFIED
27 F X X 4 G 0
NAMEJD.O.B./ADDRESS TELEPHONE
MAI PHUONG 04-24-69
H-203 NICHOLSON, MONTEREY PARK, CA, 91754 (818) 288-9918
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DE XRIBEAINJURIES: N/A
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOITFIED
60 F I I I I X I X I I I I 1 1 5 G 0
NAME/D.O.B./ADDRESS TELEPHONE
CHAU VUONG 01-02-36
H-SAME AS P-2 , , ,
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMERICAN MEDICAL RESPONSE MT. DIABLO HOSPITAL
DESCRIBE INJURIES:
COMPLAINT OF NECK AND CHEST PAIN
VICTIM OF VIOLENT CRIME NOTIFIED
NAMFJD.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
' ) VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME LD NUMBER M0. DAY YR. I REVIEWER'S NAME MO. DAY YR.
PASSALAC UA D 009318 07-03-96
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 FACTS:
2
3
4 NOTIFICATION: I was dispatched to a call of an injury traffic collision, with an ambulance
5 responding at 1010 hours. I responded from WB S.R. 4 at Solano Way and arrived on scene at
6 1016 hours. All times, speeds and measurements in this investigation are approximate.
7 Measurements were taken by Officer Dalecki # 8521 by pacing, except where otherwise
8 indicated.
9
10
1 I SCENE: At the scene of this collision, I-680 is a northbound/southbound freeway consisting
12 of four lanes in each direction. The roadway is straight and level. The surface is composed
13 primarily of concrete, the N-1 In in partially asphalt surfaced along with the center median and
14 right shoulder. See diagram.
15
16
17 PARTIES:
18
19 PaM # 1 (Phuong)was located at the scene standing near the Ufront of V-1 upon my arrival.
20 Party Phuong was identified by a valid California driver's license. Phuong was placed as a
21 party by the following items:
22
23 - personal statements
24
25 Mazda MPV Van, Driver# 1's vehicle, was located on its wheels as shown on the diagram.
26 V-1 sustained major damage to the left side ,front end (hood, bumper& grill), right rear side
27 and windshield.
28
29
30 PaM # 2 (Jackson) was located at the scene upon my arrival. Party Jackson was identified by
31 a valid California drivels license. Jackson was placed as a party by the following items:
32
33 - personal statements
34
35 GMC Safari Van, Driver# 2's vehicle, was located on its wheels as shown on the diagram.
36 V-2 sustained very minor damage to the left rear bumper.
37
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA '�'�' _
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1
2 PHYSICAL EVIDENCE: Skidmarks and vehicle debris. See diagram.
3
4
5
6 STATEMENTS:
7
8 Party # 1 (Phuong)related that he had been traveling NB I-680 in the N-1 In. at approx. 75
9 mph. when he saw V-2 in the N-3 In. change ins. toward his vehicle. P-I related that P-2 as he
10 got alongside him continued into his In. P-1 braked but was hit by V-2 and knocked into the
1l center divider.
12 Q- Do you know what the speed limit is here? A- Yeah, 70.
13 Q-But you were going 75 ? A-yes.
14
15 Party# 2 (Jackson) related that he had entered I-680 NB from Monument Blvd. and had
16 moved into the N-3 In. at approx. 25-30 mph. P-2 further related he turned on his blinker and
17 thought P-2 saw him so he (P-2) continued over into the N-1 In. P-2 felt P-1 hit his vehicle (V-
I8 2)on the I/rear fender. P-2 looked in his mirror and saw P-I out of control and hit the wall.
19
20
21
22 OPINIONS AND CONCLUSIONS
23
24 SUMMARY:
25
26 Party#1 (P-1, Phuong) was traveling NB I-680 in the N-I In. at approx. 75 mph. Party #2 (P-
27 2, Jackson) had entered NB I-680 from Monument Blvd. and was moving to his left at approx.
28 25-30 mph. accelerating into traffic. P-2 had his tum signal on and thinking P-2 saw him
29 continued changing Ins. to his left entering the N-1 In. However due to P-2's speed he was
30 unable to slow sufficiently as P-I moved into his In. and struck the Urear bumper causing his
31 vehicle (V-2) to go out of control and strike the center divider jersey wall.
32
33
34 AREA OF IMPACT:
35
36 P.O.I. established by physical evidence to be approx. .35 mi. N/of Monument Blvd. and approx.
37 10 feet E/of the Wedge of the N-I In. of I-680.
38
39
40
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
STATE OF CALIFORNIA
C (o
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF MCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1 CAUSE:
2
3 Party #2 (Jackson) caused this collision due to his unsafe lane change in violation of 21658 A
4 VC. Party #1 (Phuong) is an associated factor due to his exceeding the maximum speed limit
5 of 65 mph. in violation of 22349 A VC.
6
7 RECOMMENDATIONS
8
9 None.
10
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
• STATE OF CALIFORNIA �`e}.:r I `�'
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721
1
DIAGRAM 1-680 N/B
R/R 2' E/OF WEDGE#1 LN.
R/F ON W/EDGE#1 LN. a9j
gala
50'
A=48'
SKIDMARK A\
91'
8=89' BI
SKIDMARK
21'
C= 117'
SKIDMARK
117'
C i i Ii
12' 12' 12' 8'
z 12 N-2 N-3 i N-4
.35 MI.
N-1
TO JERSEY WALL
MONUMENT BLVD. RAISED ASPHALT CURB
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
• V •STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
07/02/96 1005 9320 009318 076U6721 7 -0
1
2
3
1=680 NIB 0
SKETCH
V_2
N-1 N-2 N-3 N-4
JERSEY WALL RAISED ASPHALT CURB
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
D PASSALACQUA 009318 07/02/96
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♦M YYYYYYYYY Y•
C •(n
CtAI�
BOA,: Or Sc:Ea :S: S Or CON':: :OS'A COJN'r, CA.IFOaN:A December 10, 1996
Claim Against the Courty, or District governed by) BOA;: A:TION
the Boare c4 Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Boa,: A:tion. All Section references are to The Copy of this document nailed to you is your notice of
Califo• is Gove•hme^t Codes. ) the action taker On your claim by the Board of Supervisors
(Paragraph IV below), given pursuant i����:� 11 eV�lt
Amount: Unknown SaCtion 913 and 915.1. ►Mase noteA Warnings".
pnv A 7 1996
CLAIMANT:Alex Bantugan COUNTY COUNSEL
ATTORNEY:Reilly Atkinson
MARTINEZ CALIF.
Tehin & Partners Date received November 6, 1996
ADDRESS: Bank of America Center BY DELIVERY TO CLERK ON
555 California St. , 33rd Flr. hand delivered; via Risk Mgmt.
San Francisco, CA 94104-1609 IT NAIL POSTMARKED:
1. FROM: Clark of toe Bard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED, November 7, 1996 VIL LATpuVyLOR, Clerl�.��„��7�a�ti _
r
11. FROM: County Counsel TO: Clara of the Surd 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 Bard cannot act for 16 days (Section 910.9).
( ) Claim is not timely filed. The Clerk should return claim on ground that it as filed tate and send
warning of cluiwnt's right to apply for leave to present a lam claim (Section 911.3).
( ) Other:
Dated: �7f B�y6 BY: Deputy County Counsel
III. fADm: Clerk of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to clsimmnt (Section 911.3).
IV. BOAR;, ORDER: By unanimous vote of the Supervisors present
(x) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Bard's Order entered In its minutes for
dais data.
Dated: KC 10 PHIL BATCHELOR, Clare, By . Deputy Clerk
HARKING (Gov. code Section 913)
Subject to certain exceptions. you have only six (B) months from the date this notice was personally served or
deposited in the Oil to file a court action ON this claim, See Govtrmaant Coda Section 946.6-
you may seek the advice of an attorney of your choice in connection with this Otter. if you went to Consult
an attorney, you should do so immediately. + For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF 1NILiK
1 declare ander penalty Of perjury that 1 sm now, and at all times herein mentioned, have been a citizen of the
United states, over age 19; and that today 1 deposited in the United states Postal Service in wrtine:,
California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to
the claiunt as show++ above. Y R� �
Dated: DEC 18 1 % BY: PHIL BATCHELOR bye /� c n i--/ ” " ��aputy Clerk
Covrty :c�,Se County Administrator —
This warning does not apply to claims which are not
sub act to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that say apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and oases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
L ('P
errithew Ron HanreY
emorial NOV 4 1996
(?W4'W lad
AND HEALTH CENTERS
November 4, 1996
To: Contra Costa County Counsel
From: William Walker,M.D., Health Services Director
Re: Alex Bantugan j
Enclosed please find a §364 Notice of Intent to Commence Action regarding the above-named
patient mailed to Merrithew Memorial Hospital by certified mail on 10-30-96.
enc. RECEP\`ED
cc: Ron Harvey
NOV — 6 !:' -'o
CLERK BOARD OF SUPERVISOR$
CONTRA COSTA CO.
i
CONTRA COSTA COUNTY
A Prof,wonal Corporation
-- C
Bank of Ameria Center
555 California Street
33rd Flonr
ATTORNEYS AT LAW SAN FRANCISCO AND HONOLULU San Francisco
California 94104 1609
fax 415 951 8808
Tel 415.951.8800
October 29 , 1996
CERTIFIED MAIL {L
RETURN RECEIPT REQUESTED
Merrithew Memorial Hopsital
Administrative Offices
2500 Alhambra Avenue
Martinez , Calitornia 94553
Re : ALEX BANTUGAN v . MERRITHEW MEMORIAL, et al .
Dear Sir or Madam:
Our law firm has been consulted by Alex Bantugan in
reference to the medical care and treatment rendered to him by
Merrithew Memorial Hospital .
The Medical Injury Compensation Reform Act , effective
December 12 , 1975 , requires that any health care provider who
is a potential defendant in a medical-negligence action be
given ninety (90) days prior written notice of an injured
party' s intent to commence suit .
Since your name ( and any and all partnerships , corporations
or entities of which you were a member at the time, ) has been
raised in connection with the events surrounding the care and
treatment of Alex Bantugan, we feel it appropriate to advise
you that it is possible that you may be named as a defendant in
an action if it is determined that a suit should be filed.
Under the circumstances , we recommend that your insurance
company be advised of this letter .
Thank you for your cooperation.
s ,
cc_ California Medical F''vard
1426 Howe Avenue, Suite 54
Sacramento, California 95825
�. �
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NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Reilly Atkinson
Tehin & Partners
Bank of America Center
555 California St. 33 fl
San Francisco, CA 94104-1609
RE: CLAIM OF: ALEX BANTUGAN
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board
of Supervisors fails to comply substantially with the requirements of California Government
Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below:
XXX 1. The claim fails to state the name and post office address of the claimant.
XXX 2. The claim fails to state the post office address to which the person presenting the
claim desires notices to be sent.
XXX 3. The claim fails to state the date, place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
XXX 4. The claim fails to state the name(s) of the public employee(s) causing the injury,
damage, or loss, if known.
XXX 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars
($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim
fails to state the amount claimed as of the date of presentation, the estimated
amount of any prospective injury, damage or loss so far as known, or the basis of
computation of the amount claimed. If the amount claimed exceeds ten thousand
dollars ($10,000), the claim fails to state whether jurisdiction over the claim would
rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on is behalf.
[ ] 7. Other:
VICTOR J. WESTMAN�, County Counsel
By:
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code§§641, 664)
1 declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez,
California 94553; 1 am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a
party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an
envelope addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in
the U.S. Mail at Martinez, California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: November 8, 1996 at Martinez, California.
cc: Clerk of the Board of Supervisors (original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
CLF:"
BOF;' Or So%Eai:S:aS 0° CCti':: CCS'F C%N'v, CA_jF0RN:A December 10, 1996
Claim Agx'n$% the County, or District governed Dy) BOW ACTION
the Board c' Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
And Boa-: Actioh. All Section referenCeS art to ) The Copy of this doC;mtnt mailed to you IS your notice of
Califc--ia Gove-mm's Codes. ) the action taken on your Claim by the Board of Supervisors
(Paragraph iV below), given pursuant U Government Code
Amount: $10,000.00 + Section 913 and 915.4. Please note a1 W7Mz
CLAIMANT: Theresa Marie Bal NOV n 7 1996
ATiDRNEY: Draper B. Gregory, Esq. COUNTY COUNSEL
Law Offices of Arnold Laub Date received MARTINEZCALIF.
ADDRESS: 807 Montgomery St. BY DELIVERY TO CLERK ON November 5. 1996
San Francisco, CA 94133
BV MAIL POSTMARKED: November 4. 1996
1. FROM: Clark of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted Clain.
DATED: November 7, 1996 P}l DeputyLa, Clerk
11. FROM. County Counsel TO: Clerk of the Bard of Supervisors
This claim Complies substantially frith sections 910 and 810.2.
( ) This claim FAILS to comply substantially with Sections 910 and 910.2, end we art SO notifying
claimant. The bard cannot act for 16 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 tate claim (Section 911.3).
( ) Other:
Dated: BY: Deputy Courty Counsel
111. FROM: Clerk of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim as returned as untimely with notice to claimant (Action 911.7).
IV. BOAR:+ ORDER: By unanimous vote of the Supervisors present
(i/\) This Clain is rejected in full.
( )
Other:
I Certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this date. NNfE f
Dated: DEC 10 1DOp PHIL BATCHELOR. Clerk, By�J,u-�-v j�O` — . Deputy Clerk
YARNING (Gov. cede section 913)
Subject to certain esreeplions. you have only side (6) months from tot data this notice was personally served or
deposited in the mail to file A Court actiem on this claim. see Government Celt Section 945.6.
You may seek the advice of an attorney of your choice in connection with this matter. 1f you ant to consult
S" attorney. you Should do so immediately. + For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF NAILING
I declare under penalty of perjury that I a now, and At all times horain mentioned, have beth • cititth of the
United SUtts, oetr age 18; end that today I deposited In toe United States Postal Service in Martinet,
California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to
the claim" as Shown above.
Dated! we 12 By: PHIL BATCHELOR by 9/� eA �S Deputy Clerk
CC: Canty Cc.—e' County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and asses
applicable to your particular claim.
The County of Contra Costa does not vaiva any of its
rights under California Tort Claims Act nor does it
naive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
LAW OFFICES OF ARNOLD LAUB C ,
A PROFESSIONAL CORPORATION
CORPORATE HEADQUARTERS
THE LAUB BUILDING • 807 MONTGOMERY STREET• SAN FRANCISCO, CA 94133
TEL: 415/362-0101• FAX: 415/296-8841 •INTERNET: alaub@laub.CO
PLEASE REPLY TO: ED
SAN FRANCISCO
Arnold Laub, Esq.Pasident November 4, 1996
Craig M.Boeger Clerk of the Board of Supervisors,
Contra Costa County
Michael E.Cardoza County Administration Building, Rm. 106
Scott T Dunning 651 Pine Street
Martinez, CA 94553
Draper B.Gregory
Frank M.Morelli TO THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY:
Michael B.Nishiyana Please take notice that claimant Theresa Bal hereby makes
Roger L.Sisneros a claim for her personal injuries against the County of Contra
Costa (Contra Costa County Sheriff's Department) as follows:
Eric Y Tosaris
Richard B.Vaught 1. Claimant' s name and home address:
Paige A.Wolverton Theresa Marie Bal
449 Sheryl Drive
San Pablo, CA 94806
2 . Send official notices and correspondence to:
Draper B. Gregory, Esq.
Law Offices of Arnold Laub
807 Montgomery Street
San Francisco, CA 94133
3 . Claimant's date of birth:
11/13/61
4 . Daytime phone:
(415) 362-0101
5. Claimant's Social Security Number:
555-23-3993
6. Date of Incident:
Monday, May 6, 1996
SAN JOSE: III WEST SAINT JOHN,#770• SAN JOSE, CA 95113 •408/297-5060•FAX: 408/288-5191
II= WALNUT CREEK:43 PANORAMIC WAY•WALNUT CREEK,CA 94595. 510/938-4400• FAX: 510/947-0172
C .(P
7. Time of incident:
Approximately 10: 15 a.m.
8 . Location of Incident:
449 Sheryl Drive
San Pablo, CA 94806
9. Basis of claim:
Contra Costa County Deputy Sheriff Marian Bailey,
badge # 44832 came to my home in connection with a
domestic disturbance involving my husband Dominic Bal,
on May 6, 1996. The deputy and my husband got into a
physical confrontation. The deputy drew her service
pistol or revolver and negligently shot in my
direction, injuring my spinal cord and making me a
paraplegic.
10. Damage:
Negligent infliction of spinal cord gunshot wound,
paralyzing claimant.
11. Value of Loss:
Monetary damages suffered by claimant are within the
monetary jurisdiction of the Superior Court for the
State of California. This includes bodily injury,
medical expenses, loss of income-producing capacity,
and emotional distress and anxiety.
12 . Witnesses:
Claimant; Dominic Bal (address is the same as
claimant's address) ; Sheriff's Deputy Marian Bailey;
Believe Ms. Mabel or Laura Kummer (same address as
claimant's) .
13 . Date of Claim:
November 1, 1996. Mailed claim on 11/4/96.
14 . Hospital:
John Muir Medical Center
Walnut Creek, California
Herrick Memorial Hospital
Berkeley, California
2
�IIII- LAW OFFICES OF ARNOLD LAUB
e ,c�
15. Signa T-;of climant' repr entative:
bi4p6r ,$. Gregory, Esq. /
Attorn y at Law
3 -
/IIII= LAW OFFICES OF ARNOLD LAUB
PROOF OF SERVICE
2
I, Lori McMartin, declare as follows;
3
I am a citizen of the United States, employed in the County
4 of San Francisco, State of California. My business address is the LAW
OFFICES OF ARNOLD LAUB, 807 Montgomery Street, San Francisco, California
5 94133 . 1 am over the age of 18 years old and not a party
to the above-entitled action.
6
I am readily familiar with the Law Offices Of Arnold Laub' s
7 practice for collection and processing of correspondence for mailing
with the United States Postal Service. Pursuant to said practice each
8 document is placed in an envelope, the envelope is sealed, the
appropriate postage is placed thereon and the sealed envelope is placed
9 in the office mail receptacle. Each day' s mail is collected and
deposited in a United States mailbox at or before the close of each
10 day' s business.
11 On November 4 , 1996, 1 caused the within documents :
12 CLAIM OF THERESA BAL TO THE BOARD OF SUPERVISORS OF CONTRA COSTA
COUNTY
13
to be served BY CERTIFIED MAIL #P790228097/RETURN RECEIPT REQUESTED:
14
I placed a true copy thereof enclosed in a sealed envelope with
15 postage thereon fully prepaid and deposited said envelope in the
United States mail in the City and County of San Francisco,
16 California.
17
Each envelope (if applicable) was addressed as follows :
18
Clerk of the Board of Supervisors
19 Contra Costa County
County Administration Building, Room 106
20 651 Pine Street
Martinez, CA 94553
21
I declare under penalty of perjury under the laws of the State
22 of California that the foregoing is true and correct .
23 EXECUTED on this 4TH DAY OF NOVEMBER, 1996, at San Francisco,
California.
24
25
26
Lori McMartin
C.�
M
n
r"
N f.
CJO`
ODA;: Or S =ER :5^=5 0= CCN':- ":S% CO,�N•v CA.lFOAN:A December 10, 1996
Claim Aga�rst the Courty, or District governed by) BOA;: ACTION
the 9060c cr Supervisors, Ro�,ting Endcrsrierts, } NOTICE TO CLAIMANT
and Sri-: A:tion. All Stolon references are to ) The copy of tnIS doCumtnt mailed t0 you IS your notice of
Califorrie 6oveo"rt codes. ) tht action taker on your Claim by the $card of Supervi&o-$
(Paragraph IV below), given pursuant to Govtr� ��eXJ
Amount: $1,308.32 Section $13 and 913.4. please note all •warn y''�►}
CLAIMANT: California State Automobile Association NOV 0 8 1996
Claim No. : 11—B21432-7 COUNTY COUNSEL
ATIDRNEI: ensured: Spain, James MARTINEZ CALIF.
Cate received
ADDRESS: 3060 Hilltop Mail Rd. 9T DELIVERY TO CLERK ON November 7, 1996
Richmond, CA 94806-2494
Rt MAIL POSTMARXM: hand delivered; via Risk Mgnt.
I. FROM: Clerk of the faro of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
OIITEO: _November 8, 1996 PIL LATA ytOR+ C/era�h.,f��� .•.�
li. FROM: County Counsel TO: Clerk of the Board of Supervisors
( ? This claim Coeplils substantially with Sections 910 and 910.2.
M This claim (AILS to comply substantially with Sections 910 and 910.2, and we are so notifying
!� Claimant. The $card cannot act for 16 days (Section 910.1).
{ ) Claim is hot timely filed. The Clark should return claim on ground that it was filed lett and send
warning of claimants right to apply for leave to present a late claim (Section 913.3).
{ ) Other:
Dated: _ /f' �{`� IT: ,�jl,e�C (t�Q, .Deputy Courty Counsel
111. fROM. Clerk of the $Card TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claimant (Section 921.3).
IY. $OARD ORDER: 9y unanimous vote of the Supervisors present
This claim is rejected in full.
( ) Other:
I evnify that this is a true and correct Copy of the /Card's Order entered in its minutes for
this data$YCp.� rfc
Dated: C 10 �f% PHIL MTCMELOR, Clerk. s� — � + Deputy Clerk
WRNINS (Gov. 00e Section 913)
Subject to Certain receptions, you Mve only $is (6) months free the date this "ties was persoMlly served or
deposited in the nil to fila a court action on this Claim. See Government Code Section 946.6.
You may seek the advice of an attorney of your choice in connection with this matter. If you want t0 Consult
an attorney, you should do so immediately. 4 For Additional Warning See Reverse Side Of Thi$ Notice.
AFFIOAYIT OF WILING
I declare under penalty Of perju.y that i 40 oft. and at 611 tiaras herein mentioned, have been s Ntisen of the
United 6tatts, ower age 19; and that today I deposited in tae United States ppitat Service in Maninet,
California, postage fully prepaid a certified copy of this 9oard Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated: wf ULM IT: PNII IATCNELOR Clerk
CC: Courty Cc.r se County Atlministrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
C4
�.,a••• . California State Automobile Association
`'�® > <*> Inter-Insurance Bureau
October 31, 1996
Jep-Bec Mod r)
Risk Management
1220 Morello Avenue Rm#101
NOV'^ 190,(
� j l
Martinez, CA 94553
Re: Our Insured: Spain, James
Our Claim No.: 11-1321432-7
Date of Loss: 06-10-96
Your Insured: Hill, Ernest Calvin
Your Claim No.: unknown
Dear Mr. Bechtold:
This is notice of our subrogation interest arising from this loss. We have arranged settlement
with our insured. Please make your payment directly to the California State Automobile
Association Inter-Insurance Bureau(CSAA-IIB).
Attached are itemized bills to substantiate our subrogation claim.
Repair Bill 1308.32
Loss of Use
Tow/Storaee
TOTAL 1308.32
Sincerely,
X,
xv
64!Johhso
Claims Adjuster
510-223-8080
RECEIVED j
LIT - k)�_ 7 '7_1
e( ,e I- 71996
CLERK BOARD OF SUPERVISORS
CONTRA COSTA CO.
3060 HILLTOP MALL RD.•RICHMOND,CA 94806.2494•P.O.BOX 6060•SAN PABLO,CA 94806-6060•(510)223-8080
F1114 5?l)
\s
r
Date: 06/10/96 01:51 P.H.
Estimate ID: 267 l 7�
Preliminary
Profile ID: Mitchell Standard
ROSE AUTO BODY
12920 SAN PABLO AVENUE RICEEND CA 94805
(510) 237-6399
Damage Assessed By: JIM ROSH
Type of Loss: Collision
Insured: JIM SPAIN
Mitchell Service: 914620
Description: 1990 FORD RANGER
License: 059902 CA
Line Entry Labor Line Item Part Type/ Dollar Labor
Item Number Type Operation Description Part Number Amount Unit
1 RUNTO REFIN REFINISH FRY AIR DEFLECTOR C 1.0 —
2 AUTO BODY OVERHAUL FRY BUMPER ASSY 1.5 '
3 400750 BODY REMOVE/REPLACE FRY BUMPER FACE BAR F3YZ 17757 C 283.98 "INCL
4 400890 BODY REMOVE/REPLACE FRY BUMPER PAD F3TZ 17K833 A 37.37'INCL
5 401910 BODY REMOVE/REPLACE L H/LAMP DOOR F2TZ 13064 H 42.97— 0.4 q
6 402270 BODY REMOVE/RBPLACK L PAARLLAMP ASSEMBLY FITZ 13201 C 37.53--INCL
7 402310 BODY REMOVE/REPLACE L MARKER LAMP ASSEMBLY E9TZ 15A201 A 14.75 IINCL
8 408380 BODY REPAIR *L FENDER PANEL 2,5*�
9 AUTO REFIN REFINISH L FENDER OUTSIDE C 2.5
10 433700 BODY REMOVE/REPLACE STRIPE TAPE SET ORDER FROM DEALER 173.08
11 AUTO RRFIN ADD'L LABOR OPR CLEAR COAT 1,2*
12 933003 REFIN ADD'L LABOR OPR TINT COLOR 4rs*l
13 AUTO ADD'L COSY PAINT MATERIALS .,5) TN.W
14 AUTO ADD'L COSY HAZARDOUS WASTE DIS 2 3B*
* Judgement Item
# Labor Note Applies
CIncrluded in Clea; Coat Calc
Addll 3 '
Labor Sublet
I. Labor Subtotals Units Rate Amount unt Totals II. Replacement Summary Amount
Body 4.4 53.00 233.20 Taxable Parts —588
Refinish 5.2 53.00 Sales Tax @ 8.25% 48.65
Labor Subtotal 508.80 Total Replacement Parts Amount: 638.33
Labor Summary Totals 9.6 508.80
X8 `1 .68
?A=WVKM,-S -�-9. II
7AIC 53'1/00
233. E
C•}) PAST 2 �(
35 .62
ESTIMATE RECALL IM., 00/00/00 00:00:00 267 A-06 z . S 3
Mitchell Data Version: JUN 96 A Copyright (C) 1990-1996, Mitchell Internationa a e— of 2-
All Rights Reserved 3 3 Z
Date: 06/10/95 01:51 P.M. C (�
Estimate ID: 267
Preliminary
Profile ID: Mitchell Standard
III. Additional Costs Amount IV. Adjustments Amount
Taxable Costs 132.50 Customer Responsibility: 0.00
Sales Tax 8 8.251 10.93
Total Additional Costs: 143.43
1. Total Labor: 508.80
11. Total Replacement Parts: 638.33
III. Total Additional Costs: 143.43
Gross Total: 1,290.56
IV. Total Adjustments: 0.00
Net Total: 1,290.56
This is a preliminary estimate.
Additional changes to the estimate may be required for the actual repair.
i
ESTIMATE RECALL MER: 00/00/00 00:00:00 267
Mitchell Data Version: JUM-96 A Copyright (C) 1990-1996, Mitchell International Page 2 of 2
All Rights Reserved
NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO: Gary Johnson
California State Automobile Association
3060 Hilltop Mall Rd.
Richmond, CA 94806-2494
RE: CLAIM OF: James Spain
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board of
Supervisors fails to comply substantially with the requirements of California Government Code Section
910 and 910.2, or is otherwise insufficient for the reasons checked below:
[XX] 1. The claim fails to state the name and post office address of the claimant.
[XX) 2. The claim fails to state the post office address to which the person presenting the claim
desires notices to be sent.
[XX] 3. The claim fails to state the date,place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
[ ) 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or
loss,if known.
[ ) 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000).
If the claim totals less than ten thousand dollars($10,000), the claim fails to state the amount
claimed as of the date of presentation, the estimated amount of any prospective injury,
damage or loss so far as known, or the basis of computation of the amount claimed. If the
amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether
jurisdiction over the claim would rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on his behalf.
[ ] 7. Other:
VICTOR J. WESTMAN, County Counsel
By: �lf
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664)
I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California
94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I
served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown
above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S. Mail at Martinez,California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: November 8, 1996 at Martinez,California.
cc: Clerk of the Board of Supervisors(original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
CLA,r
BOA;: Or Su;EP�:S: S Cr CON-;: COSTA COUN'v, CA;IFOPN:A December 10, 1996
Cla4,m Against the County, or District governed by) BOA;: ACTION
the Board c' Supervisors, Routing Endorsements, ) NCTICE TO CLAIMANT
and Boa-: Action. All Section references art to ) The copy of this document mailed to you is your notice of
Cal'forr a Government Codes. ) the action taken on your claim by the Board of Supervisors
(Paragraph IV below), given pursuant to Government Code
Amount: $300,000.00 Section 913 and 915.1. Please note all •NarRWCI [LWJJ h)
CLAiMANT:Mr. Michael C. Abney, R.N. 0 r T 2 8 1996
ATlORNEY:Law Office of Christine Vierra Boelk COUNTY COUNSEL
2800 Pleasant Hill Rd. , Ste. 200
Date received MARTINEZCAUF.
ADDRESS: Pleasant Hill, CA 94523 BY DELIVERY TO CLERK ON October 28, 1996
BY MAIL POSTMARKED: Hand Delivered: via Risk Memt.
1. FROM. Clerk of the Board of Supervisors 70: County Counsel
Attached is a copy of the above-noted claim.
DATED: October 28, 19961}t �pCu41yLOR, Clerk
11. FROM: County counsel TO: Clark of the Board of Supervisors
(Ne) This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with Sections 910 and 91D.2, and we are so notifying
claiant. The bard cannot act for 15 days (Section 910.8).
( ) Claim is not timely filed. The Clark should return claim OR 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 — / 6 BY: dnigzx' Deputy County Counsel
III. FROM: Clerk of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to claiant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(X) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this data.
Dated: XC 10 1N PHIL BATCHELOR, Clerk, Deputy Clerk
IIARNING (Gov. code section 9'1`33)'`
Subject to certain exceptions, you Mve only six (6) months from the data this Notice was personally served or
deposited in the ail to file a court active on tris claim. See Government Code Section 915.6.
you shy seek the advice of an attorney of your choice in connection with this atter. If you want to consult
an attorney, you should do to immediately. + For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF MAILING
I declare under penalty Of perjury that i as now, end at all times herein mentioned, have been a citizen Of the
United SUtei, 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 Bard Order and Notice to Claimant, addressed to
the claimant as shpm above.
1 1906
Dated BY: PHIL BATCHELOR by�j� �"��lc a —^ Deputy Clerk
CC: County Cc.,rsf County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
LAW OFFICE OF �r
CHRISTINE VIERRA BOELK
October 23, 1996 RECEIVED
Mr. Ron Harvey
Liability Claims Manager r;" 0M
Contra Costa County CIFRK BOARD OF SUPERVISORS
651 Pine Street, Sixth Floor CONTRA COSTA CO.
Martinez, CA 94553
Re: Constructive Termination of Michael D. Abney, R.N.
Dear Mr. Harvey:
This letter will serve as both a demand letter and a Notice of Claim for Damages.
I have been retained by Mr. Michael D. Abney, R.N. to advise and represent him
regarding Contra Costa County's (hereafter"County") recent constructive termination of
his employment. In this regard, I have reviewed documents concerning the conditions
under which my client worked at the Martinez Detention Facility (hereafter "Detention
Facility") and regarding his employment. Based on my review and discussions with both
my client and Mr. Victor M. Klatt, R.N. it is my opinion that Mr. Abney was forced to
leave his employment due to discrimination, harassment and retaliation.( A copy of Mr.
Abney's letter of resignation is attached hereto as Exhibit A.) It is therefore my opinion
that he has a claim for constructive wrongful termination.
At the time my client was employed at the Detention Facility as a psychiatric assessment
registered nurse Mr. Klatt was also employed there in the same capacity. Mr. Klatt was
also forced to leave his position, although he has since accepted another nursing position
with the County. (A copy of Mr. Klatt's termination letter is attached as Exhibit B). Mr.
Abney was forced to leave his position because necessary medical procedures were not
being followed by the County and he was fearful that he would loose his nursing license.
Moreover, accreditation for the Martinez Detention Facility was approaching and Mr.
Abney's non-nursing supervisor, Myra Sherman, L.C.S.W. apparently wanted to have
scapegoats to blame if the Detention Facility was not accredited. At the same time that
my client and Mr. Klatt began having difficulties with Ms. Sherman, Micheko Graves-
Matthews, M.D., a county psychiatrist, also was forced to resign her part-time position
with the Detention Facility for similar reasons. (A copy of her letter dated May 28, 1996
and addressed to Joe Hartog, M.D. is attached as Exhibit Q.
Mr. Abney has filed a Complaint with the Department of Fair Employment and Housing
2800 PLEASANT HILL ROAD, SUITE 200 • PLEASANT HILL • CALIFORNIA 94523
(510) 927-1949 • FAX (510) 930-0204
Ron Harvey
October 23, 1996
Page two.
and obtained the necessary Right to Sue letter(A copy of the Complaint and Right to Sue
Letter are attached as Exhibit D).
It appears from my review of this matter that the Detention Facility has had longstanding
problems with the delivery of medical care to the inmates. My client did not contribute
to this problem and in fact was working to clear up these problems along with Mr. Klatt
and Dr. Graves-Matthews.
Mr. Abney has worked in psychiatric nursing for 22 years, initially as a psychiatric
technician and most recently as a registered nurse. (A copy of his resume is attached as
Exhibit E). In October 1995 Mr. Abney began working at the Detention Facility as a
psychiatric assessment R.N., a position which allowed him the flexibility and funds to
pursue a bachelors degree in nursing at Saint Mary's College in Moraga. He was excited
about the position and looked forward to continued employment with the County. In this
position he was required to use his assessment skills and worked closely with county
psychiatrists while maintaining maximum autonomy. During his employment with the
County he was able to initiate several policies and procedures in conjunction with Mr.
Klatt and Dr. Graves-Matthews. Upon his arrival the Detention Facility was without
numerous medically necessary policies and procedures. His position was without a job
description and he received only minimal orientation. Moreover, my client was initially
hired by Johnnie Williams, R.N. and LaVerta Guy, R.N. Once he began work he was
informed by Ms. Sherman, who is a licensed clinical social worker and not an R.N., that
she was his supervisor. Both Mr. Abney and Mr. Klatt were surprised to find that they
had virtually no contact with nursing management and that they were to be supervised by
an individual who did not have either a clear or comprehensive concept of the legalities
of nursing or routine nursing policies and procedures.
During my client's employment with the County the following procedures were
instituted: routine laboratory checks; routine scheduling of patients for initial medical
evaluations; routine follow-up medical appointments for medication refills and procedure
for handling medication requests by inmates. These innovations elevated the psychiatric
medical care provided to inmates from substandard to a reasonable standard of care.
Because of my client's concern for his patients/inmates; nursing procedures and fear of
losing his nursing license Mr. Abney met with Johnnie Williams, LaVerta Guy and Marty
Klatt at which time they agreed that they would no longer accept telephone orders from
the Mental Health Department Nurses because none of the telephone orders were being
Ron Harvey
October 23, 1996
Page three.
signed by doctors. Moreover, these deficiencies in the delivery of care would effect the
forthcoming accreditation of the Detention Facility should the deficiencies be found.
In retaliation Ms. Sherman consolidated the two nursing positions, which had previously
been flexible, into one position with fixed hours. Ms. Sherman was well aware that the
fixed hours were impossible for my client because of the bachelor's program he is
completing. Subsequently, my client has not been able to fmd a flexible nursing position.
He is surviving, while going to school with an on-call position, at Summit Medical
Center, which only guaranties him 8 days per month. He has had to use his savings and
is facing the possibility of needing a loan. Moreover, he wants to continue with graduate
school and may not be able to do so upon completion of his Bachelor's in Nursing due to
his economic position.
I sincerely hope that you will consider the contents of this letter and the potential
exposure that the County faces. My client is willing to settle this entire matter for
$300.000.00. Should we be unable to resolve this matter amicably, it will of course, be
necessary to explore the issues of discrimination, harassment and retaliation in discovery.
Thank you in advance for your careful consideration of this matter. I am requesting a
response from the County regarding this matter by December 23, 1996. Should you wish
to discuss any aspect of this matter feel free to call me.
Very truly
CHRISTINE VIERRA BOELK
C . ce
May 20, 1996
Ms. Myra Sherman
DirectorMental Health
Contra Costa Detention Facility
Martinez,California
Dear Ms.Sherman
It is with much regret that I must inform you that I must immediately resign my position as
Psych.Assessment Nurse in your department. It has recently been brought to my attention
that the some of the present policies that you employ as standard procedure in your
department are in direct violation to my license to practice as a Registered Nurse in the state
of California and even more disturbing,possibly illegal.The recognition of these
procedures by yourself and the lack of resolution of them has left me with no other option
but to resign. I feel that the upcoming accreditation review will substantiate my concern of
this matter.
It is my hope that in the departments best interest that change will be implemented without
delay.It is my additional hope that this change will be addressed promptly so that the
nurses who may follow me will not be put into such a precarious situation as I have found
myself.I can take pride in the implementation of changes that the department has
undergone since my start in the facility. With the help of my co-worker,Victor Klatz,we
have taken a system in total disarray and converted it to one of consistency and
accessibility.
If there are questions that you may have please feel free to contact me.
Sincerely
Michael D. Abney, R-1.
c.c. Laverda Guy, R.N.
Jonnie Williams, R.N.
Dr. Hartog
C ,(P
May 22, 1996
TO: Anita Duckett, Nursing Administration
Joe Hartog, M.D. Director, Mental Health
FROM: Victor M. Klatt, RN
This letter is to inform you that I have resigned as a mental health nurse assigned
to Martinez Detention Facility. My resignation was effective May 21 , 1996. 1 did not
resign voluntarily; I was given no choice by Myra Sherman, who informed me that
if I was not able to conform to a new work schedule, M-F 8-4:30, my services would
no longer be needed. Michael Abney was told the same thing.
This was an arbitrary and vindictive decision, based not on any real need in the mental
health office, that Myra made as a way to'remove Michael and myself from the positions
that we occupied. The evidence that upholds this is overwhelming; Myra
cites the number of contacts that were documented as the statistic she used to
determine that only one nurse would be needed; in fact, we had just come to an agreement
with Myra about what the duties of the mental health nurses would be,
as we did from time to time on an informal basis. This meeting was held in Myra's
office on 4/24/96; no mention was made at this time of any plans for work redesign.
In this meeting we also put forth the question of our job performance; I asked Myra
directly if we were performing our duties to her satisfaction. She replied that we were.
Myra also suggested that we make a progress note every time we obtained a
telephone order for medications, as a way of increasing our contact statistic. Myra
agreed at this time that our performance was not measurable by the number of contacts
we documented. It was acknowledged that our job involved making a large
number of phone contacts and transcription of medication orders, as well as being
available to the clinical specialists. It should be noted that implementation of active
caseloads for mental health nurses was also accomplished in close proximity to this
meeting; I mention this because it speaks to a pattern of behavior; namely that Myra was
satisfied on 4/24/96 that we were functioning satisfactorily in our capacity
as nurses in the mental health office.
During this same time period, it was brought to everyone's attention by nursing that
a problem existed concerning the fact that telephone orders were not being signed
- 1 -
by the psychiatrist, nor wer, any informed consents for ne oleptic medications C Ftp
being obtained, again by the psychiatrist. No decisions were made on how best to proceed
, but Myra agreed to check with Medical and inform us of how she wanted this to be dealt
with. Myra decided that we would need to pull all the charts of everyone
who had recieved medications (neuroleptics) and present these to the M.D. for her
signature. We agreed with this and began implementing the plan. On 5/2/96, 1 informed
Myra that Dr. Graves-Matthews and I had discussed this plan and that the Dr. had
another idea about how best to proceed; she would sign the pink copies of the medication
orders, which were more accessible to her. I informed Myra that the Dr.
had in fact called Dr. Hartog, who had approved this plan; also that the Dr. had asked
Dr. Hartog to send a memo to Myra stating this. Myra replied that it would do no good
for Dr. Hartog to send her a memo; it should instead be sent to Anita Duckett, as this
was basically a nursing issue. Later that same afternoon, Myra handed me a memo
which announced that a meeting was to be held with the mental health nurses and
Laverta Guy and Johnny Williams. When I asked Myra what this was about, she replied
"I'm not happy." She would not elaborate.
After the memo was promulgated, Myra became noncommunicative. She would answer
no questions we would ask about day to day issues, nor would she tell us what she
was so unhappy about. She was essentially freezing us out of the loop, because of her
perception that Dr. Graves-Matthews and the nurses had decided to do things our own
way in spite of being informed about how she wanted to proceed. There is no truth to
this perception; we were all trying to correct an identified deficiency in the most
expedient manner possible, as well as conforming to legal standards. It should be noted
that the jail was readying for the arrival of accreditation, and Myra had informed
everyone that based on the aforementioned deficiencies, mental health would fail
accreditation, which would be unacceptable to her, as mental health had always passed
as a matter of course, with only a perfuntory examination by the reviewers.
It became obvious at this point that Myra was holding the mental health nurses
accountable for errors that she believed would lead to failure of accreditation.
In fact these errors were not the fault of nursing, but were directly related to the
lack of a well-defined procedure to accomplish the retroactive signing of telephone
orders by the M.D. There also was no procedure in place to make sure that informed
consents were being accomplished; Myra made it clear that we would be held accountable
for this also.
At this point I would like to address general issues of our positions as nurses assigned
to mental health at the jail. When we arrived in October 1995, we were given no
orientation to Medical, nor were we given a coherent job description. We were basically
given three days of orientation to mental health, and told verbally what
the expectations were. I oriented with Michael Abney; he was oriented by a nurse who
spent one or two days a week at the jail and was primarily assigned to the hospital.
- 2 -
At he time were we oriented 1-o a policy and procedures ma al, nor were we informed
that there was written policy dealing with issues that we would be involved with. C (A
We were basically shown our desk and told to make sure that inmates received their
medications and had access to the psychiatrist. There was no standard operating_
procedure. We created it on a day to day basis, with guidance from Myra. There also
was no procedure for interfacing with Medical; in fact Myra continually minimized
any role that Medical had in our jobs, at one point suggesting that she would investigate
the possibility of having us supervised by Anita, instead of Johnny or
Laverta. She believed that this would more thoroughly separate us from any agenda
that Medical might have for us, so that she would be able to supervise us, in effect,
even though we were nurses and she had no ability to supervise nurses. This also
speaks to a pattern of behavior that Myra is now trying to distance herself from;
that in fact Myra was the only supervisor that we ever had and she made sure we
knew this.ln the entire time we were employed in the jail, we met with Laverta
only twice; the first time was in December and dealt primarily with the fact that
Laverta and Johnny were upset that their role as our supervisors was basically
nonexistent, and the reasons for this. The second time was on 5/15/96, when Laverta
informed us how we should accomplish having medication orders signed, and Myra
informed us of he new work redesign plan. We had no guidance or supervision from
Medical, in part because of Myra's machinations thwarting this, and in part because
of no coherent policy, written or otherwise, that told us how to proceed.
In spite of all this we managed to accomplish quite a bit in our capacity as mental health
nurses acting in a new position. Nursing assessments, medications, and appointments to
see the psychiatrist were all being done in a timely and effcient
manner; I was constantly being complimented on my abilities and my performance
as a certified mental health nurse by my co-workers and by Myra, as well as nurses
working in Medical and custody staff. All the staff continually said what a difference we
made to the overalll quality of effort put forth by the mental health office.
At no time were we ever formally or informally warned or counseled about our job
performance! As far as we knew, we were doing just what was asked of us. We were eager
to please, and continually sought feedback from Myra to ensure that we carried out her
interpretation of our duties.
After the meeting of 5/15, 1 informed Myra that I could not work M-F, 8-4:30, but
I would be willing to work Tues-Sat, due to other commitments. She immediately ruled
this out without an explanation. At this time I also asked her to explain to me her
perception of what had gone wrong; why was she now so displeased with my job
performance: She replied "I'm not willing to speak with you on an informal basis; if you
want a formal counseling I'll call Johnny and set it up." At that time I saw no need; I was
leaving anyway; what did it matter. I changed my mind the next day, and on Friday
5/17/96 at approximately 1500 1 met with Johnny and Myra in the library. Myra had
a list of deficiencies; I had taken an overly long lunch break on one occasion, and on
- 3 -
another occasion I was seen Iking to a deputy O'Mary for ( ,r two hours in the mental
health office. She also said that I had been seen leaving early; when asked to document
this she replied she could not. In fact she could not document any of these deficiencies;
when she was pressed to do this she replied " This is not a disciplinary hearing anyway,
we're just meeting because you wanted this." When asked why these deficiencies were
never brought to anyone's attention until now, she replied " I did'nt feel comfortable
talking to you about it because I'm not your supervisor." This was the very first time
Myra had ever denied being my supervisor; in fact she was the only supervisor we ever
had. It became painfully obvious at this time that Myra's intention was to scapegoat the
mental health nurses to distance herself from the problems that
might lead to failing accreditation, i.e. no informed consent and no co-signatures on the
telephone orders, which she believed us to be responsible for.
I strongly believe I have the basis for a complaint to be filed with the personnel office of
Contra Costa County; although I made the decision to resign, I did so when presented with
no other options. Myra knew very well when she changed the requirements for the hours
and the days of the job that neither myself nor Michael could accomodate these new
requirements; we both had other commitments when we were hired and Myra was made
aware of this. She effectively ended our employment, which was her true intention . I am
also very concerned that I may have been placing my license as an RN in
jeopardy by carrying out aspects of the job that on the face of it are illegal, such as
obtaining telephone orders for inmates without informed consent for neuroleptic
medications, or dispensing medications without an informed consent. While it is my
intention to seek an amicable resolution to this situation, I am not optimistic that this
can be accomplished.
I look forward to meeting with Anita on 5/29/96; 1 would also welcome a meeting with
Dr. Hartog at his convenience. Thank you for taking the time to review this matter.
Sincerely,
Victor M. Klatt, RN
- 4 -
.TIN-F4-1'tW IF:IP, FFrl'1 P1T;F FFri Si F% PF('J-RTA Til -APF PIP P.PI
n.. / / ��(J „w�K, Far.
co1kgiI�0_4' []Hmff UIItr OA%�P
J 0S
1 J 1
( 1 )
Joe hartog, M.U.
Medical Directcr, Mental Health Division
Merrithew Memorial .iospital
2500 Alhambra Avenue
Martinez, CA 94553
May 28, 199G
ur. Hartog:
It is with sincere regret that I submit this letter of
resignation of my prasitiun as SLaff PbyuhiaLrisL aL the Martinez
Detention Yacility.
Per our telephone uuuveLbaLlull of May 29t1j, T must.
relinquish my position as of Tuesday, June 11 secondary to
another employment uu=iiLweaL. I apologize for any Inrnnvenience
this may cause for patients or staff.
It ib LLuly w1Lh regret. that T leave the Martinez Detention
Faciiityr as until approximately 4 weekw ago, I actually was _
1jeyi=1u9 Lu feel that. what. had starred as a nearly impossible
clinical situation was beginning to be corrected.
I sLarLed my work at MT7r 1n AvglISr of 1995 and at that
time thought that I would be working opposite another
psychiatrist. This wrnild have meant that between us, at least
Monday through Friday, there would always be psychiatric
coverage. xawaver, T was informed days prior to my startdate
that the other psychiatrist had resigned, in summary, secondaly
to clar;hAr with rorrectional staff amongst other system problems.
The problem of not being able to work effectively dune to _
Intprfaring with correctional staff, particularly when the
psychiatrist was required to visit all of the varlotis wriAtiles
to Sap patients was a problem that had apparently long been.
recognized. It was at this time, with the assist.Anrsellr nr.
Rapt , Medical Director at MDF, that we attempted to catablish
a Clinic modelforpsychiatric patient£. 1P... tI»I [,+lits from other
mruules would be transported to M module to be ocen by me on
Thursdays following Medicine clinic_ Ariel T wvu}.d see M module
patients on Tuesdays. . . UNTIL ANOTHER PSYCHIATRIST WAG AIRED.
Needless to say, this did nul, itApj>wri and the system of
care for psychiatric patients wan chaotic at the very best.
Patients routinely Znir coil or medications and waited months
to see the doctor.
Though still understnfsHcl (T was the only psychiatrist
and was working 2 days per wcok) , I had been working since
October with two experiencrel i»:yvhiatric R.N.s who were in my
opinion doing excellent work in. performing medication follow-
ups, triaging patient nNerlx acrd requests, verifying medicaticner
doing medical clearancoc ao wcll as using telephone orders from
me to attempt to cmi-0r rip on the backlog of some 50-75 patients
who were receiving psychiatric medications.
Until approxl.uALI ly 4 weeks ago, I nor these psychiatric
R.N.s were aware of .any dissatisfaction with their pRxfrlreeuaerr:P.
At a meetiny tie, Mpy 15th, the R.N.s were told for the tirct
time that only one R.N. working a 40 hour week, Monday Llertmyll
T
UN-04-1996 16: Se FROM MDF MEDICAL RECORDS TO 952662ie P.02
( 2 )
Fridays would be necessary. As staff psychiatrist working most
closely with Lheae uuLses, I was neither informed of no-
consulted with regarding this decision! Since neither of the
the R.N.s could dLoimuudaLe the new requirements, they felt
they had no choice but to resign.
A week prior Lu Llie nurses ' resignations I returned
following a week' s vacation to learn that we were no longer
allowed to do telepilucie urdL_L6 without a written informed consent
in the chart. Most of the charts had no informed consents by
myself or any other p5yuhlaLList who had treated these same
patients. At no time prior to April was it made clear to me
that this was an abseluLe requiLeatent within this correctional
setting. In April, Ms . Sherman, supervisor of the mental health
staff, informed me that this would Le required and I had plans
to begin implementing this though the forms were outdated ( 1986)
and had not gotten the impression LhaL LLis was an urgent matter.
of course, I always obtained verbal consent from the
patients i treated and explained possible and pLubaLle side
effects secondary to the medications as well as any required
laboratory work and expectations regarding the allevidLiuii of
symptoms. There was also an issue about signing the telephone
orders, again an issue that had never been focused uu den: had
no protocol for implementation. This included numerous telephone
orders received from various physicians within the system.
When I received some direction from you regarding the proper
procedure to toilow, this apparently lead to a feeling by Ms.
Sherman that we (myself and the R.N.$) were thwarting her
authority which was not the case at all. we were simply
attempting to find out what,_the correct protocol was.
Then, on Thursday, May 16th, I spoke with Dr. Rael, Medical
Director at MDF, as circumstances appeared to quickly be
deteriorating. He proceeded to relate to me that Ms . Sherman
was "very unhappy with my work" , and went on to document numerous
problems that she perceived with my performance; none of which
had been shared with me or to my knowledge, with my direct
supervisor, namely you. I was later told by Ms. Sherman that
she had perceived me as being "hostile" when she had approached
me which frankly, personal perceptions notwithstanding, was
a ludicrous accusation. I was always approachable and courteous
with both Ms. Sherman and her staff. As an occupational hazard,
I can only speculate on the source of this obvious projection.
For the record, I had only been approached once regarding the
informed consent forms, which I had agreed to do (obviously
not in a timely enough fashion) and never regarding her other
complaints.
I was quite surprised, but agreed to a meeting with Dr.
Rael, Ms. Sherman and yourself on the following Tuesday. In
the meantime, it was clear to me that a system that the nurses
and I had worked hard to develop over the past 6 months. was
being dismantled. With a few more months of organization and
another psychiatrist, we could have finally provided adequate
mental health care for the patients at MDF. I was and am VERY
disappointed and angry about this.
From then on things went downhill. The R.N.s resigned.
TOTAL P.02
TI N-04-194i Iti:! I FRrn KFF rFirtiN RFr1'RTA Tn 4:?FAPIP P.911
To - From
Camay carnwr t
Lmi rcarn DW CNVW
Poo�a/(D /;V� neem+ , rai Twr w
ta, CP �. u „ �r,�nm �calmrarzc
(3)
There we:iee 2 meetings during which I was attacked and blamed
in a public setting for ongoing system yrohlems As well as my
personAl 1,Nr rr..rmance maligned. 'Phare were many double messectes
for example: I did the best psychinl.rk: work ur any of the staff
pwytrL iet.ri.sts employed by MW , yet my evaluations were, as Ms.
Sherman nut it, "not much more t11wr1 :hr+ work of the mental health
s!.n r r"
Althouqh following the first. or IIrr,Se meetings I was still
willing to remain, correct any aeticicneies on my part and hope
for the best, after the second mee!.lny, it was clear to me that
T w,+v, as you yourself so aptly put it, "taking the fall for
longstandinq system problems".
I am a board Certified psythiatriat with more than 10 yeaib
of experience. Although ther-eIiAtl been complaints about the
level of concern for patient care no well as expertise on the
Part of previous psychiatrists, L was basically told that I
wasn't doing enough though I had been told when I began at MDF
to work at my own pace Anel t.o keep patient care paramount.
Though restricted by my part-time position, I attemyLed
to use my expertise to improved working conditions and patient
care. I implemented a.m. "rounds" to encourage staff cohesiveness
while performing sue::1 tlirricult work as well as for continuity
of ;are. i aided star* development in the area of meuLdl health
for mental health, medical and correctional staff. Along with
the R.N.a, I developed systems to track pdtiwiL care ia_
medication rr.ril.ls, laboratory work etc. an wolf as successfully
treated many patients.
T knww that this position would be imposoibie for one M.D.
to execute on a part-time basis, but db I slated earlier, things
overall wHrw improving and'1"had hope for a workable system
in the near future.
T understand that things car, change rapidly within public
health care systems particularly in light of thatat largar political
ulinrnte. Changes in my work atylo would have been needed were
I to continue working at the MDF with basically no medical
sjipport staff except for an R.N. occasionally borrowed from
an already overtaxed medical SLdff_
This is a challenge that could have been met, however ,
given the current cicc;uutsLacrces, onp I respectfully decline.
5incsr ours,
Mrhpko Graves-Matthews, M.D.
cc: James Raul, M.D.
Anita Duckett, R.N.
Myra ShaLmdu, L.C.S,w,
IUINL P.01
x x EMPLOYMENT * -
COMPLAINT OF OISCRIMINATION UNDER OFEH
THE PROVISIONS OF THE CALIFORNIA
FAIR EMPLOYMENT AND ECUS>"NG ACT
_ C4 TFORNIA OVA RTMENT OF FAIR EMPLOYMENT :ANO NOUSiNG
YOUR 7E iincicate ir, or Is. - iE_E?HONE MUMfii:a i:nctuca Area '.;ce
Mr Mir*hae La
Den hbAg ( d10 )—a59 7823
:DDRE3s 1 ' fornia 94706
T"c;'=:P _v i CUMTY ^:wE
NAMED, i5 THE EMPLOYER, LA cOR ORGAN:=.4Ti0N, EFL3YMEiT AGcVC``, ;PPQEIT�CESHi? COMMZi Ec, ST.;
OR LOCAL GOVC?NMENi AGENCY '-R MHO OiSCRIM?NATE AGAINST .ME:
a
UK -- - NE 'UH "� civaArm
Q
V.-.(/__ __ _ j10� � :^U'si'' _DOE
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.. 4Z=3:1r A'"" '4cc'',T :ZEin '6S' T 3R _ Ni:1UIN6
CK ='_;C£ ':rant cay. and Tear': + CEO
AR7*= IRS
On {U was _ " _ cen:ec ana ic;mnert _ .aniea 'ami.y 'eave
,aa a _r ^ani ":sic afr ter.ied arcraticn ceniec crecnancq 'eave
dematac ! ceniec :r_ns:ar
can ad acus; coy
iarassec _ can ied acc-+mcaz:cn
'c'rcaq 3 AultL..er �sceo%'I}
Mame arrersa Je^ i .::e isuce^n nary SandC_r;pertanrtel di Yedtar;9C].,
because Of my: y� sax ace;coiar :hvsicai cisac:ti,r _ (C:rc:e one)
..._ age •iat7cnai ar:ginlancastry .nentai aisauj'ity crctest:ng; part:c:ca::ng :^
;ami ly naritai status .ecicai ccncitio nvesC t: allot n 3or
T reiigiart _ associatian ocher (scec'fv)
the mason given by
I ,ya{� �, /{�J��)• .flame of ?>_rsar. and .:ac
was because 6T' ��2i a��G��'��
I 'wish to purue this natter in court. i heresy reouest :hat the Oecarz=ent or Fair E-mioyment and lousing pravice in
authorization to file a lawsuit_
I have net been coerced into making ;his racuest, nor cc i make it based an 'ear of retaiiat'.on if ! co net co s0. i uncerstanc
it is the Oecarzent of Fair Emcicrmeat and :'lousing s aoiic-i to not process or recewn a camaiaint once ` a
e cac faint has :eon
closed an the basis or 'complainant Piected Court Action .. -
I declare under.perralty of perjury that the foregoing is true and correct of my own knowledge except as to matters stated on my
information and belief, and as to thane o4tters I believe it to be true_
gated
COMPLAINANT'S SIGNATURE
At
City
. CATE FILED:
OFEM-300-03 (New aziga) .
DEPARTMENT OF FAIR El1PLOYMEHT AND HOUSING n STATE OF CALIFORN-
Y/
RIGHT-TG SUE COMPLAINT STATIST .AL SHEET -
e . 4 :
We need a separate_ signed complaint .'or each employer, labor organization,
employment agency, aporsnticeship committee, state or local government agency,
or individuai you wish to 'Tie against. if you are filing against- both a
company and an individual (s) , please complete separate complaint forms naming
the company or an individual in the appropriate area.
Please complete the following for statistical purposes, and return with your
signed compiaint(s) :
YOUR ETHNICITY: (Check one) YOUR AGE:
African-American 13
Asian
Caucasian YOUR GENDER:
Filipino Female
Hispanic (Other :han Mexican Mahe
or Mexican-American)
I r^ '1
Mexican-Amer-'.car, -T
.LIVG 3E";Uac l,F T s1n T"`
Mexican National YOUR DISABiLIT' .
Native American AIDS
Polynesian Blood/Circulation
Other _ Cerebral/Neuro/Muscular
_ Digest/Urinary/Reproduction
YOUR OCCUPATION: Hearing
Clerical _4 Heart -
Craft Limbs
Equipment Operator Mental
Laborer Sight
Manager Speech/Respiratory
Paraprofessional Spinal/Bgck
Professional
Sales IF FILING BECAUSEOF MARITAL STATUS.
_ Service YOUR MARITAL STATUS: (Check one)
Supervisor ,, tt Cohabitation
Technician Divorced
_ Married
HOW YOU HEARD ABOUT DFEH: Sincle
Attorney — -
Bus/BART Advertisament iF FILING SECAUSE OF RELIGION. YOUR
Community Organization RELIGION: (Check one)
EEOC Catholic
EDD Jewish
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Labor Standards Enforcement Other
Local Government Agency
Poster IF FILING BECAUSE OF SEX THE
Prior Contact with OFEH REASON:
Radio _ Harassment
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_ TV Pregnancy 4 �
Otheations
Your Signature Date
OFEM-300-03-I (03/93)
DEPARTMENT OF FAIR EMPLOYMENT AND HOUSING STATE OF CALIFORNIA
ADDENDUM TO COMPLAINT - Michael Dean Abney
California Department of Fair Employment and Housing
I worked for Contra Costa County as a psychiatric R.N. at the Martinez Detention Facility in a
newly created nursing position. I and another male nurse, Marty Klatt, held the only positions
of psychiatric nurse there. Both of us started working 30 hours a week. We were given
flexibility and I was able to attnd classes at St. Mary's College and make up any time I spent
away from work for classes. We were gradually allowed to have additional hours of work -up to
44 hours a week each. In the course of our jobs we were forced to call various physicians outside
of the detention facility for medication orders for the inmates, which we then charted as
telephone orders.
County psychiatrists were required by their supervisors to give medication orders for inmates
whom they had not previously seen. The requirement is that physicians must sign their
telephone orders within 72 hours. This was never done by any outside physicians I called for
orders. Moreover, the majority of psychiatric medications require that informed consent be
given by a physician and that consents be signed. This procedure was routinely ignored.
I complained to my supervisor, Myra Sherman, regarding these problems and no attempts were
made to get the orders signed by outside doctors while I was employed there, I consequently
became fearful that I would lose my nursing license and/or that an inmate would die and felt
compelled to leave my position when I was unable to change these practices. (Mr. Marty Klatt
also quit when I did for the same reasons).
I also have observed and heard that men are not treated fairly by Ms. Sherman and that they are
either fired or forced to quit their jobs. The environment I worked in was extremely hostile
towards me and other men.
I am a Native American and I believe that the environment was also hostile towards me based
upon this fact.
Michael Dean Abney
MICHAEL DEAN ABNEY
1106 Talbot Avenue ,Lp
Albany, California 94706
(510) 559-7823
OBJECTIVE.
A Registered Nursing position in a Chemical Dependency Unit
which will offer opportunities for professional growth and career development
CAREER HIGHLIGHTS:
o Over twenty years experience in psychiatric nursing in both adult and adolescent facilities serving a
wide variety of single and multiple diagnoses,with a strong emphasis on chemical dependency.
o Extensive supervisory experience,including Charge Nurse and Shift Supervisor responsibilities.
o Proven skills in facilitating groups,as well as crisis intervention and one-to-one counseling.
o Comprehensive assessment skills for admissions,discharge,protocols,and staffing.
o Specialized experience with dual diagnosis and multiple chemical detox patients.
o Solid familiarity with IBM PC computers on on-line hospital database systems.
PROFESSIONAL EXPERIENCE:
Registered Nurse-Staff II
ALTA BATES-HERRICK HOSPITAL Berkeley,California 1994 to Present
o Serving as Night Charge Nurse for Dual Diagnosis Program,and rotating as multi-unit Charge Nurse.
o Monitoring staffing levels based upon number and acuity of patients and special care requirements.
o Assessing patients and facilitating admissions from Alameda County and regional Kaiser hospitals.
o Administering medications,and initiating N's and IM's as needed.
o Performing crisis intervention and one-to-one counseling.
Registered Nurse-Cbemical Dependency Nurse
SUMMIT MEDICAL CENTER--MERRITT-PERALTA INSTITUTE Oakland,California 1995(present)
o Providing direct patient care in an adult chemical dependency unit.
o Coordinating multiple chemical detox,including alcohol,opiates,hypnotics,and stimulants.
c, Monitoring vitals on Q.of 15-30 minutes,monitoring labs,and implementing protocols.
o Facilitating groups,and performing crisis intervention and one-to-one counseling.
o Administering medications,and initiating N's and IM's as needed.
o Assessing patients for both admissions and discharge.
Registered Nurse/Licensed Psychiatric Technician
MT.DIABLO PAVILION—CENTER FOR RECOVERY Concord,California 1991 to Present
o Providing direct patient care in a chemical dependency unit serving Kaiser and other providers.
o Coordinating multiple chemical detox,including alcohol,opiates,hypnotics,and stimulants.
c, Monitoring vitals on Q.of 15-30 minutes,monitoring labs,and implementing protocols.
o Facilitating groups,and performing crisis intervention and one-to-one counseling.
o Administering medications,and initiating Ns and IM's as needed.
o Assessing patients for both admissions and discharge.
Licensed Psycbtatric Tecbnlclan
KAISER HOSPITAL Martinez,California 1991 to 1994
o Provided direct patient care in an adult open psychiatric unit.
o Facilitated groups,and performed crisis intervention and one-to-one counseling
o Administered and documented medications.
MICHAEL DEAN ABNEY C RESUME, PAGE 2
PROFESSIONAL EXPERIENCE: (continued)
Licensed Psychiatric Technician
FIRST HOSPITAL OF VALLEJO Vallejo,California 1987 to 1991
o Provided direct patient care for an adolescent dual diagnosis unit.
o Facilitated groups,and performed crisis intervention and one-to-one counseling.
o Assessed patients and assisted with admissions.
Licensed Psychiatric Technician
SONOMA VALLEY HOSPITAL--PARKSIDE Sonoma,California 1987 to 1988
o Provided direct patient care for an adolescent chemical dependency unit.
o Facilitated groups,and performed crisis intervention and one-to-one counseling.
o Assessed patients and assisted with admissions.
Licensed Psychiatric Technician
NAPA STATE HOSPITAL Napa,California 1974 to 1988
o Served as Shift Supervisor for 5 adult psychiatric units totaling 25 staff and up to 175 patients.
C, Monitored staffing levels based upon number and acuity of patients and special care needs.
o Ran groups encompassing a variety of diagnoses,including geriatric and forensic.
o Responded to incidents involving restraint,seclusion,injury,or death.
EDUCATION& TRAINING:
Studying for Bachelor of Science in Nursing
UNIVERSITY OF PHOENIX Extension Program 1995(present)
Associate Diploma in Nursing
NAPAJUNIOR COLLEGE Napa,California 1994
Business Management Courses
SONOMA STATE UNIVERSITY Rohnert Park,California 1978
Associate of Science—Psycbiatric Technician Licenses
NAPA JUNIOR COLLEGE Napa,California 1974
Associate of Arts—General studies
SOLANO JUNIOR COLLEGE Rockville,California 1972
LICENSES & CERTIFICATIONS:
Registered Nurse
STATE OF CALIFORNIA RN 505797 current
Licensed Psychiatric Technician
STATE OF CALIFORNIA L 15133 current
N&Phlebotomy Certification
MT.DIABLO PAVILION current
CPR-BLS Certification
AMERICAN HEART ASSOCIATION current
REFERENCES;
Available Upon Request
CLA,,.
BOA,: Or S %[a::s:as Or CON' CS-A COU%*Y, CALIFOaNIA December 10, 1996
Claim Against the County, or District governed by) BOW, ACTION
the Boart cl Supervisors, Routing Endorsements, ) NOOTiCE TO CLAIMANT
And Boa-: Action. All Section references art 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 pursuan v
Amount: $5,000,000.00 Section 913 and 915.1. Please MOMAI h T-4
CLAIMANT: David Y. Kroeger NOV 0 4 1996
SL
ATTORNEY: Dennis O'Brien, SBN 37628 �MAURNTINEZCALIF.
O'Brien, Sullivan & Jensen Date received
ADDRESS: 1299 Newell Hill Place, Ste. 300 BY DELIVERY iO CLERK ON November 4, 1996
Walnut Creek, CA 94596
9Y 14A1l POSTMARKED: Hand Delivered
1. FROM: Clerk of the Bard of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DATED: November 4, 1996 V)L LATp yIOR, Clerk
II. FROM: County Counsel TO: Clerk of the Bard of Supervisors
This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAIL$ to Comply subsuntially with Sections 910 and 910.2, and we are to notifying
claimant. The Bard cannot act for 16 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: ��f /(y BY: Deputy County Counsel
111. FROM: Clerk Of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice te claimant (Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present
(X) This Claim is rejected in full.
( )
Other:
I certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this date.
DEC 1011 . , C c�
Dated: PHIL BATCHELOR, Clerk, �i�-via'&dA-r - , OIDutY Cierk
YARNING (Gov. cede section 913)
Subject to cergin exteptiou, you have only six (B) months fro the date this notice was personally served Or
deposited in the mail to file A court action On this claim. See Government Code SOCLion 945.6.
you ay seek the advice of an attorney of your choice in connaction 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 halm, and at all times herein mentioned, he" been A citi2en of the
United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez.
California, postage fully prepaid a certified copy Of this Bard Order and Notice to Claimant, addressed to
the claimant as sholm above.
Dated: BY: PHIL BATCHELOR �ioeDutY Werk
CC: County Cc.rse County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
claim to: BOARD OF 80PERVISORS OF OMURA C(=A 077RTY
INSPR9crim m a ADm
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,
19889 must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of action. (Govt. Code §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
30
RE: Claim By ) Reserved for Clerk's filing stamp
DAVID Y. KROEGER ) RECEIVED
4d
VG
Aga
) Ld
Cm 412 '�
Inst the County of Contra Costa ; 4
District) OF SUPERVISORS
A 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 $ 5,000,000.00 and in:support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
AUGUST 12, 1996 AT 5:30 P.M.
2. Where did the damage or injury occur? (Include city and county)
ON VASCO ROAD SOUTHBOUND 5.5 MILES SOUTH OF CAMINO DIABLO ROAD
3. How did the damage or injury occur? (Give full detailas use extra paper if
required) ,
CLAIMANT WAS RUN OFF THE ROAD BY GLEN LEE PRITCHE7T, JR. WHO WAS HEADING IN THE OPPOSITE
DIRECTION, PASSING AUTOMOBILES ON CLAIMANT'S SIDE OF THE ROAD.
4. What particular act or omission on the part of oounty or district officers,
servants Or employees caused the injury x damage? THE DESIGN OF THE ROAD TO LOCATION
WAS DEFECTIVE IN THAT IT HAD INADEQUATE STRIPING, THERE SHOULD HAVE- BEEN NO PASSING, THE
SP EID CONTROL WAS INADEQUATE AND THE MAINTENANCE OF THE ROAD AND THE SMOULDER AND JOINING
AREAS WAS INADEQUATE.
(over)
5. 'What are the names of -ounty or district officers, servar is or employee's causing
the damage or injury?
CONTRA COSTA COUNTY
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. DAMAGED AORTA REQUIRING
SURGERY; DAMAGED SPLEEN; COLLAPSED LUNG; DAMAGED LIVER; VARIOUS OTHER INJURIES THE FULL
EXTENT OF WHICH ARE UNKNOWN.
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.)
CLAIMANT'S MEDICAL BILLS EXCEED $100,000.00 AT THIS TIME. CLAIMANT WILL HAVE PERMANENT,
LASTING AND SEVERE INJURIES AS A RESULT OF THIS ACCIDENT.
$. Names and addresses of witnesses doctors and hospitals.
WITNESSES: SEE ATTACHED POLICE R&PORT
DOCTORS AND HOSPITALS: JOHN MUIR MEDICAL CENTER, WALNUT CREEK; SANTA CLARA VALLEY
MEDICAL CENTER, 751 BASCOM AVENUE, SAN JOSE, CA - NUMEROUS DOCTORS
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMOUNT
NO MEDICAL BILLS .f4QE� gEN PAID YET.
Gov. Code Sec. 910.2 provides:
"The claim must be signed by the claimant
SEND NOTICES TO: (Attorney) or by some person on lf."
Name and Address of Attorney t - - - , DATE: 11-1-96
DENNIS O'BRIEN, SBN 37628 t.~tt A PORNEY FOR CLAIMANT
O'BRIEN, SULLIVAN & JENSENal�m3ilL s ai
1299 NEWELL HILL PLACE, SUITE 300 1299 NEWELL HILL PLACE, SUITE 300
WALNUT CREEK, CA 94596 (Address)
WALNUT CREEK, CA 94596
Telephone No. (510) 935-8800 Telephone No. (510) 935-8800
# # # # # # # # * M * * # # # # # #
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 beard 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 ($10000), 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.
MEMORANDUM TO FILE
RE: KROEGER V. PRITCHETT - FILING CLAIM WITH THE
BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY
ON: 10-31-96
BY: ADRIENNE GUY, SECRETARY TO DENNIS O'BRIEN
I called the Clerk of the Board of Supervisors of Contra
Costa County at (510) 646-2371, located at 651 Pine Street,
Martinez, California 94553 on October 31, 1996 regarding the
filing procedure for a Claim against Contra Costa County.
The Clerk, Susie Turner, informed me that one original and
one copy of the Claim could be hand-served or served by mail
at the address listed above, and that we would receive back
a filed-endorsed copy. /
Dated: October 31, 1996 �—
Adrienne Guy
SPATE OF CALIFORNIA C 4
TRAF�Tc COLLISION REPORT PM8 /�BP 15
SPECIAL CONDITIONS NO DO H&R PEL CITY JUDICIAL DISTRICT NUMBER
2 jq UNINC DELTA A +�
NOKILL H&AMISD COUNTY D/ST BEAT
0 CONTRA COSTA 660 a Sears. OAM468CI
COLLISION OCCURRED ON: MO �-.Y YEAR TRHE(240D) NocI OFFICER I.D.
o VASCO RD. (N/B) 08 12196 1730 9390 013756
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHS BY:
I
MONDAY (X]YEs [] NG SGT. RALEIGH
N II AT INTERSECTION WITH: STATE HWY REL
oR: 5 . 5 mile (s) S of CAMINO DIABLO RD. YES Pq NO NONE
PARTY DRIVER'S LICENSE NUMBER STATE CLASSSAFETY 'YEN YR MAKE/MODEVCOLOR LICENSE NUMBER STATI
1 K0279246 CA C G 91 HONDA. CRX. WHT. _ . .. . . BLEUKNT. , CA
DRIVER NAME(FHW,MIDDLE.LAST}
jq GLEN LEE PRITCHETT JR
PEDES- STREET ADDRESS OWNER'S NAME Pa] SAME AS DRIVER
T'rj 2821 LA JOLLA DR.
PARRK1ED CITYTSTATEMP OWNER'S ADDRESS j] SAMEASDRIVER
V'r ANTIOCH CA 94509
SIMSEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: (] OFFICER K) DRIVER []OTHER
ct M BRN BRN 5-06 160 OS 03 43 FLED SCENE
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONEAPPARENT{�TFF��
REFER TO NARRATIVE(
[] (510) 779-1316 (510) 562-5290 CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
EHIC
V
INSURANCE CARRIER POLICY NUMBER I LE TYPE []llNK ]}(]NONE []MINOR
ALLSTATE 014658223 01 (]MOD.( MAIOR ( TOTAL ��
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N VASCO RD. 55 21751
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE
2 C3287SS3 CA C B 96 CHEV CELEB WHT . . . . . 3PVZ793 ., CA
DRIVER NAME(FIRST.MIDDLE.LASI)
P] DAVID YOSHI KROEGER
PEDES- STREET ADDRESS OWNER'S NAME (] SAME AS DRIVER
TR(Af4 2010 BLOOMFIELD RD. ENTERPRISE RENTALS
PARKED CTTY/STATEMIP OWNER'S ADDRESS [] SAME AS DRIVER
VEIi1�L GILROY CA 95020 29SO MERCED ST. SUITE 128, SAN LEANDRO, CA 94577
BICY- SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE WSPO OF VEHICLE ON ORDERS OF: Ey OFflCER DRIVER ]]OTHER
cLIS{' M BRN ERN 5-07 185 03118167 R. LANCE AND SON'S TOWING IIyy�1(800) 974-9974
OTHER HOMEPHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT Fy REFER TO NARRATIVE
[] `4 0 8) 847-7310 ( ) NONE VICNLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
EHLE
INSURANCE CARRIER POLICY NUMBER (] (]NONE (]MINOR
NONE
01 (]MOMO D.(K]MAJOR ( TOTAL,
DIR TRV ON STREET OR HIGHWAY DLMT PCP
S VASCO RD. 55
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE"MODELK:OLOR LICENSE NUMBER STATE
3 C6849377 CA C G 87 CHEV . . . . . . . . . . .BLAZER GRY . . . . . . . . . . CA
DRIVER NAME(FIRST,MIDDLE.LAST)
} JEFFREY BRYAN COOKE T�I
PEDES. STREET ADDRESS OWNER'S NAME 4y SAME AS DRIVER
TT`�Aj 161 CURT I S DR. A/1
PARKED CTTY/STATEMP OWNER'S ADDRESS E'2 SAME AS DRIVER
VE BRENTWOOD CA 94513a SIC
F[�
CL SEX HAIR EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: []OFFICER {} DRIVER (]OTHER
cL[ M BRN GRN 6-02 160 12 12 62 DRIVEN AWAY yy��
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONEAPPARENTfy REFERTONARRATIVE(]
(] (510) 634-7560 (510) 422-8482 VEHCLET pf FDEUCIUB8 VEHICLE DTA�MAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER NK []NONE {s]MINOR
MERCURY APS9008786 01MOD-( ]MAOR ]TOTAL �
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N VASCO RD. 55
PREPAR£R'S NAME DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED
MORRIS M 013756 MYm rIN. fl NIA %7
SPATE OF CALIFORNIA
TRAFFIC COLLISION REPORT �% • rA s 2 oP /v
SPECIAL CONDITIONS NO INI H&R FEL ,Y IUOICIAL DISTRICT NUMBER
2 KI INCUNDELTA 8
NO KILL H&R MLSD COUNTY DIST BEAT
0 CONTRA COSTA 660 c•scarB: oANasacL
COLLISION OCCURRED ON: MO DAY YEAR TIMEO400) NCICI OFFICER I.D.
L VASCO RD. (N/1B) 08112196 1730 9390 013756
C
A MILEPOST INFORMATION: DAY OF WEEK TOW AWAY PHOTOGRAPHSBY:
T
1
G MONDAY PqYES NO SGT. RALEIGH
N [I AT INTERSECTION WITH: SPATE HWY REL
—pqOR: 5 . 5 mile (s) .5' Of CAMINO DIABLO RD. f I YES Pq NO NONE
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE
4 P0727879 CA C I L 91 TOYOTA MR2 BLU 2WHS662 CA
. . . . . . . . . . . . . .
DRIVER NAME(FlRST,MIDDLE.LASIT
P] ROSALIE ANTIONETTE VIERRA
PEDES- STREET ADDRESS OWNER'S NAME 19 SAME AS DRIVER
' ff 2149 FIRWOOD CT.
PARKED CTTY/STATEMP OWNER'S ADDRESS PJ SAMEASDRIVER
VE[i11:L BYRON CA 94514
BIC`Y-J SEX NAIR I EYES HEIGHT WEIGHT BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: P'1 OFFICER [ DRIVER [)OTHER
CL F BLK BRN 5-03 102 07 24 48 R. LANCE AND SON'S TOWING (800) 974-997 _
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPAREN REFER TO NARRATIVE[ )
[ (510) 634-984S ( ) NONE CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLETYPE 7
CSAA 77-02-72-3 01 I [IGNIc [)"GIVE MINOR
[�MOD.[�MA)OR [�TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
N VASCO RD. 55
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEIICOLOR LICENSE NUMBER STATE
5
DRIVER NAME(FIRST.MIDDLE.LAST)
[I
PEDES- STREET ADDRESS OWNER'SNAME SAME AS DRIVER
TRry
PARKED CTTY/STATE/ZIP OWNER'S ADDRESS SAMEASDRIVER
VErTL
BICY- SEX HAIR I EYES I HEIGHT WEIGH BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ OFFICER [ DRIVER [ OTHER
CL[j
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[] REFER TO NARRATIVE[)
[] CHP USE DE
ONLY SCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
INSURANCE CARRIER POLICY NUMBER VEHICLE TYPE [)UNK [ NONE [)MINOR
I MOD.[ MAIOR []TOTAL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
I
PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAFETY VEH YR MAKE/MODEL/COLOR LICENSE NUMBER STATE!
6
DRIVER NAME(FIRST.MIDDLE.LASI)
[l
PEDES- STREET ADDRESS OWNER'S NAME [ SAME AS DRIVER
TR[AN
PARKED CTTY/STATEMP OWNER'S ADDRESS SAME AS DRIVER
VTTL
CICY. SEX HAIR EYES HEIGHTWEIGH 1 BIRTHDATE RACE DISPO OF VEHICLE ON ORDERS OF: [ OFFICER [ DRIVER [)OTHER
OTHER HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: NONE APPARENT[ REFER TO NARRATIVE [
[ CHP USE ONLY DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED AREA
VEHICLE TYPE [
INSURANCE CARRIER POLICY NUMBER ]UNK [�NONE I [ MINOR
[)MOD.[]MAJOR []=AL
DIR TRV ON STREET OR HIGHWAY PD LMT PCF
PREPARER'S NAME DISPATCH NOTIFIED REVIEWER'S NAME DATE REVIEWED
MORRIS M 013756 Y�, HL N/A
SFATE OF CALIFORNIA
TRAFFIC COLLISION CODING e ' (0 PAoR 3 op /
DATE OF ORIGINAL INCIDENT TIME(2MW) NCIC NUMBER OFFICER LD, NUMBER
08 - 12 - 96 1730 9390 013756 0AM468C1 4r -
OWNERS NAMEJADDRESS NOTIFIED
PROPERTY
DESCRIPTION OF DAMAGE
DAMAGE
SEATING POSITION OCCUPANTS MM BICYCLE-HELMET SAFETY EQUIPMENT EJECTED FROM VEH
1-DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED2w6 PASSENGERS B.UNKNOWN M-AIR BAG NOT DEPLOYED V-NER I-FULLY EIELLY EJ D
T-SR. REAR C-LAP BELT USED N-OTHER V-NO 2-PARTIALLY EJECTED
I2J d-RSITIO UK.OR VAN D-LAP BELT SHOULDER HA USED p-NOT REQUIRED W-YES 7-UNKNOWN
9-POSITION UNKNOWN E-SHOULDER HARNESS USED
1 5 6 0-OTHER F-LAP/SH ULDER HARNESS USED CHILD RESTRAINT PASSENGER
7 USED -IN VEHICLE USED X-NO
H-LAP/SHOULDER HARNESS NOT USED R-N VEHICLE NOT USED Y-YES
I-PASSIVE RESTRAINT USED S-IN VEHICLE USE UNKNOWN
K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE
U-NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(')SHOULD BE EXPLAINED IN THE NARRATIVE
PRIMARY COLLISION FACTORMOVEMENT'PRECEDING
LIST NUMBER(n HI
OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 1 2 3 TYPE OF VEHICLE 1 2 3 COLLISION
A VC SECTION VIOLATED: CITED A CONTROLS FUNCTIONING I JA PASSENGER CAR/STN.WGN. I JA STOPPED
1 21751 NO B CONTROLS NOT FUNCTIONING- B PASSENGER CAR W/TRAILER X X B PROCEEDING STRAIGHT
B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD
C OTHER THAN DRIVER' X D NO CONTROLSPRFSENT/FACI'OR D PICKUP OR PANEL TRUCK D MAKING RIGHT TURN
D UNKNOWN' TYPE OF COLLISION E PICKUP/PANELTRK.W/TLR. E MAKING LEFTTURN
E FELL ASLEEP• X A HEAD ON F TRUCK OR TRUCK TRACTOR F MAKING U TURN
WEATHER(MARK 1 TO 2ITEMS) B SIDESWIPE G TRK.RRK.TRACTOR W RLR. G BACKING
X A CLEAR C REAR END H SCHOOL BUS H SLOWING/STOPPING
B CLOUDY D BROADSIDE 1 OTHER BUS X 1 PASSING OTHER VEHICLE
C RAINING E HR OBJECT 1 EMERGENCY VEHICLE 1 CHANGING LANES
D SNOWING F OVERTURNED K HWY.CONST.EQUIPMENT K PARKING MANEUVER
E FOG/VISIBILITY: GVEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC
F OTHER•: H OTHER•: M OTHER VEHICLE M OTHER UNSAFE TURNING
G WIND MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE
LIGHTNG JA NON-COLLISION O MOPED 0 PARKED
X A DAYLIGHT B PEDESTRIAN P MERGING
B DUSK.DAWN X C OTHER MOTOR VEHICLE 1 2 3 O�MARK I TO 2 ITEMS ATED OR Q TRAVELING WRONG WAY
C DARK-STREETLIGHTS D MOTOR VEH ON OTHER ROADWAY A VC SECTION VIOLATION:CTE R OTHER-:
D DARK-NO STREETLIGHTS E PARKED MOTOR VEHICLE X 23103 YES
E DARK-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CITE
ROADWAY SURFACE G BICYCLE SOBRINTY-DRUG
X A DRY H ANIMAL: C VC SECTION VIOLATION:CITE 111213 (MARK 1 TOTCAL 2ITEMS)
B WET X I X JA HAD NOT BEEN DRINKING
C SNOWY-ICY 1 FIXED OBJECT: E VIS.OBSCURED: B HBD-UNDER INFLUENCE
D SLIPPERY(MUODY.OILY.ETC.) F INATTENTION' C HBD.NOT UNDER INFLUENCE'.
J OTHER OBJECT: G STOP&GO TRAFFIC D HBD.IMPAIRMENr UNK.'
ROADWAY CONDITIONS
MARK I TO 21TEMS PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE'
A HOLES.DEEP RUTS' X A NO PEDESTRIAN INVOLVED 1 PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL'
B LOOSE MATERIAL ON RDWY' B CROSSING IN XWALK/INTERSECTION I UNFAMILIARWITH ROAD X G IMPAIRMENT NOT KNOWN
C OBSTRUCTION ON ROADWAY' C CROSSING IN XWALK NOT AT K DEFECTIVE VEH.EQUIP.:CTE H NOT APPLICABLE
D CONSTRUCTION-REPAIR ZONE INTERSECTION
1 SLEEPY/FATIGUED
E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL NFORMATION
F FLOODED' E INROAD-INCLUDES SHOULDER M OTHER': A HAZARDOUS MATERIAL
G OTHER': F NOT IN ROAD X X N NONE APPARENT B SEATBELTFAILURE
X H NO UNUSUAL CONDITIONS G APPROACHING/LEAVNG SCHOOL BUS 0 RUNAWAY VEHICLE
SKETCH v-yYO
. MISCELLANEOUS
ri N
SPATE OF CALIFORNIA
TRAFFIC COLLISION CODING PA�
DATE OF ORIGINAL INCIDENT TIME2400) NCIC NUMBER OFFICER I.D. NUMBER
08 - 12 - 96 1730 9390 013756 JOAM468C1
OWNERS NAME/ADDRESS
NOTIFIED
PROPERTY
DESCRIPTION OF DAMAGE
DAMAGE
SEATING POSITION OCCUPANTS MIC BICYCLE-HELMET SAFETY EQUIPMENT EJECTED FROM VEH
1-DRIVER A-NONEINVEHI[LE L-AIR BAG DEPLOYED D-FULLYEJECTED
JECT
21oA-PASSENGERS B-UNKNOWN M-AIRBAG NOT DEPLOYED DRIVER I-PARTIALYEJE
7-STA ULWON.REAR O C-LAP BELT USED N-OTHER V-NO 2-PARTIALLY ELECTED
127 S-ROSITIO UK.OR VAN D-LAP BELT HOULDER HA USED P-NOT REQUIRED W-YES 3-UNKNOWN
9-POSITION UNKNOWN E-SHOULDER HARNESS USED
6 3 6 0-OTHER F-LAPISH 14ARNM NOT HARNESS USED CHILD RESTRAINT PASSENGER
G-LAPISHOULDER HARNESS USED Q-IN VEHICLE USED X-NO
7 I -PASSIVE RESTRAINT
ES R HARNESS NOT USED R-IN VEHICLE NOT USED Y-YES
K PASSIVER ESRAINTNOT S-IN VEHICLE USE UNKNOWN
K-PASSIVE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE
U-NONE IN VEHICLE
ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK(-I SHOULD BE EXPLAINED IN THE NARRATIVE
PRPIARY COLLISION FACTOR MOVEMENT PRECEDING
LIST NUMBER U)OF PARTY AT FAULT TRAFFIC CONTROL DEVICES 4 5 6 TYPE OF VEHICLE 141516 COLLISION
A VC SECTION VIOLATED: CITED A CONTROLS FUNCTIONING A PASSENGER CAR/STN.WGN. A STOPPED _
1 21751 NO B CONTROLS NOT FUNCTIONING' B PASSENGER CAR W/TRAILER X B PROCEEDING STRAIGHT
B OTHER IMPROPER DRIVING' C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER C RAN OFF ROAD
C OTHER THAN DRIVER' X D NO CONTROLS PRESENTTACTOR JE
PICKUP OR PANEL TRUCK D MAKING RIGHT TURN
D UNKNOWN' TYPEOFCOLLISION PICKUPIPANEL TRK.W/TLR. E MAKING LEFT TURN
E FELL ASLEEP' X A HEAD-ON TRUCK OR TRUCK TRACTOR F MAKING UTURN
WEATHER(MARK 1 TO 2 ITEMS) B SIDESWIPE TRK./TRK.TRACTOR W/I'LR. G BACKING
X A CLEAR C REAR END SCHOOL BUS H SLOWING/STOPPING
B CLOUDY D BROADSIDE OTHER BUS i PASSING OTHER VEHICLE
C RAINING E HR OBJECT EMERGENCY VEHICLE 1 CHANGING LANES
D SNOWING F OVERTURNED K HWY.CONST.EQUIPMENT K PARKING MANEUVER
E FOG/VISIBILITY: G VEHICLE/PEDESTRIAN L BICYCLE L ENTERING TRAFFIC
F OTHER': H OTHER': M OTHER VEHICLE M OTHER UNSAFE TURNING
G WIND MOTOR VEHICLE INVOLVED WITH N PEDESTRIAN N XING INTO OPPOSING LANE
LIGHTING A NON-COLLLSION O MOPED O PARKED
X A DAYLIGHT B PEDESTRIAN OTR ASSOCIATED P MERGING
B DUSK.DAWN X C OTHER MOTOR VEHICLE 415 6 HE
O2 ITEMS�OR
Q TRAVELING WRONG WAY
C DARK.STREET LIGHTS D MOTOR VEH ON OTHER ROADWAY A VCSECHON VIOLATION:CITE R OTHER':
D DARK-NO STREET LIGHTS E PARKED MOTOR VEHICLE
E DARK-STREET LIGHTS NOT FUNCTION F TRAIN B VC SECTION VIOLATION:CRE
ROADWAY SURFACE G BICYCLE SOBREETY-DRUG
SICAL
XLSLIPPERY
H ANIMAL: C VC SECTION VIOLATION:CRE 4 5 6 (MARKKII TO 2ITEMS)
X A HAD NOT BEEN DRINKING
1 FIXED OBJECT: E VIS.OBSCURED: B HBD-UNDER INFLUENCE
DY.OILY.ETC.) F INATTENTION' C HBD-NOT UNDER WnUENCE'
1 OTHER OBJECT: G STOP h GO TRAFFIC D HBD.IMPAIRMENT UNK.'
ROADWAY CONDITIONS
MARK 1 TO 21TEMS PEDESTRIAN'S ACTIONS H ENTERING/LEAVING RAMP E UNDER DRUG INFLUENCE'
A HOLES,DEEP RUTS' X A NO PEDESTRIAN INVOLVED 1 PREVIOUS COLLISION F IMPAIRMENT-PHYSICAL'
B LOOSE MATERIAL ON RDWY' B CROSSING IN XWALKRNTERSECTION J UNFAMILIAR WITH ROAD G IMPAIRMENT NOT KNOWN
C OBSTRUCTION ON ROADWAY' C CROSSING IN XW ALK NOT AT K DEFECTIVE VEH.EQUIP.:CRE 1 NOT APPLICABLE
INTERSECTION
D CONSTRUCTION.REPAIR ZONE - I SLEEPY/FATIGUED
E REDUCED ROADWAY WIDTH D CROSSING NOT IN CROSSWALK L UNINVOLVED VEHICLE SPECIAL INFORMATION
F FLOODED' E IN ROAD-INCLUDES SHOULDER M OTHER': A HAZARDOUS MATERIAL
G OTHER': F NOT IN ROAD X N NONE APPARENT B SEATBELT FAILURE
X H NO UNUSUAL CONDITIONS IG APPROACHINGILEAVING SCHOOL BUS O RUNAWAY VEHICLE
SKETCH MISCELLANEOUS
STATE OF CALIFORNIA _
INJURED/WITNESSES/PASSENGERS C' .AGB 5
DATE OF COLLISION TIMENCIC NUMBER OFFICER I.D. NUMBER
O/0fq
08 - 12 - 96 1730 9390 013756 OAM468C1 $ -
EXTENT OF INJURY('XONE) INJURED WAS ('X' ONE)
WITNESS PASSENGER AGE SEX PARTY $EAT SAFETY FJECI'ED
ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED. BIKE OTHER
29 M X X 2 1 1 B 0
NAMEM.O.B./ADDRESS TELEPHONE
DAVID YOSHI KROEGER 03-18-67
H-2010 BLOOMFIELD RD. , GILROY, CA, 95020 (408) 847-7310
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
LIFE-FLIGHT (CAL STAR) JOHN MUIR MEDICAL CENTER
DESCRIBE INJURIES:
TEAR IN AORTA AND SPLEEN
VICTIM OF VIOLENT CRIME NOTIFIED
48 F I X I I X 1 4 1 L O
NAME/D.O.B./ADDRESS TELEPHONE
ROSALIE ANTIONETTE VIERRA 07-24-48
H-2149 FIRWOOD CT. , BYRON, CA, 94514 (510) 634-9845
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
AMR DELTA HOSPITAL
DESCRIBE INJURIES:
BRUISES TO BOTH ARMS, KNEES, AND CHEST. C.O. P. TO CHEST AND R/FOOT
VICTIM OF VIOLENT CRIME NOTIFIED
1 38 M
NAME/D.O.B./ADDRESS TELEPHONE
JOHN R IANSON 02-19-58
H-1400 G. ST. , ANTIOCH, CA, 94509 (510) 706-8486
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
2 44 M
NAMFJD.O.O./ADDRESS TELEPHONE
LEE BROWN 09-21-51
H-637 HOREY LN. , OAKLEY, CA, 94561 (510) 625-4124
(INJURED ONLY)TRANSPORTED BY: TAKEN T0:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
3 F
NAME/D.O.B./ADDRESS TELEPHONE
MELANIE EWING #10876
CHP-DUBLIN (510) 828-0466
(INJURED ONLY)TRANSPORTED BY: TAKEN T0:
DESCRIBE INJURIES:
( ) VICTIM OF VIOLENT CRIME NOTIFIED
PREPAREWSNAME LD NUMBER MO. DAY YR. REVIEWER'S NAME MO. DAY YR_
MORRIS M 013756 08-12-96
SPATE OF.CALIFORNIA
INJURED/WITNESSES/PASSENGERS xy
DATE OF COLLISION TIME(ZZ - NCICNUMBER OFFICER I.D. NUMBER
08 - 12 - 96 1730 9390 013756 OAM468C1 S^ 7
EXTENT OF INJURY ('X' ONE) INJURED WAS ('X' ONE)
WITNESS PASSENGER AGE SEX PARTY SEAT SAPEIY EJECTED
ONLY ONLY FATAL SEVERE OTHER VISIBLE COMPLAINT NUMBER POS. EQUIP.
INJURY INJURY INJURY OF PAIN DRIVER PASS. PED,
BIKE OTHER
4 M
NAME/D.O.B./ADDRESS .TELEPHONE
PAUL AGUINAGA #2526
ANTIOCH P.D. (510) 757-2236
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
1 77
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN T0:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TA EN 0 K T :
DESCRIBE INJURIES: !
VICTIM OF VIOLENT CRIME NOTIFIED
NAME/D.O.B./ADDRESS TELEPHONE
(INJURED ONLY)TRANSPORTED BY: TAKEN TO:
DESCRIBE INJURIES:
VICTIM OF VIOLENT CRIME NOTIFIED
PREPARER'S NAME LD NUMBERMO. DAY YR. REVIEWER'S NAME MO. DAY YR.
MORRIS M 013756 08-12-96
. -, � (* v --'77
8-12-96 1735 9390 013576 PAUL✓ 7
LEGEND
X=E/RDWY EDGE
Y= GUARD RAIL LOCATED 5.5 MILE S/OF CAMINO DIABLO RD.
VEHICLES POINT OF REST
V-1 FLED THE SCENE.
V-2'S R/F TIRE 43 FT E/OF X AND 58 FT N/OF Y .
V-2'S R/R " 50 FT " " " 55 FT "
V-3 WAS LOCATED ON THE E/SHOULDER N/OF V-2.
V-4'S R/F TIRE 9 FT E/OF X AND 47 FT N/OF Y .
V-4'S R/R " 1 FT " " 47 FT
PHYSICAL .VID .N . .
A)42 FT SKID MARK
B) 66 FT SKID MARK
C) TIRE MARK ON CURB
D) 1 FT GOUGE
E) 3 FT SIDE SKID
F) 4 FT GOUGE
G) 4 FT SCRAPE
H) 15 FT DIAMETER( GLASS & VEH. DEBRIS ) F
I) 5 FT SKID MARK
.I) 3 FT SKID MARK
K) 8 FT TIRE MARK ON CURB
L) 32 FT TIRE TRACK
M) 21 FT TIRE TRACK
N) 6 FT SKID MARK
P) 7 FT SKID MARK
Q) 22 FT SKID MARK
R) 51 FT SKID MARK
S) 187 FT CENTRIFUGAL SKID MARK
T) 203 FT CENTRIFUGAL SKID MARK
M. EWING 010876 8-12-96
08-12-96 1735 9390 013576 PAGES
MEASUREMENTS
A) BEGIN 2' W/OF X AND 17' S/OF Y. END 5' W/OF X AND 25' N/OF Y.
B) BEGIN 8' W/OF X AND AT THE Y. END 17' W/OF X AND 66' N/OF Y.
C) BEGIN 8' W/OF X AND 47' S/OF Y.
D) BEGIN 4' E/OF X AND 48' N/OF Y.
E) BEGIN 1' W/OF X AND 47' N/OF Y. END 2' E/OF X AND 52' N/OF Y.
F) BEGIN 6' E/OF X AND 52' N/OF Y. END 2' E/OF X AND 59' N/OF Y.
G) BEGIN 1' E/OF X AND 58' N/OF Y. END 2' E/OF X AND 54' N/OF Y.
H)BEGIN 12' E/OF X AND 49' N/OF Y.
I) BEGIN AT THE X AND 74' N/OF Y. END 7' E/OF X AND 69' N/OF Y.
J) BEGIN AT THE X AND 79' N/OF Y. END 7' E/OF X AND 75' N/OF Y.
K) BEGIN 8' E/OF X AND 79' N/OF Y. END 8' E/OF X AND 87' N/OF Y.
L) BEGIN 15' E/OF X AND 87' N/OF Y. END 50' E/OF X AND 55' N/OF Y.
F
M) BEGIN 9' E/OF X AND 79' N/OF Y. END 43' E/OF X AND 58' N/OF Y.
N) BEGIN 11' W/OF X AND 74' N/OF Y. END 2' W/OF X AND 76' N/OF Y.
P) BEGIN 11' W/OF X AND 79' N/OF Y. END 2' W/OF X AND 80' N/OF Y.
Q) BEGIN 3' W/OF X AND 80' N/OF Y. END 8' E/OF X AND 58' N/OF Y.
R) BEGIN 13' W/OF X AND 107' N/OF Y. END 1' W/OF X AND 56' N/OF Y.
S) BEGIN 29' W/OF X AND 23 8' N/OF Y. END AT THE X AND 5FN/OF Y.
T) BEGIN 28' W/OF X AND 250' N/OF Y. END 8' E/OF X AND 47' N/OF Y.
M.J. EWING 010876 08-12-96
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CHP 555—Page 4 (Rev II-85) OPI 042
STATE OF CALIFORNIA
NARRADMEMUEPLEMENTAL PAGE L t
DATE OF INCIDENT TIME NCIC NUMBER OFFICERLD. NUMBER
08/12/96 1730 9390 013756 OAM468CI $'-77
I FACTS:
2
3 NOTIFICATION: I WAS DISPATCHED TO A CALL OF AN INJURY TRAFFIC COLLISION, WITH AN
4 AMBULANCE RESPONDING AT 1733 HOURS. I RESPONDED FROM A PREVIOUS COLLISION E/B I-
5 580 E/GREENVILLE AND ARRIVED ON SCENE AT 1747 HOURS. ALL TAMES,SPEEDS AND
6 MEASUREMENTS IN THIS INVESTIGATION ARE APPROXIMATE. MEASUREMENTS WERE TAKEN
7 BY ROLLMETER,EXCEPT WHERE OTHERWISE INDICATED.
8
9 SCENE:IN THIS AREA,WHICH IS APPROXIMATELY 5.5 MILES S/OF CAMINO DIABLO RD. ,VASCO
IO RD. IS A NORTHBOUND/SOUTHBOUND RURAL ROADWAY CONSISTING OF TWO LANES. THE
I I ROADWAY CURVES . THE POSTED SPEED LIMIT IS 55 M.P.H. THE SURFACE 1S COMPOSED
12 PRIMARILY OF ASPHALT. SEE DIAGRAM.
13
14 PARTIES:
15
I6 PARTY#I (PRITCHETTI WAS LOCATED AT HIS RESIDENCE AT APPROXIMATELY 1910 HRS..
17 PARTY PRITCHETT WAS IDENTIFIED BY A VALID CALIFORNIA DRIVER'S LICENSE. PRITCHETT
18 WAS PLACED AS A PARTY BY THE FOLLOWING ITEMS:
19
20 -PERSONAL STATEMENT
21 -WITNESS STATEMENTS
22 -BEING REGISTERED OWNER
23
24 HQNDA CRX,DRIVER# I'S VEHICLE,WAS LOCATED IN P-I'S GARAGE. P-1 HAD NO TIC DAMAGE.
25 NO PRIOR MECHANICAL DEFECTS WERE NOTED OR REPORTED.
26
27 PARTY#2(KROEGER)WAS LOCATED BEING TREATED FOR HIS INJURIES NEXT TO V-2.. PARTY
28 KROEGER WAS IDENTIFIED BY RECORDS AT JOHN MUIR HOSPITAL AND BY STATEMENTS
29 OBTAINED FROM HIS FATHER(BILL KROEGER)AT JOHN MUIR HOSPITAL. KROEGER WAS
30 PLACED AS A PARTY BY THE FOLLOWING ITEMS:
31
32
33 -WITNESS STATEMENTS
34 -LOCATION
35 -INJURIES
36
37
38 H .VY Ct,FBRITY,DRIVER#2'S VEHICLE,WAS LOCATED ON ITS WHEELS AS SHOWN ON THE
39 DIAGRAM. V-2 SUSTAINED MAJOR DAMAGE TO THE R/SIDE,REAR,AND UREAR QUARTER
40 PANEL. NO PRIOR MECHANICAL DEFECTS WERE NOTED OR REPORTED.
41
42 PARTY#3(COOKE)WAS LOCATED STANDING S/OF V-3. PARTY COOKE WAS IDENTIFIED BY A
43 VALID CALIFORNIA DRIVER'S LICENSE. COOKE WAS PLACED AS A PARTY BY THE FOLLOWING
44 ITEMS:
45
46 -PERSONAL STATEMENTS
47 -WITNESS STATEMENTS
48 -LOCATION
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
M MORRIS 013756 08/12/96 `-
STATE OF CALIFORNIA
NARRATIVE/SUPPLEMENTAL
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
08/12/96 1730 9390 013756 OAM468CI g-7 7
I
2 -BEING REGISTERED OWNER
3 -BEING IN POSSESSION OF THE VEHICLE'S KEYS
4
5 CHEVY BLAZER,DRIVER#3'S VEHICLE, WAS MOVED PRIOR TO C.H.P.ARRIVAL. V-3 SUSTAINED
6 MINOR DAMAGE TO THE LEFT REAR TIRE AND BUMPER. NO PRIOR MECHANICAL DEFECTS
7 WERE NOTED OR REPORTED.
8
9 PARTY#4(VIERRAI WAS LOCATED SITTING BEHIND THE WHEEL OF V-4 BEING TREATED FOR
10 HER INJURIES.PARTY VIERRA WAS IDENTIFIED BY A VALID CALIFORNIA DRIVER'S LICENSE.
I 1 VIERRA WAS PLACED AS A PARTY BY THE FOLLOWING ITEMS:
12
13 -PERSONALSTATEMENTS
14 -WITNESS STATEMENTS
15 -LOCATION
16 -INJURIES
17 -BEING REGISTERED OWNER
18 -BEING IN POSSESSION OF THE VEHICLE'S KEYS
19
20 TOYOTA MEL DRIVER#4'S VEHICLE,WAS LOCATED ON ITS WHEELS AS SHOWN ON THE
21 DIAGRAM. V-4 SUSTAINED MAJOR DAMAGE TO THE ENTIRE FRONT OF THE VEHICLE. NO PRIOR
22 MECHANICAL DEFECTS WERE NOTED OR REPORTED.
23
24 PHYSICAL EVIDENCE: (1)LOCKED WHEEL SKIDMARKS.(2)TIRE MARKS.(3)GOUGE MARKS
25 APPROXIMATELY 1' AND 4' IN DIAMETER.(4)SCRAPE MARKS.(5)GLASS AND VEHICLE DEBRIS
26 APPROXIMATELY 15'N DIAMETER.(6)TIRE TRACKS.(7)CENTRIFUGAL SKID MARKS. REFER TO
27 DIAGRAM AND LEGEND FOR APPROXIMATE LOCATION.
28
29 INJURIES: P-2(KROEGER)WAS TRANSPORTED FROM THE SCENE BY LIFE-FLIGHT TO JOHN MUIR
30 HOSPITAL. P-2 SUSTAINED MAJOR INJURIES CONSISTING OF A TEAR TO HIS AORTA AND A TEAR
31 TO HIS SPLEEN.P-4(VIERRA)WAS TRANSPORTED FROM THE SCENE BY A.M.R.AMBULANCE CO.
32 TO DELTA HOSPITAL. P-4 SUSTAINED MODERATE INJURIES CONSISTING OF BRUISES TO BOTH
33 ARMS, KNEES AND THE CHEST AREA. P-4 ALSO HAD COMPLAINT OF PAIN TO HER ENTIRE
34 CHEST AREA AND HER RIGHT FOOT.
35
36 HIT AND RUN NARRATIVE: BASED ON WITNESSES STATEMENTS,V-1 MADE AN UNSAFE
37 PASSING MOVEMENT THAT CAUSED V-2 TO LOSE CONTROL P-1 FAILED TO STOP AND
38 CONTINUED TO TRAVEL NB VASCO RD. WITNESS#1(W-1)FOLLOWED V-1 AND WAS ABLE TO
39 CATCH UP TO V-1 WHEN V-1 STOPPED FOR THE RED LIGHT IN THE LEFT TURN POCKET AT
40 VASCO RD.AT CAMINO DIABLO RD.AND OBTAINED A DETAILED DESCRIPTION OF V-1 AND P-1.
41 W-1 RELATED TO ME AT THE SCENE THAT V-1 WAS A WHITE HONDA CRX WITH A PLATE OF
42 `BLEUKNT'AND A C.B.ANTENNA ON IT'S ROOF WITH A"TRIPLE A" STICKER ON THE BUMPER
43 W-1 RELATED T 4ATP-1 WAS A WHITE MALE IN HIS FORTIES WITH A BEARD. WHEN ASKED IF HE
44 COULD POSITIVELY I.D.THE DRIVER,W-I STATED"ABSOLUTELY,THERE IS NO WAY HE SHOULD
45 GET AWAY WITH DRIVING THAT WAY AND HURTING THOSE PEOPLE". I THEN CONTACTED
46 WITNESS#2(W-2)AT THE SCENE. W-2 RELATED HE WAS STANDING NEXT TO P-1 IN A MINI-
47 MART ON VASCO RD.JUST NORTH OF 1-580 APPROXIMATELY 20 MINUTES PRIOR TO THE
48 COLLISION. W-2 STATED P-I WAS IN HIS LATE FORTIES,ABOUT 5'5"TALL AND ABOUT 200
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
M MORRIS 013756 08/12/96
STATE OF CAUFORKA I,Cn
NARRATIVE/SUPPLEMENTAL PAof
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
08/12/96 1730 9390 013756 OAM468CI V-77
I POUNDS. HE WAS WEARING LEVI SHORTS WITH A BLUE SHIRT AND WHITE SOCKS. WHEN
2 ASKED IF HE COULD POSITIVELY I.D.P-1,W-2 STATED"ABSOLUTELY". BOTH W-1 AND W-2
3 RELATED THAT P-1 WAS DRIVING RECKLESSLY,PASSING UNSAFELY ON SEVERAL OCCASIONS,
4 FOLLOWING OTHER VEHICLES TOO CLOSELY,AND SPEEDING. AFTER OBTAINING R/O
5 INFORMATION THRU DISPATCH, I REQUESTED THAT ANTIOCH P.D. DRIVE BY THE ADDRESS TO
6 LOCATE V-l. I ARRIVED AT THE R/O'S ADDRESS AT APPROXIMATELY 1910 HRS. ANTIOCH P.D.
7 OFFICER P.AGUINAGA#2526 MET ME EAST OF P-I'S RESIDENCE FOR BACKUP. I OBSERVED A
8 WHITE HONDA CRX,LICENSE PLATE"BLEUKNT",PARKED IN THE GARAGE(THE GARAGE DOOR
9 WAS OPEN)WHICH MATCHED THE DESCRIPTION PROVIDED BY THE WITNESSES. I CONTACTED
10 THE R/O(P-1)AT HIS FRONT DOOR AND REQUESTED THAT HE STEP OUTSIDE FOR A FIELD
1 I INTERVIEW. P-1 MATCHED THE DESCRIPTION GIVEN BY BOTH WITNESSES. P-1 ADMITTED TO
12 BEING IN THE AREA AT THE TIME MENTIONED. WHEN I ASKED HIM IF HE FELT HE HAD BEEN
13 DRIVING RECKLESSLY HE REPLIED"NO". WHEN ASKED ABOUT THE INCIDENT P-I RELATED
14 THAT HE DID PASS SEVERAL VEHICLES ON THE LEFT AT ABOUT 50 M.P.H. HE SAW A"WHITE
15 CAR COME OUT OF NO WHERE TRAVELING SB VASCO RD. BUT HAD ENOUGH TIME TO GET
16 BACK IN THE NB LN." P-I RELATED HE WAS UNAWARE THAT HIS PASSING MOVEMENT HAD
17 CAUSED A COLLISION AND WOULD NEVER HAVE LEFT AN ACCIDENT SCENE. ANTIOCH P.D.
18 DROVE WITNESS#1 TO MY LOCATION AT APPROXIMATELY 1925 HRS. TO POSITIVELY I.D. THE
19 DRIVER OF V-1. P-I WAS STANDING IN HIS DRIVEWAY APPROXIMATELY 15' FROM W-1. I ASKED
20 W-1 IF HE COULD POSITIVELY I.D.PRITCHETT(P-1)AS THE DRVER OF V-1. W-1 REPLIED"OH
21 YEAH,THAT'S HIM." I PLACED P-1 UNDER ARREST AT APPROXIMATELY 1930 HRS.FOR
22 20001(A)V.C.-LEAVING THE SCENE OF AN ACCIDENT WITH INJURIES AND 23104(A)V.C.-
23
3104(A)V.C:23 RECKLESS DRIVING-CAUSING INJURY. P-I WAS TRANSPORTED TO M.D.F.AND BOOKED AT
24 APPROXIMATELY 2050 HRS.
25
26
27
28
29
30 STATEMENTS:
31
32 PARTY# 1 (PRITCHETT)WAS CONTACTED AT HIS RESIDENCE LATER THAT EVENING AND HE
33 RELATED THAT HE WAS NB VASCO RD."AT ABOUT 50 M.P.H." P-I ENTERED THE SB LANE TO
34 PASS SEVERAL SLOWER VEHICLES IN FRONT OF HIM. P-1 SAW A WHITE CAR"COME OUT OF
35 NOWHERE"TRAVELING SB VASCO RD.APPROACHING RAPIDLY AND RE-ENTERED THE NB IN.
36 "I HAD PLENTY OF TAME". P-1 HAD NO IDEA THAT ANY COLLISION HAD OCCURED BEHIND HIM
37 AND CONTINUED NB.
38
39 PARTY#2(KROEGER)NO STATEMENT OBTAINED DUE TO P-2'S EXTENSIVE INJURIES.
40
41 PARTY#3(COOKE)RELATED THAT HE WAS NB VASCO RD.AT 50 M.P.H."ALL OF A SUDDEN
42 THIS WHITE HONDA(V-1)COMES HAULING PAST ME PASSING CARS. I SAW THE OTHER CAR(V-
43 2)COMING SB AND I THOUGHT THEY WERE GOING TO COLLIDE". V-1 CUT BACK INTO THE NB
44 LANE. V-2 VEERED TO THE RIGHT TO AVOID A COLLISION AND STARTED TO LOSE CONTROL. V-
45 2 VEERED INTO THE.NB LANE AND HIT THE LEFT REAR OF V-3."I THINK HE SPUN AROUND
46 AFTER THAT BUT I'M NOT SURE".
47
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
M MORRIS 013756 08/12/96
STATE OF CALIFORNIA Y
NAERAINEICIIDDf CI ENIAI PAGE
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
08112/96 1730 9390 013756 OAM468CI $ 7 7
1 PARTY# 1 Ni 'RRA1 WAS CONTACTED AT DELTA HOSPITAL AT APPROXIMATELY 1955 HRS.BY
2 OFFICER M. EWING#10876 AND RELATED THAT SHE WAS NB VASCO RD.FOLLOWING A LONG
3 LINE OF CARS AT ABOUT 50 M.P.H. ALL OF A SUDDEN"I SEE THIS WHITE CAR A COUPLE OF
4 CARS IN FRONT OF ME START PASSING CARS ON THE LEFT AND I THOUGHT HE WAS CRAZY,
5 HE'S GOING TO KILL SOMEBODY. I SAW V-2 SWERVE TO AVOID V-I." V-2 LOST CONTROL, SPUN
6 SIDEWAYS IN FRONT OF P-4 AND STRUCK V-4.
7
8 WITNESS( ANI SON)WAS CONTACTED AT THE SCENE. IANSON RELATED THAT V-1 "WAS
9 DRIVING LIKE A MANIAC"FOR SEVERAL MILES PRIOR TO THE COLLISION. "HE'S BEEN CUTTING
10 PEOPLE OFF,PASSING CARS,AND GETTING RIGHT ON PEOPLES BUTTS". "WHEN VASCO RD.
I I SPLITS INTO TWO LANES FOR NB TRAFFIC,HE(V-I)STARTED PASSING ON THE LEFT OVER
12 DOUBLE YELLOW LINES,AND GETTING RIGHT BEHIND PEOPLE IN THE FAST LANE(#I LN.)
13 TRYING TO MAKE THEM MOVE OVER YOU COULD TELL BY OTHER DRIVERS EXPRESSIONS
14 THAT THEY WERE GETTING TICKED OFF." W-1 SAW V-1 CAUSE V-2 TO MOVE TO THE RIGHT TO
15 AVOID A COLLISION AND LOSE CONTROL AND GET HIT BY V4. "I TOLD MYSELF,I'M NOT
16 LETTING THAT JERK GET AWAY WITH IT. SO I FOLLOWED HIM NB ON VASCO RD.AT CAMINO
17 DIABLO TO GET HIS LICENSE PLATE AND A DESCRIPTION OF THE CAR THEN I DROVE UP
18 ALONG SIDE HIM AT THE LIGHT TO GET A GOOD LOOK AT HIM".
19
20 WITNESS(BROWN)OWN)WAS CONTACTED AT THE SCENE. BROWN RELATED THAT HE WAS
21 STANDING NEXT TO P-1 AT A MIN-MART ON VASCO RD.KIST NORTH OF 1-580 AT
22 APPROXIMATELY 1710 HRS. "I REMEMBER HIM SO WELL BECAUSE HE WAS REALLY AGITATED
23 WITH THE LINE". "HE PASSED ME ON VASCO RD.AROUND THE DUMPS AND I THOUGHT HE"S
24 GOING TO HURT SOME ONE DRIVING LIKE THAT." I SAW HIM PASSING ALL THOSE CARS AND
25 CAUSE V-2 TO LOSE CONTROL AND GET HIT BY THAT TOYOTA. "I REMEMBER EXACTLY WHAT
26 HE LOOKED LIKE AND WHAT HE WAS WEARING".
27
28 OPINIONS AND CONCLUSIONS
29
30 GARY: V-I WAS NB VASCO RD.TRAFFIC WAS HEAVY BUT WAS FLOWING FREELY AT
31 APPROXIMATELY 50-55 M.P.H. V-1 WAS OBSERVED BY SEVERAL INDEPENDENT WITNESSES
32 PASSING UNSAFELY ON THE LEFT AND,FOLLOWING TOO CLOSELY AND CUTTING OFF OTHER
33 VEHICLES. V-1 ATTEMPTED TO PASS A LONG LINE OF VEHICLES TRAVELING NB VASCO RD. AS
34 V-1 WAS PASSING TRAFFIC ON THE LEFT, V-2 WAS SB VASCO RD.AT APPROXIMATELY 55
35 M.P.H. V-1 CUT BACK IN THE NB JUST AS V-2 APPPROACHED THIS LOCATION TRAVELING SB.
36 THIS CAUSED V-2 TO SWERVE TO THE RIGHT TO AVOID A COLLISION WITH V-1. V-2 LOST
37 CONTROL AND SWERVED IN A SOUTHEASTERLY DIRECTION. V-3 WAS TRAVELING NB VASCO
38 RD.AT APPROXIMATELY 50 M.P.H. V-2 SWERVED INTO THE NB LANE OF VASCO RD.AND
39 STRUCK THE LEFT REAR OF V-3. THIS CAUSED V-2 TO SPIN TO THE LEFT. V4 WAS TRAVELING
40 NB VASCO RD.AT APPROXIMATELY 50 M.P.H. V-2 WAS STRUCK BY V-4 AS V-2 CONTINUED TO
41 TRAVEL IN AN EASTERLY DIRECTION. THE IMPACT OF THIS COLLISION CAUSED V-2 TO
42 CONTINUE TO ROTATE,COMING TO REST FACING IN A WESTERLY DIRECTION IN A GRASS FIELD
43 EAST OF VASCO RD.
44
45 ARRA OF IMPACT: #1)V-2 VS.V-3 WAS APPROXIMATELY 5.5 MILES S/OF THE S/PROLONGATION
46 MINUS 375' AND I1' W/OF THE E/RDWY EDGE OF VASCO RD.#2)V4 VS. V-2 WAS
47 APPROXIMATELY 5.5 MILES S/OF THE S/PROLONGATION OF CAMINO DIABLO RD,MINUS 80' AND
48 4' W/OF THE E/RDWY EDGE OF VASCO RD.
PREPARER'S NAME I.D.NUMBER - DATE REVIEWER'S NAME DATE
M MORRIS 013756 08/12196
STATE OF CALIFORNIA / CAP
NARRATIV /SUPPLEMENT AL
DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER
08/12/96 1730 9390 013756 OAM46SCI &-77
1
2 "BOTH A.O.L'S WERE ESTABLSHED BY PHYSICAL EVIDENCE AND OBTAINED STATEMENTS.
3
4 CAUSE* P-I(PRITCHETT)CAUSED THIS COLLISION BY DRIVING IN VIOLATION OF 21751 V.C.-
5
.C:5 UNSAFELY PASSING ON THE LEFT. THIS CAN BE ESTABLISHED BY STATEMENTS OBTAINED
6 FROM P-3,P-4,W-1 AND W-2. THE DAMAGE SUSTAINED TO V-2,V-3 AND V-4. AND THE INJURIES
7 SUSTAINED BY P-2 AND P-4.
8
9
10 RECOMMENDATIONS
11
12 THAT A COPY OF THIS REPORT BE SUBMITTED TO THE DISTRICT ATTORNEYS OFFICE FOR
13 REVIEW AND FILING OF THE FOLLOWING CHARGES AGAINST P-1(PRITCHETT JR).20001(A)V.C.-
14
.C:14 FELONY HIT AND RUN,23104(A)V.C.-RECKLESS DRIVING CAUSING INJURY.
15
16 THE CHARGE OF 20001(A)V.C. IS ESTABLISHED BY THE FACT THAT P-1 DID NOT STOP AT THE
17 COLLISION SCENE AND CONTINUED NB ON VASCO RD. P-1 DENIES KNOWLEDGE OF CAUSING A
18 TRAFFIC COLLISION. THIS IS NOT REASONABLE DUE TO THE FACT THAT V-1 CAUSED V-2 TO
19 TAKE EVASIVE ACTION IN ORDER TO AVOID A COLLISION. AS A RESULT OF V-2'S EVASIVE
20 ACTION,V-2 LOST CONTROL AND STRUCK V-3 BEFORE BEING STRUCK BY V-4. AS A RESULT OF
21 THIS COLLISION,P-2(KROEGER)SUSTAINED MAJOR INJURIES. P-4(VIERRA)SUSTAINED
22 MODERATE INJURIES.
23
24 THE CHARGE OF 23104(A)V.C.IS ESTABLISHED BY THE FACT THAT P-1 WAS OBSERVED DRIVING
25 BY TWO INDEPENDENT WITNESSES DRIVING IN A RECKLESS MANNER SEVERAL MILES PRIOR
26 TO CAUSING THIS COLLISION. BOTH WITNESSES,ALONG WITH PARTY#3 AND PARTY#4
27 OBSERVED V-1 PASSING UNSAFELY NST PRIOR TO THE COLLISION. AS A RESULT,P-
28 2(KROEGER)SUFFERED A TORN AORTA AND SPLEEN SUSTAINING MAJOR INJURIES. P-4(VIERRA)
29 SUFFERED BRUISES TO HER CHEST,ARMS AND KNEES SUSTAINING MODERATE INJURIES. BOTH
30 PARTIES INJURIES WERE DOCUMENTED ON MEDICAL REPORTS.
PREPARER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE
M MORRIS 013756 08/12/96
CLA!..
BOA;: Gr Su:ER :S: S Gt CCN':: :^c-A CGuN'r CA.IFGRN:A
.December 10, 1996
Claim Aga'nst the COuety, Or DiStriet governed by) BGAO A:T!GN
the Board C' Supervisors, Routing Endorse'htntS. ) NOTICE TO CLAIMANT
and Bpa': A:tion. All Section rtftrencts art t0 ) The COPY Of thiS d0Cu1h1nt mailtd t0 you is your notice Of
Califc-ria Gove-hmert Codes. ) the action taken on your claim by the Board of Supervis:'S
(paragraph IM below), given pursuant to Wre�$�`��
Amount: Unknown Section 913 and 916.4. Plant hots all „alt
CLAiMANT:gast Bay Municipal Utility District N nu n 7 1996
c/o Rachel M. Vasquez COUNTY COUNSEL
ATiORNEr:375 Eleventh St. MARTINEZ CALIF.
Oakland, CA 94607-4240 Date received November 7, 1996
ADDRESS: ST DELIVERY TO CLERK ON
IT MAIL ►OSTMAXM: November 5, 1996
1. FROM: Clerk of the soars of Supervisors TO: County Counsel
Attached is a copy of the above-toted claim.
DATED' November 7, 1996 OIL LATpCVyLOR.
11. SAW. County counsel TO: Clerk of the surd of Supervisors
{ ) This claim Complies substantially with Sections sic 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 16 days (Section 910.8).
{ ) Claim is not timely filed. The Clerk should return claim On ground that it ass filed )ata and send
warning of claimant's right to apply for leave tO present a late claim (Section 911.3).
( ) Other:
Dated: 11 7 b BY: /�If.,RfrlQ/�.4,d�Deputy County Counsel
Ill. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to Claimant (Section 911.3).
IV. IOM ORDER: By unanimous vote of the Supervisors 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 data.
Dated: DEC 1010 PI411. SATCMELOR, Clerk, 9t' Deputy Clerk
WANING (low. sods section 923)
We" to Certain easeptiana, you have Only SIR (6) months from the date this notice Ma personally served or
deposited in the mil to file a court actiea on tnis claim. See Government Code Section 916.6.
You Cay seek the advice of an attorney of your choice in connection with this matter. If you want to consult
All stormy, you should do to immediately. Is For Additional WArnir4 See Reverse Side Of This Notice.
ArFIDAVIT OF hNILING
I declare undar penalty of perjury that 1 so now, and at all times herein mentioned. Inve Man a citizen of the
United Stotts, aver age it', and that today I deposited in Use United States postal Service in Martinet.
California, postage fully prepaid a certified Capt' Of this pard Order and Notice to Claimant, addressed to
S" claimant as�+Shown above.
Dated: IEC 12 1 br: PHIL BATCHELOR Deputy Clerk
r
CC: COvrty :C"Se County Administrator
This varning does not apply to claims vhich are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period vithin vhich suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not vaive any of its
rights under California Tort Claims Act nor does it
vaive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
EAST BAY
4L-1J MUN/Ci AY UTILITY DISTRICT
RECEIVED
NN 77W
CLOW OF SUPERVISORS
CONTRA COSTA CO.
Contra Costa County
ATTN: Clerk's Office
725 Court
Martinez, CA 94553
NOTICE OF INTENT TO BILL
District File 96/208
Date of Incident : August 22, 1996
Location Round Hill Country Club, Alamo
District Property: Gate pots paved over by your Paving Department.
Damage has occurred to District Property as noted above. Our information indicates that the
damage is your responsibility,therefore, you will be billed for the repair costs. It is suggested
that your insurance agent or company be notified of the claim. .
An invoice will be forwarded to you within 30-60 days. If you will need a breakdown, please
call me at the number below and reference my file number above. IF YOU DO NOT AGREE
WITH OUR CONCLUSIONS, PLEASE ADVISE IN WRITING WITHIN 30 DAYS.
Thank you,
Rachel M. Vasquez
Claims Representative
(510) 287-0167
Letter dated: November 4, 1996
375 ELEVENTH STREET. OAKLAND . CA 94607-4140. (510) 8353000
BOARD OF DIRECTORS JOHN A.COLEMAN. KATY FOULKES . JOHN M.GIDIA
FRANK MELLON. NANCYJ.NADEL. MARY SELKIRK. KENNETH H.SIMMONS
. . CAP
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NOTICE OF INSUFFICIENCY
AND/OR
NON-ACCEPTANCE OF CLAIM
TO:East Bay Municipal Utility District
c/o Rachel M. Vasquez
375 Eleventh St.
Oakland, CA 94607-4240
RE: CLAIM OF: East Bay Municipal Utility District
Please Take Notice as Follows:
The claim you presented against the County of Contra Costa or District governed by the Board
of Supervisors fails to comply substantially with the requirements of California Government
Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below:
[ ] 1 . The claim fails to state the name and post office address of the claimant.
[
12. The claim fails to state the post office address to which the person presenting the
claim desires notices to be sent.
[ ] 3. The claim fails to state the date, place or other circumstances of the occurrence or
transaction which gave rise to the claim asserted.
[ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury,
damage, or loss, if known.
XXX 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars
($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim
fails to state the amount claimed as of the date of presentation, the estimated
amount of any prospective injury, damage or loss so far as known, or the basis of
computation of the amount claimed. If the amount claimed exceeds ten thousand
dollars ($10,000), the claim fails to state whether jurisdiction over the claim would
rest in municipal or superior court.
[ ] 6. The claim is not signed by the claimant or by some person on is behalf.
[ ] 7. Other:
VICTOR J. WESTMAN, County Counsel
By: iV
Deputy County Counsel
Page 1
CERTIFICATE OF SERVICE BY MAIL
(C.C.P. §§ 1012, 1013a, 2015.5; Evidence Code§§641, 664)
1 declare that my business address is the County Counsel's Office of Contra Costa County, 651 Pine Street, Martinez,
California 94553; 1 am a citizen of the United States, over 18 years of age, employed in Contra Costa County, and not a
party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an
envelope addressed as shown above, sealed and postage fully prepaid thereon, and thereafter was, deposited this day in
the U.S. Mail at Martinez, California.
I certify under penalty of perjury that the foregoing is true and correct.
Dated: November 8, 1996 at Martinez, California.
cc: Clerk of the Board of Supervisors (original)
Risk Management
(NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8)
Page 2
CLAN
BOA;: or S,;Ep,:S:.S or CON' :'c'A COJN'v. CA;iFOPN:A December 10, 1996
Claim Aga'nst the County, or District governed by) BOA.: A:TION
the Board c' Supervisors, Routing EnddrSlmertS, ) NVICE TO CLAIMANT
and Brad A:tion. All Section references are to ) The COPY of this document maned to you is your notice of
California Sove'nmert Codes. ) the action taken on your claim by the Board of SuDerviid•s
(paragraph iv below), given pursuant
Arpunt: $10,000.00 + Section 913 and 915.4. Please note a rnings
CLAIMANT: Steven Thomas Guggiana Nnv n -7 1996
COUNTY COUNSEL
ATTORNEY: Jon Webster, Esq. MARTINEZCALIF.
The Law OFC of Jon Webster ate received
ADDRESS: 3478 Buskirk Ave. , Ste. 1000
BY DELIVERY TO CLERK ON November 7, 1996
Pleasant Hill, CA 94523 Hand Delivered
IT TAIL roSTMARKED:
1. FROM: Clerk of the Bard of Supervisors TO: County Counsel
Attached is a Copy of the above-hated clam.
DATED: November 7, 1996 PIL LATTuuVELOR, Clerlt_A�Q,
I1. FROM: County Counsel TO: Clerk of the turd 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 turd cannot act for 15 days (Section 910.1).
( ) Claim is not timely filed. The Clerk should return claim on ground that it as filed late and send
warning of claimant's right to apply for leave to present a late claim (Section 911.3).
( )
Other:
Doted: U�(n IY: Deputy County Counsel
III. FROM: Clerk of the Bard 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 Supervisors present
This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct Copy of the turd's Order entered in its minutes for
this data. �mme
Dated: DLC 10 WJE PHIL BATCHELOR, Clerk, Byis " _ . Deputy Clerk
YARNING (tor. Coda section 913)
Subject to certain nceptimis, you have Only Zia (6) months free the date this notice as personalty served or
deposited in the mail to file a Court action on this claim. See Goverment Code Section 946.6.
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, m For Additional Warning See Reverse Side Of alis Notice.
AFFIDAVIT OF FAILING
I declare under penalty of perjury that I as now, and at all times herein mentioned, have seen a Citizen of the
United States, over age 19; and that Loaf I deposited in the United States Postal Service in Martinez,
California, Postage fully prepaid A Certified COPY of this Bard Order and Notice to Claimant, addressed to
the claimant as shown above.
Dated. DEC 12 1996 BY: PHIL BATCHELOR b
�j1.e�—��`�•-QOCT•aDuty Clerk
CC: COurty CC"Se County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and oases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
Claim to: BOM,41F SUPERVISORS OF CMMA MSTA Ob"T=
• Z1iS'PRUCTIONS M M ADUT
1. Claims relating to causes of action for death or for injury to person or to per.
, conal 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 4911.2.)
B. Claim 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 and of this
TO.
sasaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaaa
RE: Claim By Reserved for Clerk's filing stamp
STEVEN THOMAS GIIGGTANA RECEIVED
nst t County of ntra sta )
or NOV _ 7 10
)
ou
District) CLE K BOARD F SUPERVISORS
—7ill in name ) CONTRA COSTA CO. ,___
'The undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ +10.000.00 and in support of
this claim represents as follows:
1. when did the damage or injury occur? (Give exact date and hour)
May 8. 1996 1511 hrs.
2. where did the damage or injury occur? (Include city and county)
Concord,SCA �Willow Pass Rd. E/gP—kSjylp Drive)
3. How did the damage or injury occur? (Give full details; use extra paper if
required)
A private vehicle operated by Contra Costa Co. deputy D.A. Virna L. DePaul
and used in the course of her duties as a deputy D.A. struck the rear of claimant's
patrol vehicle operated by Concord polite. This caused claimant personal iniuries.
4. what particular act or omission on the part of county or district officers,
servants or employees roused the injury or damage?
Deputy D.A. DePaul was negligent in the manner in which she operated the car
she was driving. Specifically, she was looking at office materials while driving and
failed to observe that officer Guggiana's police canine patrol vehicle was stopped in
front of her car. Ms. DePaul was operating her vehicle at an unsafe speed for
conditions, in violation of Cal. Vehicle Code §22350. (mer)
5. What are the names of k my or district officers, sect is or employees causing
the damage or injury?
Virna Lynn DePaul DOB: 04/23/70 Employed as a deputy D.A.
442 Starbridge Ct. Pleasant Hill, CA 94523
6. What damage or injuries do you claim resulted? (Give full extent of injuries or
damages claimed. lttach two estimates for auto damage.
Claimant suffered personal injury: cervical and thoracic sprain; pain and suffering;
lost wages (sick time debit) .
7. Hou was the amount claimed above computed? (Include the estimated amount or any
prospective injury or damage.)
current known damages: medical expenses 1,763.59*
sick time debit: 10 hrs x 26.67 hr. ) = 266.70
* known to date _
S. blames and addresses of Witnesses, doctors and hospitals.
Mt. Diablo Hospital
Centers for Occupational Medicine 2231 Galaxy Ct. Concord, CA 94520-1960
9. List the expenditures you made on account of this accident or injury:
DATE ITEM AMJUA*f
Travel expense to medical facilities for treatment to be determined.
{ ! ! f f f 1 1 ! f ! f • f ! ! ! i f f f ! f f ! { f f f { f i f f { { { f ! ! f f
Gov. Code_Sec. 910.2 provides;
"The claim must be signed by the claimant
SEND NOTICES T0: (Attorney) or by—some,verson on his behalf."
ame and Address of Attorney
Jon Webster, Esq.
THE LAW OFC of JON WEBSTER (Claimant's Signature
3478 Buskirk Ave. Suite 1000
Pleasant Hill, CA 94523 (Address)
(510) 686-8790
Telephone No. Telephone No.
{ { { { { { f f { f f { { { { 9 V 0 a a V 9i f f
NOTICE
Sectim 72 of the Penal Code provides:
"Dory 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.
C . (o
CLAN
BDA;: Or SUREW5:;5 Or CON-;-* :^57A COuN'r, CALIFDRNIA December 10, 1996
Claim Against the County, or District governed by) BOAC ACTION
the Boirc c' Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Boa-., 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: $882.75 Section 913 and 915.4. Please note all •Warnings-
CLAIMANT:Valentine Riley
3605 BellflowerTC mavl )
ATiORNEY:Antioch, CA 9450
ZLDate received
ADDRESS: 0 C T 3 1 1996 BY DELIVERY TO CLERK ON October 30, 1996
COUNTY COUNSEL October 31, 1996
MARTINEZ CALIF. BY MAIL POSTMARKED:
1. FROM: Clerk of the Bard of Supervisors 70: County Counsel
Attached is a copy of the above-noted claim.
DATED: October 31, 1996 }L �puC�iylOR, Clerk
11. FROM: County Counsel TO: Clerk of the Bard of Supervisors
TO This claim complies substantially with Sections 910 and 910.2.
( ) This claim FAILS to comply substantially with SectiOns 930 and 910.2, and we are to notifying
clainnt. The Bard 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: � / 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).
lV. 60ARD ORDER: By unanimous vote of the Supervisors present
0) This Claim is rejected in full.
( ) Other:
I certify that this is a true and correct copy of the Bard's Order entered in its minutes for
this data.
Dated: DEC 1 0 IM pMIL BATCHELOR. Clerk, By�/L` " � . Deputy Clerk
WARNING (Gov, code section 813)
Subject to certain exceptions, you have Only six (6) months from the date this notice mss personally served or
deposited in the nil to file a court action on this claim. See Government Code Section 946.6.
you may seek the advice of an attorney of your Moire 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 002en of the
United States, Over age 18; and that today I deposited in the United States postal Service in Martinet,
California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to
the Claimant as shown above.
Dated: KC 12 BY: PHIL BATCHELOR �1 ` ' �j^- Deputy Clerk
CC: Conrty Corse' County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims Act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
e .c,
Claic to: Boom of SJPERVisws of aknu COSTA COUNTY
I?:Sff UIONS TO CLAMANT
A. Claiss 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 carries of action for death or for injurq to person
. or to personal property or growing crops and which accrue on or after January 1,
19889 must be presented not later than six months after the accrual of the cause
of action. Claims relating to any other cause of action must be presented not
later than one year after the accrual of the cause of.action. (Govt. Code 5911.2.)
B. Claims mast be filed with the Cleric of the Board of Supervisors at its office in
Room 1060 County Administration Buildings 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_-
! • !E « f IF 1F i 1f 1f ! # ♦E If f * IE /F * * /t tE 1F ♦F w' � 1E IF 1k !f if 1f 1f IF f � * M 1E E 1E • IE
RE; Claim By ) Reserved for Clerk's filing stamp
\ZA {-1.f71 kV-, ft I. RECEIVED
C,UUN� )
Against the onW r of Contra Costa ) OCT 3 0 1996
District) CLERK BOARD OF SUPERVISORS
Fill in name)) CONTRA COSTA CO.
Zhe undersigned claimant hereby makes claim against the County of Contra Costa or
the above-named District in the sum of $ „ 75 and in support of
this claim represents as follows:
1. When did the damage or injury occur? (Give exact date and hour)
G� e� i OU, - 2)
2. Where did the damage or injury occur? (Include city and county)
I 6 1 1 4 LIDLA LQ-51L --
3. How did the damage or injury occur? (Give full details; use extra paper if
required) VqT .rAr COVNTV WAS '' J1R
,1 �lI"f N � CI�CP<S ftJ TUE-
. xD TU P�V1
2 6N(M ll�. THfy lnE�Ac: V�IN'4 �ruhcrC[N'i> TD WIDEN 1uE e� WNlcs I Klc.kr�
UP GI2A�'a, AT- A- NiUH V&,LM ati ���lU�r rskUs�y� D�C�E rv�lnWT
or.% rub
4. What particular act or omission on the part of county or district officers,
servants or employees caused the injury or damage? ,-Rj�qe- NZs4L f,;S
Po_�"'_ED M NSD-T �D 1 If'J �4WF&V AC6aSJ K3 ' MEF -
5-Y4"Q_R w_k�;- OBD) (fit OVi� -� KA-S OS-FD -i-7 BLOYJ 71J-� V-,
Q".
5. wnat are --tic na:Des of county or district officers, servants or employees causing
the .^.3::3ae or Injury?
NTI2A- COW-A GV l i Kq-V
5. Khat damage or injuries do you Claim resulted? (Give full extent of injuries or
damages claimed. Attach two estimates for auto damage. LUpr sto& of—" c44fZ 4 Top
DF c ra m i/i !Z-�D NA Ln p i i� pA<t�JT
7. How was the amount claimed above computed? (Include the estimated amount of any
prospective injury or damage.) / .Vv")at ta'-rN
1t1
B. Names and addresses of witnesses, doctors andhos itals. ' / ��/
A"' HavA T140P 7 I L' I g G r ��A �-, C}I'KC ICA 'f
9. List the expenditures you made on account of this accident or injury-.
DAME ITEM: AMOUNT
Esc * �r ■ r �t � * .� ■ � ■ * t� �ra � -v �.ax �t * r ■ �t � at � at * r� � � � rt � � rt ■ rt
Gov. Code Sec. 910:2 provides:
"The claim must be signed by the claimant
SEND NOSICES 1D: (Attorney) or by some person on his behalf."
Name and Address of Attorney f` f
Claimant s Signature
t- .x4
�
(Address)
Telephone No. � Telephone No. � � 777 - 0�
N Q 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 --u-h Lnd fine.
3620
ANTIOCH AUTO BODY, INC.
1401 Verne Roberts Circle
Antioch, CA 94509
(510) 757-3586
Fax: (510) 757-5246
EPA #CAR000004440
BAR #AJ180155
Visible Damage Quotation #3620 by DENNIS GOODMAN on 10-16-96
VALENTINE RILEY
3605 BELLFLOWER DRIVE Style Insurer .
Lic. Plate: Adjuster :
ANTIOCH, CA 94509 Paint Code: Appraiser: DENNIS GOODMAN
Phone: 777-1088 HOME/757-1981 WORK Prod. Date: Claimant :
90 US ONLY MITSUBISHI MITSUBISHI ECProfile : STANDARD Insured .
VIN: Deductible: 0.00 Policy # :
Mileage: 0 Claim #
Options:
Mitchell Service: 918386
Line Entry Labor Line Item Part Type/ Dollar Labor CEG
It N..ber Type 0P.ratio. Description Part Number Amount Unit Unit
1 006110 REFIN REFINISH L FENDER OUTSIDE C 2.4 2.4
2 826140 REFIN REFINISH L FRT DOOR OUTSIDE C 1.9 2.3
3 820480 REFIN REFINISH ROOF PANEL C 2.0 2.4
4 829880 REFIN REFINISH L QUARTER PANEL OUTSIDE C 2.1 2.5
5 900500 BODY * REPLACE MASK FOR OVERSPRAY AFTERMARKET NEW 5.00• 0.3* T
6 900500 BODY * REPLACE RUST COAT APPLICATION AFTERMARKET NEW 12.00* 0.5* T
7 933002 REFIN* ADL OPER CLEAR COAT 2.2
8 933003 REFIN ADL OPER TINT COLOR 0.5-
9 AUTO ADL COST PAINT MATERIALS 244.20• T
10 AUTO ALL COST HAZARDOUS WASTE 5.00*
* Judgement Item
Add'1
Labor Sublet
I. Labor Subtotal. Units Rate Amount Amount Totals II. Part Replacement Summary Amount
BODY 0.8 50.00 40.00 Taxable Parts 17.OU
REFINISB 11.1 50.00 555.00 Sales Tax @ 8.250% 1.40
Nontaxable Labor 595.00 Total Replacement Parts Amount: 18.40
Labor Summary Totals: 11.9 595.00
ESTIMATE RECALL NUMBER: 30-16-96 16:26:32
Mitchell Data Version: OCT_96 EstiMate Plus is a trademark of Mitchell International
Copyright 1991-1996 All Right. Reserved
43620 90 US ONLY MITSUBISHI MITSUBISHI ECLIPSE RILEY Page 2
III. Additional Costs Amount IV. Adjustments
Taxable Costs 244.20
Sales Tax O 8.250% 20.15
Nontaxable Costs 5.00 Customer Responsibility: 0.00
Total Additional Costs: 269.35 I. Total Labor: 595.00
II. Total Replacement Parts: 18.40
III. Total Additional Costs: 269.35
Oro$$ Total: 882.75
IV. Total Adjustments: 0.00
Net Total: 882.75
PAR'S' PRICES SUBJECT TO INVOICE +++++++++++++++++++++ww+wwww+++««««««+www++««+++«««««««
AUTHORIZED AND ACCEPTED: You are hereby authorized to make the above specified repairs. I understand that payment in full will be
due upon release of vehicle, including additional supplemental damage charges, and hereby grant you and/or your employees,
permission to operate the car, truck or vehicle herein described on street, highways or elsewhere for the purpose of testing and/or
inspection. An express mechanic's lien is hereby acknowledged on above car, truck or vehicle to secure the amount of repairs
thereto. You will not be held responsible for loss or damage to vehicle or articles left in vehicle in case of fire, theft,
accident or any other cause beyond your control.
OLD PARTS REMOVED FROM CARS WILL BE JUNKED UNLESS OTHERWISE INSTRUCTED.
Work authorized hy: Date
ESTIMATE RECALL NUMBER: 10-16-96 16:26:32
Mitchell Data Version: 0CT96 EatiMate Plus in a trademark of Mitchell International
Copyright 1991-1996 All Rights Reserved
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CLAIM
BOA;: Or SU.Ea :SCEs 0' CON';: :CS'A COUNTY, CA.IFOPN!A
December 10, 1996
Claim Against the County, or District governed by) BOAa: ACTION
the Board d' Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT
and Boa-: Action. All Section references are to ) The copy of this document mailed to you is your notice of
Cai+forria Government Codes. ) the action taken on your claim by the Board of Supervisd's
(Paragraph IV below), given pursuant to Goverment Code
Amount: $10,000.00+ Section 913 and 915.1. Please note ail •kIElIRJ' �SiYJ
CLAIMANT: Devin MacKenzie Wilkes by his mother 111SSS�llllllj��
Kathleen A. Wilkes OCT 2 8 1996
ATiORNEY: Law Offices of Alan M. Mayer, Inc. COUNTY COUNSEL
55 Shaver St. , /300 Date received MARTINEZ CALIF.
ADDRESS: San Rafael, CA 94901 BY DELIVERY TO CLERK ON October 28, 199
1Y MIL POSTMARKED: October 28, 1996
1. FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
�Il ATC�fEIOR, Clerk
DATED: October 28, 1996 : depu y
11. FROM. County Counsel TO: Clerk of the Bard Of Supervisors
(>J 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 bard cannot act for 15 days (Section 910.6).
( ) Claim is not timely filed. The Clark 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 2A I b� BY: (liPllk� `-�`�� 4L O/puty County Counsel
III. FROM: Clerk of the Bard TO: County Counsel (1) County Administrator (2)
( ) Claim was returned as untimely with notice to Claimant (Section 911.3).
IV. 8OARD ORDER: By unanimous vote of the Supervisors present
K) 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: DEC 10 in PHIL BATCHELOR, Clark, ty��/' O� . Deputy Clerk
WANING (Gov. code section 913)
Subject to certain exceptions. you have only six (6) m"ths from the date this notice as personally served or
deposited in the mail to file A court action on this claim. Sae Government Code Section 815.6.
you may seek the advice of an attorney of your choice in connection with this matter. If you went to consult
an attorney, you should do so immediately. % For Additional Warning See Reverse Side Of This Notice.
AFFIDAVIT OF AILING
I declare under penalty of perjury that I am now, and at all times herein mentioned. have been a citizen of the
United Sutes, over age 16; and that today I deposited in the United states Postal Service in Martine:.
California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimsnt, addressed to
the claimant as ahpwn above. ( 9
Dated. DEC 12 10 BY: PHIL BATCHELOR Clerk
CC: CG,rty Cc..rse County Administrator
This warning does not apply to claims which are not
subject to the California Tort Claims act such as
actions in inverse condemnation, actions for specific
relief such as mandamus or injunction, or Federal
Civil Rights claims. The above list is not exhaustive
and legal consultation is essential to understand all
the separate limitations periods that may apply. The
limitations period within which suit must be filed may
be shorter or longer depending on the nature of the
claim. Consult the specific statutes and cases
applicable to your particular claim.
The County of Contra Costa does not waive any of its
rights under California Tort Claims Act nor does it
waive rights under the statutes of limitations
applicable to actions not subject to the California
Tort Claims Act.
RECEIVED
OCT 2 81996
TO: COUNTY BOARD 0 SUPERVISORS CLERK 80ARD OF SUPERVISORS
651 Pine St et, Room 106 CONTRA COSTA CO.
Martinez, 94553
CLAIM
This claim is being made pursuant to California
Government Code Section 910 et seq.
This claim is being made on behalf of Devin MacKenzie
Wilkes by his mother and guardian Kathleen A. Wilkes and is being
presented through their attorney, the Law Offices of Alan M. Mayer,
Inc.
All notices should be sent to the Law Offices of Alan M.
Mayer, Inc. at 55 Shaver Street, #300, San Rafael, California
94901.
This claim concerns the death of Shawn Lewis Wilkes which
occurred on July 30, 1996 at Merrithew Memorial Hospital in
Martinez , California. Mr. Wilkes was killed by Semisi Saluni who
was a patient/inmate under the care and control of Contra Costa
County. The County, through its facility at the hospital , took
improper care and improper measures for the safety of its patients,
including Mr. Wilkes and allowed a situation to exist where a
person with known tendencies toward violent behavior was
-interacting with innocent bystanders such as Mr. Wilkes .
As a result of the County's improper conduct, Devin
MacKenzie Wilkes the actual claimant, has been deprived of monetary
Claim
Page Two
October 25, 1996
support and emotional support from his father who suffered injury,
damage, and loss in an amount currently unknown related to these
claims.
At the current time, claimant is unaware of the names of
the public employee or employees causing the injury, damaqe or
loss.
At this time it is impossible to estimate the amount of
perspective injury, damage or loss; however, it is certainly in
excess of $10, 000.
If you have any questions or require any further
information, please do not hesitate to contact me. In the meantime
please let me have your response to this claim within 45 days from
the date below.
Thank you for your courtesy and cooperation.
Very truly yours,
ALAN M. MAYER
AMM:kh
cc: County Counsel's Office
Kathleen A. Wilkes
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IN THE BOARD OF SUPERVISORS
OF
CONTRA COSTA COUNTY, CALIFORNIA
In the Matter of Honoring the )
West County Toxic Coalition on )
the Occasion of its Tenth )
Anniversary ) Resolution 96/545
WHEREAS, the West County Toxic Coalition was established in 1986, and
staffed by a group of concerned citizens in West Contra Costa County; and
WHEREAS, for the past ten years the West County Toxic Coalition has made it
a priority to help decrease the amounts of toxins our county residents are exposed to on a
day to day basis; and
WHEREAS, the Coalition was instrumental in helping to gain a financial
commitment from Chevron and General Chemical to aid in the construction of the
proposed Health Facility in Richmond; and
WHEREAS,the West County Toxic Coalition is actively involved in educating
the community on the effects of lead poisoning and has aided in acquiring grants for
citizens of Contra Costa County who are afflicted with prostrate and breast cancer; and
WHEREAS, the West County Toxic Coalition continues its commitment to the
community by being an active watchdog with respect to the operation of industries and
refineries in our county who handle toxins and hazardous materials; and
Now, therefore be it resolved that the Board of Supervisors of Contra Costa
County does honor and commend the West County Toxic Coalition for its dedication to
the betterment of the community and congratulates it on the occasion of its tenth year
anniversary.
PASSED AND ADOPTED on December 10, 1996 by a unanimous vote of the Board of Supervisors
present.
v 'um Roget
fnu yle Bishop
Mark De Saulnier Joe Canciamilla
I hereby certify that the foregoing is a true and correct copy of an order entered on the Minutes of said Board of
Supervisors on the aforesaid date.
Witness by hand and the seal of the Board of Supervisors affixed
this tenth day of December, 1996.
PHIL BATCHELOR,Clerk of the Board of Supervisors and
County Administrator
By (, .
Deputy Clerk
t0: BOARD OF SUPERVISORS
FROM: William B. Walker, M.D. �.
Health Director
DATE: November 26, 1996
SUBJECT: Technical amendment of Hazardous Materials Response Plans and Inventories
Ordinance
SPECIFIC REQUEST(S)-dFMECOMMENL)ATION(.5) &BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS
Adopt ordinance regarding hazardous materials response plans and inventories.
Waive reading and set December 17, 1996 for adoption.
FISCAL IMPACT
BACKGROUND/REASONS
This ordinance is necessary to amend section 450-2.014 of the County
Ordinance Code (Hazardous Materials Release Response Plans and Inventories),
regarding appeals from a decision of the administering agency, to correct
an outdated Ordinance Code reference.
CONTINUED ON ATTACHMENT: /YES SIGNATURE:
_RECOMMENDATION OF COUNTY ADMINISTRATOR _RECOMMENDATION OF BOARD COMMITTEE
_APPROVE _OTHER
SIGNATURE(S): /
ACTION OF BOARD ON ncr 10 1000 APPROVED AS RECOMMENDED ✓
OTHER
VOTE OF SUPERVISORS
_'TEUNANIMOUS(ABSENT ) I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY
AYES: NOES: OF AN ACTION TAKEN AND ENTERED N THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE SHOWN.
ABSENT: ABSTAIN: DEC10 ft
ATTESTED L
PHIL BATCHELOR, CLERK OF THE BOARD OF
cc: Lew Pascalli, Hazardous Materials SUPERVISORS AND COUNTY ADMINISTRATOR
William B. Walker, M.D. , Health Services BY \ , _d 4' .n . Y( � 0._� —, DEPUTY
Contact: Andy Parsons/6-2286 AlW 5,-BO DOC
M382
ORDINANCE NO. 96-
(Hazardous Materials Response Plans and Inventories)
The Contra Costa County Board of Supervisors ordains as follows (omitting the
parenthetical footnotes from the enacted or amended provisions of the County Ordinance
Code):
SECTION I. SUMMARY. This ordinance amends section 450-2.014 of the County
Ordinance Code, regarding appeals from a decision of the administering agency, to
correct an outdated Ordinance Code reference.
SECTION II. Section 450-2.014 of the County Ordinance Code is amended to read:
450-2.014 Appeals. Any decision of the administering agency may be appealed
to the hearing authority, in the manner and according to the procedures for appeals from
the permit authority in decisions concerning underground storage of hazardous
substances, set forth in Sections 450-6.802 through 450-6.806, inclusive, of this code.
(Ords. 96-_ § 2, 87-5.)
SECTION III. EFFECTIVE DATE. This ordinance becomes effective 30 days after
passage, and within 15 days after passage shall be published once with the names of
the Supervisors voting for and against it in the CONTRA COSTA TIMES, a newspaper
published in this County.
PASSED on by the following vote.
AYES:
NOES:
ABSENT:
ABSTAIN:
ATTEST: PHIL BATCHELOR, Clerk
of the Board of Supervisors and
County Administrator
By:
Deputy Board Chair
[SEAL]
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