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HomeMy WebLinkAboutMINUTES - 01091996 - C19 pl=ED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 19, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. P��I��:,,ea3e'mote, al'T'�„War.n`n"gs Lease _ w � CLAIMANT: Paul Shaffer I n 7 35 ATTORNEY: COUIL"`y Wu'NoL l< Date received MAR INC-ZCALIF. ADDRESS: 3512 Moraga Blvd. , Apt. 2101 BY DELIVERY TO CLERK ON : Deremher '7, 1995 Lafayette, CA 94549 BY MAIL POSTMARKED: Hand Delivered �1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL BATCHELOR, Clerk DATED: December 7, 1995 �q: Deputy_ AU eL—ad� II. FROM: County Counsel TO: Clerk of the Board of Supervisors (v<This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). (� Other: icj-A,,,A 14% -ruAleL-/ &�16At 2"D4D _ (:-pW4r/4 Q- WOSN Tk't- TSR- k. DATE bF 4-4 2— '-t-- is, i LT42KIN4D ►G1.Ai!d tA&i w FaLT gti UN71JUILL Dated: Z-7 ' 7s BY: ADeputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ✓) This Claim is rejected in full. ( ) Other; I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /-9— / 99 _PHIL BATCHELOR, Clerk, By .� , Deputy Clerk .: ,._ �. WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 9(1 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claim lo: BOARD OF SUPERVISORS OF CONTRA COSTA cD= INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of -the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Fine 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. entityq separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp PAUL SHAFFER RECEIVED Against the County of Contra Costa DEC - 7 or I M% District) CLERK BOARD OF SUPERVISORS —Mill in nameY L_ - CONTRA 1. CO. I The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 2. When did the damage or injury occur? (Give exact date and hour) Between 11 : 00am and 12 : 00 noon last week of JkLy-.' 1995 '2., Where did the damagi,,or injury occur? (Include city and county) In front of 1404 Pomona St . , Crockett , CA . 3. How did the damage or injury occur? (Give full details; use extra paper if required) I was walking on Pomona St . toward 3rd St . and tripped on the curb which circles around on to the sidewalk in front of Designers Arts & Crafts of Crockett , causing me to fall and injure my wrist and hip . 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Dangerously designed and constructed sidewalk . (over) 5. What are the names of county or district officers, servants or employees causil,ig the damage or injury? To be determined . 6. What damage or injuries do you claim resulted? (Give full extent of Injuries or damages claimed. Attach two estimates for auto damage. Broken wrist and hip thrown out of socket . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $1700 . 00 for chiropractor to treat hip injury . 8. Names and addresses of witnesses, doctorsandhospitals. A . Veterans Administratio- Hospit'al , Martinez . B . Veterans Administration Hospital , San Francisco . C . Lamorinda Chiropractic , Dr . Ryan Ike , Lafayette . 9. List the expenditures you made on account of this accident or injury: DAM ITEM AMOUNT June 1st-30th Lien on chiropractic bill 51700 . 00 . Z Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTi"=i-T-.O,.-,- :(Attorney .) or by some person on his behalf." 4 Nam and Kddf1-ds!§'6f.,A1-ttorhey, imant I s-Sigr���) k'0 6'-pIPWArv-2-)CJ (Address) Telephone No. Telephone No. * * * * * * a Z Z 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 ($10000)9 or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000p or by both. such imprisonment and fine. CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 'January 9, 19967' Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Paul Shaffer ATTORNEY: OEC DateZ)rece�Vt ,; ADDRESS: 3512 Moraga Blvd. , Apt. 2101 BY bFEF'V_ER:YTO_CL'ERK ON November 30, 1995 Lafayette, CA 94549 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QQ IL BATCHELOR, Clerk p DATED: December 1 1995 ea: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( v-Y This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) _Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /r2 —l" r'JS BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, 6y , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the :nail to file a court action on this claim. See Government Code Section 945.6. You may seek the aJvice 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 K. (LING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES: CONTRA COSTA COUNTY PHILLIP S. _ SHARON L. ANDERSON BRANDON D. BAUM COUNTY ADMINISTRATION BUILDING ANDREA W. CASSIDY VICKIE L. DAWES P.O. BOX 69 MARKE S. ESTIS VICTOR J.WESTMAN MARTINEZ, CALIFORNIA MICHAEL D. FARR COUNTY COUNSEL 94553-0116 LILLIAN T. FUJII DENNIS C. GRAVES SILVANO B.MARCHES[ TELEPHONE (510) 646-2041 GREGORY C. HARVEY ARTHUR W.WALENTA,JR. FAX (510) 646-1078 KEVIN T. KERR ASSISTANTS EDWARD V. LANE, JR. MARY ANN M. MASON PAUL R. MUNIZ December 4 , 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: Paul Shaffer 3512 Moraga Blvd. Apt. 2101 Lafayette, CA 94549 RE: CLAIM OF: November 30, 1995 Please Take Notice as Follows : The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910 .2, or is otherwise insufficient for the reasons checked below: [] 1 . The claim fails to state the name and post office address of the claimant. [] 2 . The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [x] 3 . The claim fails to state the exact 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. 1 [] 5 . The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10, 000) . If the claim totals less than ten thousand dollars ($10, 000) , the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10, 000) , the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [] 6 . The claim is not signed by the claimant or by some person on is behalf . [x] 7 . Other: Please identify the exact date on which you tripped on the curb. If the date of injury was prior to May 30, 1995 you may be required to apply for leave to present a late claim. (See `Government Code sections 911 .4 to 912 .2 and 946 . 6 . ) Under some circumstances leave to present a late claim may be granted. (See Government Code section 911 . 6 . ) You must act quickly, and may wish to seek the advice of an attorney to assist you. VICTOR J. WESTMAN, County Counsel By: �_�. — Deputy County Counsel 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: December 4, 1995 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE §§ 910, 910.2, 920.4, 910.8) Claim 'to: BOARD OF SUPERVISORS OF CONTRA COSTA OMM INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp PAUL SHAFFER ) ---- RECEIVE J�Q Against the County of Contra Costa ) LNOV 3 U 1995 or ) District) CLERK BOARD OF SUPERVISORS F111 in T)aIDe ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Between 11 : 00am and 12 : 00 noon last week of May , 1995 . . 2. Where did the damage or injury occur? (Include city and county) In front of 1404 Pomona St . , Crockett , CA , 3. How did the damage or injury occur? (Give full details; use extra paper if required) I was walking on Pomona St . toward 3rd St . and tripped on the curb which circles around on to the sidewalk in front of Designers Arts & Crafts of Crockett , causing me to fall and injure my wrist and hip . 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Dangerously designed and constructed sidewalk . (over) 5. What are the names of county or district officers, servants or employees cau�.ing the damage or injury? To be determined . S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Broken wrist and hip thrown out of socket . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $1700 . 00 for chiropractor to treat hip injury . 8. Names and addresses of witnesses, doctors and hospitals. A . Veterans Administration Hospital, Martinez . B . Veterans Administration Hospital , San Francisco . C . Lamorinda Chiropractic , Dr . Ryan Ike , Lafayette . -------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT June 1st-30th Lien on chiropractic bill $1700 . 00 . Gov. Code Sec. 910.2 provides: "The claim must.be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address 'of�Attorney Wla imantIs igre -3 S'-- z I? l��14x1210 Address o, l� `T s Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9, 1996) Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $750,000.00 Section 913 and 913.4. Please note all "Warnings". U&X=1ETLW1ZM CLAIMANT: Diane M. Fetherolf ATTORNEY: DEC 1 2 1445 Date received COUNTY COUNSEL ADDRESS: 129 Bishop Road BY DELIVERY TO CLERK ON D Q4QF1995 Crockett CA 94525 BY MAIL POSTMARKED: Not Legible 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppy g DATED: December 12, 1995 BaII Deputy OR, Clerk 1 n z¢ t H. FROM: County Counsel TO: Clerk of the Board of Supervisors (� This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /Z L— S S BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( v) This Claim is rejected in full. ( ) Other: -- I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: I q _J q/z PHIL BATCHELOR, Clerk, By fi r. L ,� • Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States over age I8; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /—/p —/qg(o BY: PHIL BATCHELOR by eDeputy Clerk CC: County Counsel County Administrator y Claim ',o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. I_f the claim is against more than one public entity, separate claims must be 'L l Cci GAG 1145b ci �iai ruuiA v E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp DTANF' M. FE=ROLF ) RECEIVED ) - ; Against the County of Contra Costa ) OEC I 11M or ) ., � & District) CLERK BO. D OF SUPERVISORS Fill in name ) CON SA COSTA Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 750,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) August 30, 1995 2. Where did the damage or injury occur? (Include city and county) MERRI=1 HOSPITAL, Contra Costa County 2500 Alhambra Ave, Martinez, CA 94553 3. How did the damage or injury occur? (Give full details; use extra paper if required) and endometriosis Lett surgical tape/in abdomen after surgery and failure to remove cervix 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See 3 (over) 5. What are the names of county or district officers, servants or employees causing -, the damage or injury? Merrithew Hospital, Drs. Edwin Carlson, Stewart Foreman, Kimberly Duir " S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Pain, suffering, emotional distress, diminution of earning capacity, loss of earnings 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) It is too early to dztermine the precise-nature and extent of injuries and permanent residuals so the amount is based on my attorney's experience 8. Names and addresses of witnesses, doctors and hospitals. Merrithew Memorial Hospital and Clinic, 9. List the expenditures you made on. account of this accident or injury: DATE ITEM AMOUNT none j Y .E 3 li j ( Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) orb some erson on his behalf." Name and Address of Attorney i mac' Clai is Signature 129 Bishop Road:_ Address Crockett, CA 94525 'Pel pnhnnr? Nr�. '^-,-^'---- NTo 510=787-3249 ,n NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. RECEIVE® LAW OFFICES OF DEC I 11995 JAMES F. KEMP CLERK RD OF SUPERVISORS CONTRA COSTA CO. SONOMA.CALIFORNIA 9'S476 428 FIRST STREET'EAST P. O. BOX 176 December 8, 1995 TELEPHONE(707) 938-2700 TO: Clerk of the Board of Supervisors County of Contra Costa Room 106, County Administration Building 651 Pine Street Martinez, CA 94553 RE: F ENCLOSED: Original and two copies Claim of Diane M. Fetherolf Return envelope PLEASE: File claim form and return filed stamped copy THANK YOU. JAMES F. KEMP D 0 N Z � 4 0. v t` iy\ r•" tP � !' lv t3\��� a CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 9, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $100,000.00 Section 913 and 915.4. Please note all „Warnings". CLAIMANT: Jessica Aburime '' =' "` `� 1E,I� ATIORNEY: Louis E. Kahn {:r n 3F 3100 Oak Road, Ste. 230 Date received ADDRESS: Walnut Creek CA 94596 BY DELIVERY TO CLERK ON Decemberj-&,-_19995., , BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. �dIL BATCHELOR, Clerk DATED: December 6, 1995 : Deputy II. FROM:: County Counsel TO: Clerk of the Board of Supervisors (✓) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /o� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. r Dated: PHIL BATCHELOR, Clerk, Byo4 Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United Sta ;es Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: BY: PHIL BATCHELOR by, rA 4A eputy Clerk CC: County Counsel County Administrator ~Claim ',o: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the, cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 914553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By ' ) Reserved for Clerk's filing stamp Jessica Ab ur ime RECEIVED Against the County of Contra Costa 5 1995 or ) 2 . 7 row District) aMIKSOAR OFSUPERVISORS Fill in name ) CONTRA COSTA CO. The midersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 100, 000 - 00 and in support of this claim represents as follows: ...�-w-M-----------------w---- -�-w--mow.---�----------w-w------ - 1. When did the, damage or injury occur? (Give exact date and hour) The damage occurred continuously during the period from June 1995 through July 1995. 2. Where did the damage or injury occur? (Include city and county) In the City of Concord, County of Contra Costa 3. How did the damage or injury occur? (Give full details; use extra paper if required) Please see attached. 14. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? I was forced, under order of my supervisors , to work with this patient despite my continued complaints (and the complaints. of another female. health care .worker) of sexual harassment and fear of battery by Mr. Russell . (over) It 5. What are the names of county or district officers, servants or employees causing the damage or injury? Sue Guest, Nursing Supervisor, Contra Costa County Home Health Agency. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. I have suffered emotional distress, embarrassment, humiliation, anxiety and lost wages :. ( current and future) . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Based on my medical bills , severe emotional distress and lost wages to presents , as well as future loss of wages because the incident has damaged my ability to deal with patients at this time. 8. Names and addresses of witnesses, doctors and hospitals. Kaiser -Permanente, 200 Muir Road, Martinez, CA 94553 Kaiser Permanente, 1425 S. Main Walnut Creek, CA 94596 Kaiser Psychiatry, 391 Taylor Bfvd. , Pleasant Hill, CA Kaiser Mental Health, 710 S. Broadway, Walnut Creek, CA 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 8/95 - Present Catholic criarities $50 Psychotherapy-,--- Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney)-__ orb some person q t his behalf." Name and Address of Attorney":--."':-''� - a 3 Louis E. Kahn #16077 -: �rjl/(/1 �• r-C"51 c' ��KV �w�C LAW OFFICES OF JOHN F. MARTIN Clai is Signature 3100 Oak Road, Suite 230 1491 Bahian Drive, #202 Walnut Creek, CA 94596 Address Concord, CA 94521 Telephone No. ( 510 ) 937-5433 Telephone No. ( 510 ) 680-1230 * * * * * * NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ATTACHMENT BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT Claim By: JESSICA ABURIME I was a home health aide for Contra Costa County Home Health Agency. I was subjected to continuous incidents of severe sexual harassment during the care of a patient, James Russell. Despite my repeated and continuous complaints to my supervisors about this, I was forced to continue to work in this unsafe working environment as a condition of my continued employment with the County. Mr. Russell harassed and abused me, asking me on a regular basis to "help him get an erection" and to "let him put his head in my vagina". Despite my fear for my mental and physical health, I complied with my supervisor's intimidation and demands that I continue to work with Mr. Russell. It was made clear to me that my job was in jeopardy if I refused the assignment. Mr. Russell then assaulted me, fondled me in a sexually explicit manner against my wishes, physically hit me, and attempted to detain me in his house. I am currently on leave due to the emotional distress caused by these incidents. attach.bod/nc Q / 9 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 9, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $298.00 + Section 913 and 915.4. Please notejj all "Warnings". CLAIMANT: Gene Castagnini ATTORNEY: Date received COUNTY ' f.F, ADDRESS: 1934 Basalt Ct. BY DELIVERY TO CLERK ON Dece_m1j� T'S z1:94S Walnut Creek, CA 94595 December 4, 1995 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. cppH IL geTCHyLOR, Clerk —� a �fA GATED: December 5, 1995 Bh: BATCHELOR, II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: l — Le - C(S� BY: ) Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: ------ I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /-9-/99(4 PHIL BATCHELOR, Clerk, By e_ ��, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /-/D /996 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claic to: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person • or to personal property or growing crops and which accrue on or after January 11 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=. R£: Claim,By ) Reserved for Clerk's filing stamp fa�1J� C11'�i I�-tp�►�I� -� ) RECEIVE® Against the County of Contra Costa ) DEC - 51995 or ) CLERK BOARD OF SUFEWSORS District) CONTRA COSTO CO. ��^ Fill in name The undersigned claimant hereby makes claim, Linst the County of Contra Costa Or the above-named District in the sum of $ ol6)%S0 and in support of this claim represents as follows: ALIWAte-i,4- , 4 04r of-rl" CoSKSW _fa crao 1. When did the damage or injury occur? -(Give exact date and hour) Wim- 3b 1,,(4q.3 = as i 10�'�/9 f0 i �r f 1a �fl CMR7+)L'I 4--� �Jf r1'r 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) arw a c J 040aD ,J 0 a)EO I W A WWI. Sl", A)&-,-I-i "V-"MT tUg WYOJ T];_ Cp7L IAS del L o N1 t TNS Lw gma3 a"s Tl fii-�_ /i'L_I(,,JrA 0/7 O d kLL. 4 T ec:S, W h-:S i 7tAoW J 0r!` ArJO L_ &Jdg_rJ c3"�l A A (L�'�J�T. ti-i�r171.)J0 (vga je, � Pos�-a S9� urn i� u. What particular act or omission on the part of county or district officers, ffa-l'e:Oe471- 'J'Igo se.^vants or employees caused the injury or damage? i+I TTI L)6 11tt-6F S-&-is I -r kSl S pro u L.D /4-AJC f'hYO V0AA0 A_ 1b Hplty OZ O. L) AJ eJ 0i "k-ts. :51k-kc -'ftm Pusan ,Mo v- 5E5J eAJt W(50QS Sm8011p ftWD J fie^vL-0 MO-P.5 wnat are ne na-nes of county or district officers, servants or employees causing the da:: ae or i n j ry? At L_ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. A-Li w t-n ev,*,' 5a)O'L&LY "oca_L_-D L)-1 - C#Y1_ g�. h- 15 t Ll F1�1;'� /hJ 0 flava X11✓ 5 � =t_. ku�a►x�u, u�Inco C � �-7 ; 1D 2O� wOa#J 0�ae -na,� 13vU-r 14sz7 fi tF. r-i(,v Ak �a 7. How was the amount claimed above computed? (Include the estimated amount of any Prospective injury or damage,) Auc3ae-ri' 1-71 �aJ llae> A-< 597a' of q{—O $. Names and addresses of witnesses, doctors and hospitals. w�M aoc�� k3e.) �'inz'w�rrta.+►�s�1 as A'S toa�ucA M,u� Wh)C - ta)alorX On NZOX AJ &LO M�)' CDAIA,0706) - YOL) AWS He AIAR U 9. List the expenditures you made on account of this accident or injury: CLJ�ate DATE ITEM` AMOUNT &TIE 1 A.M A , - Ah(=-LW -}J 1'--t n1 16,q -C-0,3 c ih.a��vk l�y�lc►r< ,►�� Gt-ti.t7t. su►►J 2itrnoJ •4.: Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or b some-person on his behalf." Name and Address of Attorney4W2�� CG-WC1 Claimant' Signature 1134 &".:Z &A , a. qqY% Address. Telephone No. Telephone NA N �io -vq� -A�/q iJ 1(,e 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 ort-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 im-priso.ni-jent- and fine. � F, -. s=-.•-.;.Y `� x T .. +A •t r•f,i r x _ • r� -i J:I1 ::diSSOTA ''ES; t .' _ Private_Investigations. , San Diego Los Angeles Las gas, .:Jack H.Suttie C.F:E.` Tel/Fax(619).:7.43••7072 i President ' P.U.Box 46U'23 .,T �t C ;CA PI-142081NV 698 Escondido.-CA; 92446' , JOAt Ilk J - i -+.,, yr .�'t•r yrs.!`ted� :']�. / j I^ y ..�>•,-`•.r.,,. ��._ ;�' .r rr � rpt.�+ '? OIL NOt. III �-V • "r RyNck'c'a&z.,-D tt�)} TIRE & V AUTO CENTERS ALAMEDA PLEASANTON DUBLIN PITTSBURG 861 Madna Vmage Pkwy. 4216 Rosewood Dr. 6028 Dough"Rd. 2145 Railroad Ave. Alameda,CA 001 Pleasarim,CA 94588 Dublin,CA 94568 P8lsburg,CA g4565 (510)523.2900 (510)7343444 (510)833-9700 . (510)4274000 LIVERMORE PLEASANTON CASTRO VALLEY STOCKTON 1485 first St. 3420 Stanley 8W. 3130 Casbo Valley BML. 945W.Rob Llywvs,CA 94550 Pleasatdan,CA 94566 CastroValley,CA 94546 Slocldan,CA 95207 (510)4554330 (510)4624900 (510)886.9500 (209)478-8740 WALNUT CREEK SAN RAMON . 1231 Walnut MainSt.,C 2131SanRaCA Va8 BNd. fS10) Creek;094596 San Rana-,16 845 - {5!0)935-4820 (51 0 )838.1160 TIRE SIZE DESCRIPTION EACH PRICE SERV.INCLUDED ❑ WHEEL BALANCE ❑ VALVE STEMS ❑ TIRE PROTECTION P ANON A ____ -ALIGNMENT ❑ MISC.SERVICE too TOTAL COST ( r� jl • , r. O � f � r b�Nvi vo .11 ,© Q .-- 7- 2 .1 i J' J V 1 s � � CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9, .1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all CLAIMANT: Diane and Nathan Cornwell ®E C 1 5 1995 ATIORNEY: J. Niley Dorit COUNTY COUNSEL 44 Montgomery St. , Ste. 3400 Date received ADDRESS: San Francisco, CA 94104 BY DELIVERY TO CLERK ON MW :Qe_4Ug4, 1995 BY MAIL POSTMARKED: December 13, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gg DATED: December 15, 1995 Bp gIL Deputy Oi ,, OR, tlerk I.— II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (� This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: c Dated: �ecow.ls� lIY9.S BY: �• Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Gated: /— q — /9 9 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. 1f you want to consult an attorney, you should do so immediately. * For additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 16; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /- /Q -�9g� 8Y: PHIL BATCHELOR byRIM, eputy Clerk CC: County Counsel County Administrator OFFICE OF COUNTY COUNSEL DEPUTIES= CONTRA COSTA COUNTY PHILLIP S. ALTHOFF i SHARON L. ANDERSON ANDREA W. CASSIDY COUNTY ADMINISTRATION BUILDING VICKIE L. DAWES P.O. BOX 69 MARKS S. ESTIS MICHAEL D. FARR VICTOR J. WESTMAN MARTINEZ, CALIFORNIA LILLIAN T. FUJII COUNTY COUNSEL 94553-0116 DENNIS C. GRAVES GREGORY C. HARVEY SILVANO B. MARCHESI TELEPHONE (510) 646-2074 KEVIN T. KERR ARTHUR W. WALENTA, JR. FAX (510) 646-1078 EDWARD V. LANE, JR. ASSISTANTS MARY ANN M. MASON PAUL R. MUNIZ December 19, 1995 VALERIE J. RANCHE DAVID F. SCHMIDT DIANA J. SILVER VICTORIA T. WILLIAMS NOTICE OF INSUFFICIENCY AND/OR NON-ACCEPTANCE OF CLAIM TO: J. Niley Dorit 44 Montgomery St, Suite 3400 San Francisco, CA 94104 RE: CLAIM OF: Diane and Nathan Cornwell 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. [ ] 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. [xx] 4 . The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [xx] 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: VICTORJ. WESTMAN, County Counsel By: , Depu J unty C unsel 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: December 19, 1995 at Martinez, California. cc: Clerk of the Board of Supervisors (original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM: GOVT. CODE S§ 910, 910.2, 920.4, 910.8) e RECEIVED y DEC 1 41995 J NILEY DORIT ATTORNEY AT LAW CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. TELEPHONE 44 MONTGOMERY STREET (415)956-2757 SUITE 3400 SAN FRANCISCO,CA 94104 December 13 , 1995 CERTIFIED MAIL Sharon Hiner, M.D. Merrithew Memorial Hospital 2500 Alhambra Martinez , CA 94553 Administrator Merrithew Memorial Hospital 2500 Alhambra Martinez , CA 94553 Board of Supervisors Contra Costa County P. 0. Box 911 Martinez , CA 94553 Re: Cornwell v. Merrithew Hospital et al Consumers Legal Remedy Act Notice and Demand Dear Dr. Hiner, Merrithew Hospital and County of Contra Costa: You are hereby notified that on or about May 1995, at Merrithew Hospital , in Martinez , you provided services, including medical services to Diane and Nathan Cornwell. In providing such services you violated Section 1770 of the Civil Code known as the Consumers Legal Remedy Act of California. Demand is hereby made that you compensate Diane and Nathan Cornwell for the substandard services provided. Under California law you have 30 days to respond to this notice and provide a remedy. Very truly yours, J 4NE DORIT JD Fax: 415/433-3308 � r Y 4� l r I r� 0 cc► o � � v o a� ) � o v � U N N s: 4 v � v 1.? y o CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 9, 1996 ' Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note a:1 � k1a;r,.n:i�ngs'�c � CLAIMANT: Heirs of Patricia Hamer ATTORNEY: David J. St. Louis COUNTY C+:UNISSEL Date received MARTINEZ CALIF. ADDRESS: 575 E. Alluvial, Ste 102 BY DELIVERY TO CLERK ON Nov tuber f3_ 1995 Fresno, CA 93720 BY MAIL POSTMARKED:_ November 7, 1995 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ��IL BATCHELOR, Clerk DATED: December 5, 1995 : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 7 BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ('+� ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated-__i PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. X Dated: /- /D — /9 9 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVED RECEIVED DEC DEC - 51995 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. CHER OARD 0 S RVISORS CONTRA C�OSTA - 1 DAVID J. ST. LOUIS #041122 LAW OFFICES OF DAVID J. ST. LOUISI INC. 2 575 E. Alluvial, Suite 102 Fresno, CA 93720 3 Telephone: (209 ) 431-5563 4 CLERK, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 651 Pine Street 5 Martinez, CA 94553 6 7 In the Matter of the Claim of CLAIM-FOR DAMAGES AGAINST the Heirs of PATRICIA HAMER against) PUBLIC ENTIT!( 8 COUNTY OF CONTRA COSTA, owner and ) [Government Code Section operator of MERRITHEW MEMORIAL ) 905, 905.2, 910, and 9 HOSPITAL ) 910.2] 10 11 TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 12 PLEASE BE ADVISED that the law firm of David J. St. Louis, 13 Inc. represents the heirs of PATRICIA HAMER, decedent, in 14 regards to this claim for damages against CONTRA COSTA COUNTY, 15 owner and operator of MERRITHEW MEMORIAL HOSPITAL, its staff and 16 employees, and makes the following statements in support of the 17 claim: 18 1 . Claimant, EMMA RAMER's, address is 897 Bierglen Way, 19 Sacramento, CA 95834 . 20 2 . The date and location of the negligence giving rise to 21 this claim are January 19, 1995 through April 10, 1995, and 22 MERRITHEW MEMORIAL HOSPITAL in Contra Costa County. 23 3 . The circumstances giving rise to this claim are as 24 follows: The claimant, due to brain tumor, submitted to a right 25 tempo I ral lobectomy on January 19, 1995, after which she lapsed 26 into a coma and subsequently died. 27 , 4. The claimant lapsed into a coma and died as a result of 281 1 1 negligence on the part of the hospital staff and employees. 2 5. Claimant will seek all damages allowed by law, including, 3 but not necessarily limited to past, present, and future lost 4 wages, attorney' s fees, costs, and general damages of 5 $250, 000.00. 6 6 . The names of the public employees causing the claimant's 7 injuries are Dr. Craig Nielsen, Dr. Jeffrey Schweitzer, 8 Merrithew Memorial Hospital, its staff, and employees. 9 7 . To date, this claim is within the jurisdiction of the 10 Superior Court . 11 8. Any notices regarding this claim should be sent to the 12 Law Offices of David J. St. Louis, Inc. , 575 E. Alluvial, Suite 13 102 , Fresno, California 93720. 14 Dated: October 3, 1995. 15 LAW OFFICES OF DAVID J. ST. LOUIS, INC. 16 17 BY.- or- DAV_W J. ST. UIS, Attorney f 18 Heirs of PATRICIA HAMER, Decedent 19 20 21 22 23 24 25 26 27 28 2 C 9 APPLICATION TO FILE LATE CLAIM December 5, 1995 BOARD OF SUPERVISORS OF CONTRA COSTA COUNT_Y, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this ocument mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 91.1.8 and 915.4• Please note the WARNING" below. Claimentt Heirs of Patricia Hamer Attorneys David J. St. Louis, Inc. Address: 575 East Alluvial, Ste. 102 Fresno, CA 93720 Amount: $250,000.00 By delivery to Clerk on _ November 8, 1995 Date Received: Nov. 8, 1995 By mail, postmarked on November 7, 1995 .I. : Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: November 27, 1995 PHIL BATCHELOR, Clerk, By Deputy I. FROM: County Counsel 70: Clerk of the Board of Supervisors ( � The Hoard should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Claim (Section 911.6). HATED: 1/ d7 R S VICTOR WE':S'IMAN, County Counsel, By Deputy I. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ✓) This Application is granted (Section 911.6). ( ) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: i o s- /9 9.se- PHIL BATCHELOR, Clerk, By Deputy WARN= (Gov. Code 5911.8) If you wish to file a court action on this matter, you oust first petition the appropriate court for an odder relieving you from the provisions of Ooverr mt Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of aBy attorney of your choice in connection with this matter. If M want to oosmult an attorney. You should do so i®ediately. TV. FROM: Clerk of the - -- s county Counsel AV County Administrator Attached are copies of the above Applioation. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Hoard's copy of this Claim in accordance with Section 29703• DATED: - o(o - /9 9S PHIL BATCHELOR, Clerrk, BY Deputy 9. FROM: 1County Counsel 2 County Administrator 70,e Clerk oF t e Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE MAIN (7 r9 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9, .1 996 , Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph 1V below), given pursuant to Government Code Amount: $1,000,000.00 + Section 913 and 9�5�4� Iez,s,e-,note a 1 "warnings". CLAIMANT: Maria De La Luz Gomez Martinez, et al. , ATIORNEY: Steven H. Henderson COUNTY COUN CL, . Jill Stern-Henderson Date received MAHTING2VALSG, ADDRESS: 3024 Railroad Avenue BY DELIVERY TO CLERK ON DPeemhPr 7, 1995 Pittsburg, CA 94565 BY MAIL POSTMARKED: Hand Delivprpd I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppH g DATED: December 7, 1995 BaII Deputy OR, Clerk - 1 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (t/) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a tate claim (Section 911.3). ( ) Other: Dated: -7 eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDS ORDER: By unanimous vote of the Supervisors present (�/) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /— y - / 991x, PHIL BATCHELOR, Clerk, By _ ,� ��, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 1-1© —192& BY: PHIL BATCHELOR by _ eputy Clerk CC: County Counsel County Administrator t�jj 1 STEVEN H. HENDERSON - SB #88620 RECEIVE® JILL STERN-HENDERSON - SB #148172 2 Attorneys -Abogados 3024 Railroad Avenue —L7 3 Pittsburg, California 94565 ARK _ - - DEC� WSM MPE 4 5101427-1771 COMM CosrA co 5 Attorneys for Claimants 6 TO THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, 7 MERRITHEW MEMORIAL HOSPITAL AND INDIVIDUAL EMPLOYEES OF 8 MERRITHEW MEMORIAL HOSPITAL 9 IN THE MATTER OF THE CLAIMS CLAIM FOR DAMAGES MARIA DE LA LUZ GOMEZ MARTINEZ, (Wrongful Death and 10 individually; MARIA DE LA LUZ GOMEZ Negligence) 11 MARTINEZ, as Guardian Ad Litem for her minor children - SERGIO MARTINEZ, 12 FRANCISCO MARTINEZ, IRMA MARTINEZ, VERONICA MARTINEZ, RUBEN MARTINEZ, 13 RAFAEL MARTINEZ; and ALMADELIA A. 14 RODRIGUEZ 15 1. Claimants, MARIA DE LA LUZ GOMEZ MARTINEZ, the surviving 16 spouse of decedent, JAVIER MARTINEZ; MARIA DE LA LUZ GOMEZ MARTINEZ 17 as Guardian Ad Litem of the minor children of the decedent, .SERGIO MARTINEZ, 18 FRANCISCO MARTINEZ, IRMA MARTINEZ, VERONICA MARTINEZ, RUBEN 19 MARTINEZ, and RAFAEL MARTINEZ; and ALMADELIA RODRIGUEZ the 20 surviving adult daughter of the decedent, make claims for damages as set forth 21 below. 22 2. At all times herein mentioned, defendant SHEILA DAVID, M.D. was 23 a physician engaged in the practice of medicine at Merrithew Memorial Hospital, 24 Contra Costa County, California. 25 3. On or about June 7, 1995, the decedent presented at Merrithew 26 Memorial Hospital emergency room for treatment complaining of severe chest 27 pain, accompanied by pain on the left side of the neck, soreness in the arms and 28 Page - 1 mgWartinezlClaim ;T 1 a recent history of vomiting several times prior to arrival. Thereafter the 2 . decedent was admitted for treatment, and defendants, and each of them, 3 Undertook to diagnose the decedent's illness and to treat and care for the 4 decedent. 5 4. Following the decedent's admission to Merrithew Memorial Hospital 6 for treatment, defendants, and each of them, negligently failed to exercise the 7 proper degree of knowledge and skill on examining, diagnosing, treating, and 8 caring for the decedent as hereinafter described. 9 5. At all times herein mentioned, decedent was suffering from coronary 10 artery arteriosclerosis and myocardial infarct. Defendants, and each of them 11 nonetheless incorrectly diagnosed the decedent's condition as esofagitis. The 12 decedent was released and given a prescription for Mylanta. 13 6. As a proximate result of the negligence of the defendants, and each 14 of them, as herein alleged, the decedent died on or about June 8, 1995, at 12:43 15 a.m. from coronary artery arteriosclerosis and recent myocardial infarct. At and 16 prior to the time of decedent's death, MARIA DE LA LUZ GOMEZ MARTINEZ, 17 SERGIO MARTNEZ, FRANCISCO MARTINEZ, IRMA MARTINEZ, VERONICA 18 MARTINEZ, RUBEN MARTINEZ, and RAFAEL MARTINEZ were totally 19 dependent on him for his support and maintenance. At all times prior to his death, 20 decedent was a faithful, loving, and dutiful husband and father. 21 7. As a proximate result of the negligence of the defendants, and each 22 of them, as herein alleged, and of the decedent's death, all of the claimants have 23 been deprived of the decedent's society, comfort, attention, services, and support 24 _ all to their damage. 25 8. As a further proximate result of the negligence of the defendants, 26 and each of them, as herein alleged, and of the death of the decedent, claimants 27 incurred funeral and burial expenses - all to their damage. 28 Page -2 mgWlartinezlClaim y t 1 9. As a further proximate result of the negligence of the defendants, 2 and each of them, as herein alleged, each of the claimants sustained general 3 damages, funeral and burial expenses, and each is entitled to interest on all 4 economic damages at the legal rate of interest, plus costs of suit, which may be 5 incurred in the prosecution of this claim. 6 10. Claimants' Address - 72 Pacific Avenue #D, Bay Point, 7 California. 8 11. Address For Notice Re This Claim - Steven H. Henderson, Esq., 9 3024 Railroad Avenue, Pittsburg, California. Telephone number 510/427- 10 1771. Fax number 510/427-4282. 11 Amount of damages claimed - in excess of $1,000,000.00. 12 13 Respectfully submitted, 14 15 STEVEN H. HENDE 16 Attorney for Claimants 17 Dated: December 7, 1995. 18 19 20 21 22 23 24 25 26 27 28 Page -3 mgWlan`inezlClaim 1 2 PROOF OF SERVICE BY PERSONAL SERVICE 3 4 am employed in the County of Contra Costa, California. I am over 5 the age of eighteen (18) years and not a party to the within cause. My 6 business address is: P.O. BOX 2353, Antioch, CA 94531. 7 On the date shown below, a copy of the attached document(s): 8 CLAIM FOR DAMAGES (Wrongful Death and Negligence) was . 9 served on the interested parties in this action by placing a true copy thereof in a 10 sealed envelope, causing each such envelope to be delivered by hand, as 11 addressed, with instructions that it be personally served on: 12 CONTRA COSTA COUNTY BOARD OF SUPERVISORS 13 651 Pine Street 14 Martinez, CA 94553 15 1 declare under penalty of perjury under the laws of the United States 16 that the foregoing is true and correct. 17 Executed December 7, 1995, at Pittsburg, California. 18 19 20 21 Maurice 0. Ortiz, Jr. 22 23 24 25 26 27 28 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9. 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "warnings". CLAIMANT: Demetrio Mora, Concepcion Rodriguez, Jesus Mora Silva Mora, Armando Mora, Hugo Mora, Pedro Mora, Norma Rodriguez, Trinidad Mora and Erica Mora. ATTORNEY: James Geagan, Esq 411 Russell Ave. 3&X=121 1 �7ate received ADDRESS: Y DELIVERY TO CLERK ON Decemeber 12, 1995 Santa Rosa, CA 9540 E C t 3 1995 BY MAIL POSTMARKED: Hand Delivered COUNTY COUNSEL MARTINF7 QAI IF 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 13, 1995 Iptl Deputy OR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late cleim (Section 911.3). ( ) Other: Dated: /02—/:5 9r BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /— 9 — / 2_2J4 PHIL BATCHELOR, Clerk, 6y , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 1 /�j -��q� BY: PHIL BATCHELOR by � ,,)Deputy Clerk CC: County Counsel County Administrator r LwAJ 1 JAMES GEAGAN, ESQ. (State Bar #68922) LC RECEIVED 411 Russell Avenue 2 Santa Rosa, CA 95403 12 1995 3 Attorney for Claimants4 BOARD OF SUPERVISOF` CONTRA COSTA CO. 5 In re the Claim of: ) 6 DEMETRIO MORA, CONCEPCION ) CLAIM FOR PERSONAL RODRIGUEZ, JESUS MORA, ) INJURIES (Section 910 7 SILVA MORA, ARMANDO MORA, ) of the Government Code) HUGO MORA, PEDRO MORA, NORMA ) 8 RODRIGUEZ, TRINIDAD MORA, ) and ERICA MORA, ) 9 ) Claimants ) 10 ) VS. ) 11 ) MERRITHEW MEMORIAL HOSPITAL ) 12 AND HEALTH CENTER, CONTRA ) COSTA COUNTY HEALTH SERVICES, ) 13 COUNTY OF CONTRA COSTA, ) 14 Respondents. ) 15 16 TO THE GOVERNING BOARD OF CONTRA COSTA COUNTY HEALTH SERVICES: 17 YOU ARE HEREBY NOTIFIED that DEMETRIO MORA, CONCEPCION 18 RODRIGUEZ, JESUS MORA, SILVA MORA, ARMANDO MORA, HUGO MORA, PEDRO 19 MORA, NORMA RODRIGUEZ, TRINIDAD MORA, and ERICA MORA, whose mailing 20 address for the purpose of this claim is 129 Tradaen Road, 21 Pittsburg, California, claim damages from CONTRA COSTA COUNTY HEALTH 22 SERVICES. 23 This claim is .based on personal injuries sustained by claimants 24 on or about June 18, 1995 at MERRITHEW MEMORIAL HOSPITAL AND HEALTH 25 CENTER, under the following circumstances: 26 Claimants are the heirs at law of TRINIDAD MORA, who died on 27 June 18, 1995. Said decedent presented at said hospital and came 28 under the care and treatment of Gerard Bland, M.D. , Daniel Livey, 1 M.D. , D. Warner, M.D. , J. Balich, M.D. , M. Applegate, M.D. , John 2 Doe Hunt, M.D. , John Doe Sancedo, M.D. , John Doe McDonald, M.D. , 3 John Doe Smith, M.D. , Pauline Velez, M.D. , Stuart Forman, M.D. , 4 Stephen D. Weiss, M.D. , Timothy J. Martin, M.D. , and other agents 5 and employees of said facility. At that time and place said persons 6 negligently and carelessly diagnosed, treated, and advised decedent, 7 causing her death on June 18, 1995. 8 Jurisdiction for this claim would rest in Superior Court. 9 All notices or other communications with regard to this claim 10 should be sent to: it James Geagan, Esq. Law Offices of James Geagan 12 411 Russell Avenue . Santa Rosa, CA 95403 13 14 Dated: December 11, 1995 15 16 J ES GEAbAN A�forney for Claimants 17 18 19 20 21 22 23 24 25 26 27 28 -2- 1 JAMES GEAGAN, ESQ. (State Bar #68922) 411 Russell .Avenue RE�EB�E� 2 Santa Rosa, CA 95403 3 Attorney for Claimants DEC 12 05 4 0:-0a - M CLERK 60ARD OF SUPERVISORS 5 CONTRA COSTA CO. 6 In re the Claim of: ) 7 , DEMETRIO MORA, CONCEPCION ) CLAIM FOR PERSONAL RODRIGUEZ, JESUS MORA, ) INJURIES (Section 910 8 SILVA MORA, ARMANDO MORA, ) of the Government Code) HUGO MORA, PEDRO MORA, NORMA ) 9 RODRIGUEZ, TRINIDAD MORA, ) and ERICA MORA, ) - 10 ) Claimants ) 11 ) VS. ) 12 ) MERRITHEW MEMORIAL HOSPITAL ) 13 AND HEALTH CENTER, CONTRA ) COSTA COUNTY HEALTH SERVICES, ) 14 COUNTY OF CONTRA COSTA, ) 15 Respondents. ) 16 TO THE GOVERNING BOARD OF COUNTY OF CONTRA COSTA: 17 YOU ARE HEREBY NOTIFIED that DEMETRIO MORA, CONCEPCION 18 RODRIGUEZ, JESUS MORA, SILVA MORA, ARMANDO MORA, HUGO MORA, PEDRO 19 MORA, NORMA RODRIGUEZ, TRINIDAD MORA, and ERICA MORA, whose mailing 20 address for the purposes of this claim is 129 Tradaen Road, 21 Pittsburg, California, claim damages from COUNTY OF CONTRA COSTA. 22 This claim is based on personal injuries sustained by claimants 23 on or about June 18, 1995 at MERRITHEW MEMORIAL HOSPITAL AND HEALTH 24 CENTER, under the following circumstances: 25 Claimants are the heirs at law of TRINIDAD MORA, who died on 26 June 181 1995. Said decedent presented at said hospital and came 27 under the care and treatment of Gerard Bland, M.D. , Daniel Livey, 28 1 M.D. , D. Warner, M.D. , J. Balich, M.D. , M. Applegate, M.D. , John 2 Doe Hunt, M.D. , John Doe Sancedo, M.D. , John Doe McDonald, M.D. , 3 John Doe Smith, M.D. , Pauline Velez, M.D. , Stuart Forman, M.D. , 4 Stephen D. Weiss,. M.D. , Timothy J. Martin, M.D. , and other agents 5 and employees of said facility. At that time and place said persons 6 negligently and carelessly diagnosed, treated, and advised decedent, 7 causing her death on June 18, 1995. 8 Jurisdiction for this claim would rest in Superior Court. 9 All notices or other communications with regard to this claim 10 should be sent to: 11 James Geagan, Esq. Law Offices of James Geagan 12 411 Russell Avenue Santa Rosa, CA 95403 13 14 Dated: December 11, 1995 15 16 JgS GEAGAtrney for Claimants 17 18 19 20 21 22 23 24 . 25 26 27 28 -2- 0 0'1A 1 JAMES GEAGAN, ESQ. (State Bar #68922) RECEIVED w: 411 Russell Avenue � �,. --1 2 Santa Rosa, CA 95403 12 1995 3 Attorney for Claimants b! 0 M�., 4 CL�K OARD OF SUFFR��dr CONTRA COSTA CO 5 In re the Claim of: ) 6 DEMETRIO MORA, CONCEPCION ) CLAIM FOR PERSONAL RODRIGUEZ, JESUS MORA, ) INJURIES (Section 910 7 SILVA MORA, ARMANDO MORA, ) of the Government Code) HUGO MORA, PEDRO MORA, NORMA ) 8 RODRIGUEZ, TRINIDAD MORA, ) and ERICA MORA, ) 9 ) Claimants ) 10 ) VS. ) 11 ) MERRITHEW MEMORIAL HOSPITAL ) 12 AND HEALTH CENTER, CONTRA ) COSTA COUNTY HEALTH SERVICES, ) 13 COUNTY OF CONTRA COSTA, j 14 Respondents. ) 15 TO THE GOVERNING BOARD OF MERRITHEW MEMORIAL HOSPITAL AND HEALTH 16 CENTER: 17 YOU ARE HEREBY NOTIFIED that DEMETRIO MORA, CONCEPCION 18 RODRIGUEZ, JESUS MORA, SILVA MORA, ARMANDO MORA, HUGO MORA, PEDRO 19 MORA, NORMA RODRIGUEZ, TRINIDAD MORA, and ERICA MORA, whose mailing 20 address for the purposes of this claim is 129 Tradaen Road, 21 Pittsburg, California, claim damages from MERRITHEW MEMORIAL 22 HOSPITAL AND HEALTH CENTER. 23 This claim is based on personal injuries sustained by claimants 24 on or about June 18, 1995 at MERRITHEW MEMORIAL HOSPITAL AND HEALTH 25 CENTER, under the following circumstances: 26 Claimants are the heirs at law of TRINIDAD MORA, who died on 27 June 18, 1995. Said decedent presented at said hospital and came 28 under the care and treatment of Gerard Bland, M.D. , Daniel Livey, 1 > 1 M.D. , D. Warner, M.D. , J. Balich, M.D. , M.- Applegate, M.D. , John 2 Doe Hunt, M.D. , John Doe Sancedo, M.D. , John Doe McDonald, M.D. , 3 John Doe Smith, M.D. , Pauline Velez, M.D. , Stuart Forman, M.D. , 4 Stephen D. Weiss, M.D. , Timothy J. Martin, M.D. , and other agents 5 and employees of said facility. At that time and place said persons 6 negligently and carelessly diagnosed, treated, and advised decedent, 7 causing her death on June 18, 1995. 8 Jurisdiction for this claim would rest in Superior Court. 9 All notices or other communications with regard to this claim 10 should be sent to: 11 James Geagan, Esq. Law Offices of James Geagan 12 411 Russell Avenue Santa Rosa, CA 95403 13 14 Dated: December 11, 1995 15 16 JAM GEAGAVO A t rney for Claimants 17 18 19 20 21 22 23 24 25 26 27 28 -2- F� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9, 1996, Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. _) the action taken on your claim by the Board of Supervisors (Paragraph 1V below), given pursuant to Government Code Amount: $500,000.00 ;1Dyction 913 and 915.4. Please note all "Warnings". CLAIMANT: Steven Ray Payn � 19�`T ATTORNEY: cpuN'f`�Z�p,SF� Date received ADDRESS: 1354 2 Warren VWW1 BY DELIVERY TO CLERK ON December 12, 1995 Martinez CA BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 13 1995 BUIL BATCHELOR, Clerk �_�L.DATED: e ut J II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( L-r This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying Claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /2—/3 —9d^ BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (V ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Gated: /— 9 PHIL BATCHELOR, Clerk, By -A Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /- I - J 9 9 (v BY: PHIL BATCHELOR by &�� Deputy Clerk CC; County Counsel County Administrator Claim lo: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 19 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 Roam 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 j RECEIVED Against the County of Contra Costa or ) DEC 1 21995 District) 1,'/5 0'M - Fill in name ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �S Dom , 0 0 0 and in support. of this claim represents as follows: p[� strr��c, 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) TZ 0 3. How did the damage or injury occur? (Give full details; use extra paper if required) SEV0kAL P s 4. What particular act or omission on the part of county or district officers, servants o� � r employees caused the injury or damage? p S1 �i S � A '" e� 1 �Qp'Kg.J . NOs �J d N� .Sf4F_�`�i � 17�D�C � )��S � 1� "� ✓� o --0A e- -�p,&e aP My HCA1 1 Rs 0 J The �row�d Cd ✓er' (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? b 5 a � � V L( � A S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. N,-u)1�� — f'l r J - --- - -------------- -- 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) r ,�Ps�� i ti e Sc Ga P s 3 /`1 y AA c-1<< As 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: s+ "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney l Claimants Si tune Address CAL • Telephone No. Telephone No. _C) LS- NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA JANUARY 9, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors � (Paragraph IV below), given pursuant to Government Code TERAmount: $6,000.00 + ti>?; =�L'`S�eEt�ort? 3 and 915.4. Please note all "warnings". CLAIMANT: Matthew S. Suttie Cir c ATTORNEY: COUNTY C�'j(OSEL MARTINEZ Ctilfe received ADDRESS: 1759 S. Mammoth Place BY DELIVERY TO CLERK ON December 11, 1995 Escondido, CA 92029 BY MAIL POSTMARKED: Not Le3zible I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IVIL gATCHELOR, Clerk if DATED:_ Decmeber 12, 1995 : Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (✓- This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 12 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 9 1 9 9/e PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. " 1 ✓ Dated: / -uL z 96 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ,I.K -& ASSOCIATES CA License, PI u142Q$ Nevada License#698 December 5 1995 L 1 Esconzhdo,.cA' R E GE I V ELS v . 5 CONTRA COSTA COUNTY DEC I J CLERK .OF`THE'BOARD OF:.SUPERVISORS' 65I Pine Street. tstlPERVIsoRS Martinez; CA ,94553' RE CLAIM FOR PROPERTY'DAMAGE AND;:BODILY INJURY<" Dear Clerk 's (Office, Ori"August 13,,1995,' ,a approximately.'3 45 pa,-"my son,.Matthew S "Suttie was;involved in a:motor.,veh>cle accident ori Marsh Creek Road AAs ou are aware.Contra Costa,Coun y h` maintains'an 'has jurlsdlctiom:over` ;this road As you are',also aware,,a'vast number of serious ry. accidents have occurred in the exact.location where my son had"his;'.accident t The location of the accident was approxllnately one'and a half miles.east of Clayton, In the first area where a passing:zone is.lacated My,;son-,had been fal owing``two;vehicles for about"_,: `. a mile, drat we're travelling about 35 to>40 les per-hour He had driven this road only;one time,before, 'When-he saw yth6,,pass ng zoite, he,began to pass:; �.M lie was about r -e d to' come back Into'.the eastbound lane (still within the.passing zone), all'of axsudden";a pick up truck appeared:from'no where 'My son hit,'the:pick uptruck head-on.,'My son never saw the.pick-up truck, he-told-me that the passln" zor e` d two:bl nd areas where you couldn't . ., -.- g see onconung''traffic.: I;doubted-my 21 year old 'son, since they tend to exaggerate a'1616- at' '1616at' times, ,! y _ My�son"was aloneriri.hls-vehicle There were three occupants'(of the`other vehicle, two of which were treated for minor mjurles and one had a broken:aria M syn suffered multiple cuts about h1s-`face; with permanent scarring:; ince, my'son's 1990 Nlssah Sentra two-door-car was totalled he has no transportation " My wife and I had to come up; ta':help hili out,;which cast:me significant billable flours My >nsurapce dId°:riot cover"comprehensive or collision on;tfie:,Sentra, so h1s ,$51, - ,, 0 cai, 1s one `We were a1d;$250 00 for the car m.salva ewaliie�onl Towin story e`and transfer ` g p g,,., y g= g fees, brought this amount down ao ,$36.00­'_1 hale several photographs.of the car, one of. _, which I`,am enclosing for:proof ` The car'was. towed by:Frank's Tow of Concord of 5101 Clayton.Road; at the' request.of f the C:H P:;who handled the,.accident My son was cited for an illegal .pass The CHF. log number was" 1156 and the report . rluinber was A`9648: The"cut wholesale Kelly blue,boak an hlscar Is.$3,675.00 and;the `.. retail 1s-$5,990.00 His car-is considered"totalled,according ta,Concorde,Auto Dismantlers, -. f (619);;743-7072, P`O Box 460723 Professional inyestigarions. Ecco' do CA_9204G 0723 Inc Since th'e're was;no insurance, we accepted this amount; our,final check for a cituthat` WAS worth $5,000.00 was` $30:00 His, car had :70,000 miles ,on it,°with a:standard l transmission and power steering/arr''conditioriing My, son� further, incurred additional" non- reimbursed medical charges of $639.13 (Arriliulance/Paramedic) and $606 J3 (John Muir.'Hospital).''`-This-does`:not include' the 4 Physician Charges from the plastic surgeon', however;Lairi�not including those charges,as 'myr son did not,have his seat belt on. Copies of.ALL"_bills.are attached to,xhis le't'ter., ; , I am a veteran"State Pohce;(Ilhnois) and San Diego`Police:officer I have handled;testified, and'beeit-deposed numerous times onissues of liability._0 certarn',occasions I`;have.been considered aniexpert witness I`.am currently a CA and NV licensed private investigator, r who conducts civil°litigationdefOns,e and civil%criminal prosecution c"ase work foraaw'firms and;eniployers I am attaching amy resume':for your perusal ` I was also.°a Certified:,Motor Carrier'Safety inspector with the.Illinois',State Police ; I have handled specialized:. accident investigations 'which ',included <those regarding road coristructionAafety conditions and vehicle ;"hazards with commercial ;vehicles:: ,Those. accidents were much',more detailed than passenger'car accidents In all of the accidents I m investigated, the juries ranged-from, 'minor`injuries to multiple fatalities: , I received",a one week training course-;on highway;construction hazards and safety issues' pertarmng to accident investigation with,the;Illinois State rPolice as well;as\further.P:O:S T training;at the San,Diego Police�Acaderny ^. nor about August .5, 1995, I travelled,to the location of'storage of the Nissan Sentra:a�nd took photographs of it. After this, I went to-=the scene`of;the accident and took;a one half hour. video tape'';of the complete travel.route my sson Matthew took_fromjgancio Valley -,,'Road East oft,,. arsh Creek- Road n)=to the first`passing zone Tqm where. Marsh "Creek begins two" wo lanesof traffic 1;then `observed; and video"taped' the two `COMPLETEL"Y blind spots that my son:had referred to when he.told me oriprially that h'e<never saw ahe pi'ck�up truck`coming at him y I was absolutelyahocked;.�In:almost ten years of Police work,,:with 2ALL that I have seen, I have NEVER seen;a passing zone like:this where simply'stated; "There should'never have been a`passing- zone !,: This, assiri zone with the-si n clearl ;in the video. shows a down P g passing ( g,, y grade, into two curves where `the-onconung;traffic CANQT be seen `WHY? I then video taped two,.other passing zones:were.the road is straight and no grade, with visibility ry J that is unobscured for_at least one' m e..in either directro i. Through investigation;VI was~able`to e"stablrsh clear.hability on.the part of'the County for having a passing zone in this,area:' I ama lrcerised private investigator:in CA and NV.:This is riot fo"reign;territory for;ine to::be in Contra Costa County- has had previous ;claims for srmiiar mishaps'•at this exact area I still ask nyself; "Why{is this still`a passing zone"? I am n Q { i e' 1 currently in contact with`two Walnut-Creek law firms who are willing to handle this claim, as,they are as they said "quite^familiar-with this passing:-zone°and,j 6 9 " prior,claims:that''h'ave resulted" ,However,"I was:_aduised to ,snake,,a clairri directly t, the' County 'first, ,to avoid r litigation: ',s.. - My;:insurance,'company is handling tile"claim on-the part of medical"payments to':the other } " b parties v t y . Myintere'st on:behaIf of ' ' son{power of attorney attached)is twofold ;I am_requestmg payment for his car,-his outstanding medical charges outside of the..plasttc'surgeon,Rand a' stern request;'that this area'on 1Vlarsh,Creek:.Road become a iio passing,zone Ifithis claim is not Honored; Contra:Costa County will bey nairied in the lavv suit to recover ,. damages.for personal'injur and"property damage Th e.amount,will`include:the time I:have spent on handling my son's rnatters.which-at present amounts to, approximately anadditional X3,000:00: I am asking fora reasonable amount of payment,for the.car, and the medical bills, nothing _ else Trus totals; :$1,24546 for medical.and $5;000 460 for:, the .vehicle. Your,prompt consideration of this:claim is appreciated Since`the statute of filing ends on February 13, 1996, if 1-have notreceived`i e mbursement,on this claim, I will be:fihng the case with-the Siiperior'Court and:it will} be represerted:�by competent counsel who is familiar wrtl the '. ;histary of Marsh Cieek.Road I,will be working in the,bayarea on December 14 and iii order that someone from the Board may contact me.to meet with,me-if needed I will have the'video-tape,Wnth rre In ahe event the Board or,their'designee would have need of`contacting me while I am up in the Bay area, they may contact me at my cell phone(voice-mail'_pager:number of 9),991-3919. Sincerely; Jack H.' 466;,C E13 (Agent,through Power of Attorney for.Mat#hew S:Suttle) Jhs a _ i 0� SPECIAL POWER OFATTORNEY I, Matthew S. Suttie, residing at 1759 S. Mammoth Place, Escondido, California 92029, USA, hereby appoint Jack H. Suttie of 1759 S. Mammoth Place, Escondido, California 92029, USA, as my Attorney-in-Fact ("Agent"). If my Agent is unable to serve for any reason, I designate Kathleen V. Suttie of 1759 S. Mammoth Place', Escondido, California 92029, USA, as my Successor Agent. My Agent shall have full power and authority to act on my behalf but only to the extent permitted by this Special Power of Attorney. My Agent's powers shall include the power to: 1. Open, maintain, or close bank accounts (including, but not limited to checking accounts, savings accounts, and certificates of deposit), brokerage accounts, and other similar accounts with financial institutions. This power shall include the authority to conduct any business with any banking or financial institution with respect to any of my accounts, including but not limited to making deposits and withdrawals, obtaining bank statements, passbooks, drafts, money orders, warrants, and certificates or vouchers payable to me by any person, firm, corporation, or political entity. 2. Perform any act necessary to deposit, negotiate, sell, or transfer any note, bond, security, or draft of the United States of America, including U.S. Treasury Securities. 3. Have access to any safety deposit box(es)that I might own, with the power to remove any, or all of the contents of such box(es). 4. Take any and all legal steps necessary to collect any amount or debt owed to me, Qr to stele any claim, whether made against me or asserted on my behalf against any other person or entity, including the power to sign releases and agreements. 5. Sell or convey any tangible or intangible personal property that I might own(whether currently owned or later acquired). This power shall include the power to (i) sign contracts of sale and documents to transfer title (including bills of sale), and (ii) accept a security interest for any unpaid portion of the purchase price. 6. Obtain credit or borrow money as deemed appropriate by my Agent. This power shall include the power to (i) obtain credit upon such terms as my Agent may deem appropriate, lnitialto// _ "11Z subject to the limitations(if any) stated above, (ii) sign any documents(including notes, credit agreements, security agreements, and financing statements), and (iii)take any other action that may be required to complete the above transaction. 7. Prepare, sign, and file`documents with any governmental body or agency, including but not limited to, authorization to: a. Prepare, sign, and file income and other tax returns with federal, state, local, and other governmental bodies. b. Obtain information or documents from any government or its agencies, and negotiate, compromise, or settle any matter with such government or agency(including tax matters). c. Prepare applications, provide information, and perform any other act reasonably requested by any government or its agencies in connection with governmental benefits (including military and Social Security benefits). 8. Act on my behalf with respect to the following matters: - Employment benefits of any kind - The purchase and/or maintenance of life insurance on my life or the life of any other appropriate person. CAn ployment of professional and business assistance as may be appropriate, luding attorneys, accountants, and real estate agents. sulting Actions of Motor Vehicle Accident 08/13/95 y recovery of losses related to Accident: 08/13/95. agement of counsel to further any claim for losses. 9. Disclaim any interest which might otherwise be transferred or distributed to me from any other person, estate, trust, or other entity, as may be appropriate. I hereby grant to my Agent the full right, power, and authority to do every act, deed, and thing necessary or advisable to be done regarding the above powers, as fully as I could do if personally present and acting. Any power or authority granted to my Agent under this document shall be limited to the extent necessary to prevent this Power of Attorney from causing(i) my income to be taxable to my Agent, (ii) my assets to be subject to a general power of appointment by my Agent, and (iii) my Agent to have any incidents of ownership with respect to any life insurance policies that I may own on the life of my Agent. Page 2 of 4 Initials: My Agent shall not be liable for any loss that results from a judgment error that was made in good faith. However, my Agent shall be liable for willful misconduct or the failure to act in good faith while acting under the authority of this Power of Attorney. I authorize my agent to indemnify and hold harmless any third party who accepts and acts under this document. My Agent shall be entitled to reasonable compensation for any services provided as my Agent. My Agent shall be entitled to reimbursement of all reasonable expenses incurred in connection with this Power of Attorney. My Agent shall provide an accounting for all funds handled and all acts performed as my Agent, if I so request or if such a request is made by any authorized personal representative or fiduciary acting on my behalf. This Power of Attorney shall become effective immediately. This Power of Attorney shall continue effective until my death. This Power of Attorney may be revoked by me at any time by providing written notice to my Agent. Dated A ItIV. 19'9< at Escondido, California, USA. J tthew S. Suttie r Page 3 of 4 Initials: State of California County of S rd -D I C(, y r On ( "a7- �! S' before me, int (2, (AN Z - /47-711K-J, personally appeared Matthew S. Suttie, [ ] personally known to me - OR- ] proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument and acknowledged to me that /she executed the same in his/her authorized capacity, and that by is er signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument. WITNESS my hand and official seal. .•r�„� . OFFICIAL SEAL NADINE R. GANZ Q, NOTARY PUBLIC-CALIFORNIA Cr e COMM.NO. 1063820 4' SAN DIEGO COUNTY ��ap.,• MY COMM.EXP—SEPT,8, 1994 Signature of Notary Page 4 of 4 Initials: JACK H." SUITIE� ,P O Box 460723, z Escondido;CA 92046-0723, (619) ;>743 7072 OUALIFICATIONS,:SUMMARY,, Specialized;education and experience in both Law Enforcement, Corporate Loss Prevention;and Private Investigations,building.,, a reservoir of resources,."' t T Key Strengths * `Sensuig',and Solvmg.ProblemsA efore;They,Surface' * 'Keen Oliservation%Judgement,Skills Effective Employee Communication r *':Ability to Follow Detailed"Instructions 1 *`=Soong Stress Management,Skills ti * 'Situatioiial-Analysis r ' "-PROFESSIONAL ACCOMPLISHMENTS' Presently owns and:operates the„new breed�of Private,Investigative firms which excels ihprofessionalism, ethics, experience and' prompt:service-to,"Satisfied clientele t90°jo`admission'rato m`Investigative Interviews-relating to'misconduct or fraud Supervised Undercover Narcotic and Fraud Investigations for the largest and oldest Frivate Investigatioa firm in`Elie West -Directly Supervised all Security/Safety Operations in over 100 Auto Parts Stores which were comprised of.over 1500 employees Maintained Corpoiate Liaison with direct responsibility to the'Chief Of Executive icerof,the Nations Largest Auto Parts Cham..t, Part of a-six man team that was,resporisible for an annual 33,% iu nover rate for-terminations with a;company of over 6000 employees: Solely discharged over 600'employees in 6 years: v 100% success yratio in Employee Prasecutians and Unemployment Hedrin6.( Pet fect score on.the F.B.I? Special Agent Entrance,Exam r „H Supervised an,8 man highly technical group of State-Police Officers mi enforcing State and Federal Transportation Laws. Live-m Bodyguard-for the Lieutenant Governgr of the Stafe of Illinois t Master Nfarksinan;- on the Honorary Deputy Sheriff s,Association Award in the'104th San Diego Police Academy g Received 4'separate commendations from the,Governor:s Office addressing exemplary public relations ability in handling_difficult ehforceiiienf'and arrest situations. Honored each year with Superior"Standards Ratings' ; Trained New Recruits in all aspects of`Cruninal; Traffic, and:Commercial Vehicle I;aws Reduced alcohol related traffic accidcnts.by 20°To through personal and group dedication of'special task force Received national media coverage ' At-2ff years of iax age,`managed �•consuka'tion office EDUCATION&,CERTIFICATIONS s y $. A.'Crimiiial Justice, University'of Illinois •Graduate„Illinois Sfate.-Police Academy Graduate;',San Diego Police Academy- Baton & Tear.-,Gas Permits `. .• Graduate;Reid,Polygraph-Institute-Seminar on Interviewing,and Interrogation Techniques:•` Licensed Private Investigator & Firearms Permit, State of California s .Licensed Private Investigator,,State of Nevada Certified Motor"Carrier,Safetyjnspector, Illinois State,?ohce. Traffic Violator'School 4nstructor,'State of California '- Certified Fraud Exarnuier:;- A.C:F.E. accreditation Concealed Weapons Permit Sari'Dtego'County.Sheriff` r, PROFESSIONAL':HISTORY'I%9 -,Present} J K.,&Associates,'Private.Investrgations President=Qualified Manager/Owner? I{rout & Schneider Ine; ors-,*. ;T Supervisor of CorporaWinvestigations,-San Diego orthern NAutomotive,Corpoiation`Incorporated Loss Prevention Manager/Corporate-Investigator ? Diego rCity&'':Harbor Police Departments San ,. Police COffieer •� . _ . Illinois Siate'Pohce. f° `Acting Sergeant Master Trooper Juvenile.Officer Daken Gallery and'Fraxne�Shop,� ” Sales Representative Marriott-Corporation Securzty'Officer Dave Suttze Auto`Sales 'Mechanic Lord &;Taylor' Y Store'Detective' s' McDonald's -Corporation'.j Corporate and'Unit Security , MR 81oek,Incorporated ; Income Tax Consultant'. Vila'rin! Company Owner/Operator Residential/Commercial'Intrusion/Fire:Alarm'Systems, .AFFILIATIONS California"Association of':Licensed Investigators California;Instrtute.for'Professonal Investigators n` Amer ican`Society for Industrial`Security,- Past San Diego Chapter`:Officer. k' Los ngele"s County Bar Association,-:Directory,of Experts & Consul Atants San'-Diegq'County,'Robbery Investigators A ss' ociat ion ' Association of'Certified`Fraud EXammers � FraternalfOrder`of Pohc:e'- Trooper's Lodge#41 Escondido,Chamber of Commerce -North County Personnel,Association (San Diego County) Membership Committee- s O m -4 O vii "" O 3 Cf►.r aJc ,:�«.►e j v w-+ :<to O m O lr alt m z o M 3? # Z 03 ^nm .1h or, 14 ��Em x� rll< o to I <"M �"3�m n--1 w ti,•-4 z m ca= rear ` alrxrn- 5 r-n �Ir44 cr m z� rvm STP--q rn{ Ir m t'l►�+t tom+ r-z m RrZ r" t!} P,m -•{: �. cM �� m o rn ' m < ave m M a O ? m ( fVwhl�-srJ — to �? �1 N •.+°.�,{ _ � O � crn r� r n rnZ 0W t'r 'Q �~ m m co z M N t'7 r7 z -„ i 1 mm ....,..,., .. c) o o m - M `,. w CIG cio K. M c� G 1? ? •pNJG� h10" M Ej to m z Eb . cSz f * A4 X�.Om to *.:j i'r!* :,c i�itlitJ �+l�1LCCID Sm * z z w * 3>rn H f- 3 m 1i Cn o o ' (� J3. a;Crf m m z 1' �i '� rn rn p o "' m "{ D n t * • m m x n m - co 16D . � tim Off. Q` Ob mm oT C1 b-A .. n1 V -,m m t'" r to ' r.�I �1 n z r cd o .m m r. Acn O. z t,, �, o D ro .ts -G ' m < z 0 D (/a ren'Z ` m s ;:u o zrn -1 rn m CORPORATE NO. G{IARANTOFt NAINIF 033 �77'� !MATTHEW SUTTIE i 9522500114, MATTHIFW SUTTIE 606 . 33 PAY THIS AMOUNT. PLEASE REMIT YOUR PAYMENT TO: JOHN MUIR,MEDICAL CENTER 1601 YGNACIO VALLEY ROAD ( -- WALNUT CREEK CA 94598-3194 V / MATTHEW S U T T I F. _ ---- ' (510)938-2400 1144 WcST HAROING , Cf1Ar1GF. TO�,IY: I_. ,r� . Petr.,i I �, .;� STOCKTON, CA '45203 ACCT. NO. L— I EXPIRATION DATE SIGNATURE AMOUNT PAID S ACCOUNT NO. PATIENT NAME ADMISSION DATE DISCI IA;:!';,F DA'E PATIEN— 9522500114 MATTHEW StITTIE ')P/13/05 0A./13 /05 col ?q 08 /18 /95 BILLED aALANCF 09/19/ 95 H'10 01DO CONTRACT ALLOWANCE 250.76CP 09/19/95 OTHER C0mME,a,CIAL. PAYMENT.._, hh2. ?SC? ACCOUNT RALAld<CE 355. 57 ESTIMATFD INSURANCE LIA.aILTTY 0.00 PATIENT RESPONS19TLI TY 606. 33 THE -�ALANCE ON THIS ACCOUNT TS YOUP PESPO"1S1QTLTTY . YOUR OAYI''-ENT IN FULL OR A CALL TO THE PATIENT ACC.OUNTTNG DEPT TO 'RAKE OTHER ARPANGEMFNTS IS A.PPPFCIATED . THA YOU . C= ,o e v SUMMARY OF ACCOUNTS FOR: MATTHEW SUTTI E BALANCE FORWARD FOR ALL ACCOUNTS TOTAL CHARGES AND ADJUSTMENTS 2 5 0. 7 6C R TOTAL INSURANCE PAYMENTS 662. 25 TOTAL PATIENT PAYMENTS n•00 JOHN MUIR MEDICAL CENTER -t OTA._P,(-,'COUNT BALANCE 155 . 97 1601 YGNACIO VALLEY ROAD 2 5^ . 7 6 C P WALNUT CREEK, CA 94598-3194 FOR BILLING INQUIRIES PLEASE GUARANTOR RESPONSIBILITY h. 3 3 CALL(510)938-2400 ti NOT RESPONSIBLE FOR ANY DAMAGES AS A RESULT OF WEAK BUMPERS ALL CLAIMS MUST BE ACCOMPANIED BY THIS BILL r _i A DAT TIME Tow 1 PAY FROM �{ r�C BY DERE THIS INVOICE 4 J i 44 F.. E NAME t ADDRESS �7/ 4 �_yy �'�I IAC f� T�TT' �T CITY2IP /? - 2 7 /71 t a PHONE fid» i i MAKE EAR LIC.NO. V.LN. r START TIME END TIME ORY50 TRUCK NO. r f FROM Z ' ODOMETER Edf i TO: ODOMETER Tow DOLLY ❑ FRONT - REAR. ❑ t k. ROAD t SERVICE p LABOR HAZARDO WASTE 7 DISPOSA h 1 / I OVER MILEA ` !/. MILES AT PER MILE DROP t j DRIVE `t I k BRIDGE t TOLL STORAGE: DAYS AT ER DAY= C 1 R.O. P.O. NO. NO. i CASH ❑ PAY FROM THIS INVOICE TOTAL I 'CHARGE: ❑ ACCOUNTS ARE DUE AND PAYABLE WITHIN 30 DAYS OF INVOICE. PAST DUE ACCOUNTS WILL BE CHARGED A ' STORAGE ❑ SERVICE CHARGE. � RELEA r ' TO,,, .;t / -- 3 DATE RUTH IZED` { SIGNATURE . 1 i } FRAN WS TOW .rF.W.THOMPSON,INC. d1evmn 5101 Clayton Road Concord,Ca 94521 PHONE 689-8540 I I I ` I Continental Towing N4 19927 I 24 LOCAL AND LONG DISTANCE HOUR CONVENTIONAL TOWING (510) 680-7726 Service 2151 ARNOLD INDUSTRIAL WAY #15 CONCORD, CA 94520 E ADD Ess t C O w STAL� ZIP PHONE ASH C O Y U ENSE O. STn A FR r0 R� FOR TOW D=DENT CHARGE AMOUNT N=NICKS rBENDO G O O� S=SCRATCHES ROAD B= SERVICE REAR FRONT DRIVER, TOWING 0 CODE DOLLIES LTJ �ME � HOURS LEFT DA STORAGE METE \ truSC 0 IN RIGHT OUT TOTAL P.O.# PAID J SIPNATURE BALOWCE DUE NOT RESPONSIBLE FOR A1VY44QAGE AS THE RESULT OF WEAK BUMPERS. ALL COM UST BF REPORTED AND ACCOMPANIED BY THIS BILL 15 DAYS. I CONCORD AUTO DISMANTLERS, INC. WELLS FARGO BANK 38322 2211 ARNOLD INDUSTRIAL WAY CONCORD,CA 94520 CONCORD,CA 94520 11-24/1210(8)-175 (510)685-7703 8./23/95 PAY TO ORDER OFTHE DEROFE Matthew Stephen Suttie $ ******30.00 Thirty and 00/100****************************************************** DOLLARS MEMO 90 Nissan Sentra - ul0 38 3 2 211' 1: 1210002484017S 0 4 7 58811' CONCORD AUTO DISMANTLERS,INC. 8/23/95 38322 Matthew Stephen Suttie 1250 Inventory 30.00 90 Nissan a50, V 0 N�NVU S A0VANCE. al yeS aa0 o a CAD, Inc. 90 Nissan Sentra ******30.00 C �a 1 C r t. j G \/ C .v con, ...�'. 1y M/1V © ++ v r� 'J _ 4 V�� �Jq CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 9, 1996; Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph 1V below), given pursuant to Government Code Amount: $53,718.79 Section 913 and 915.4. Please not all "Warnings". �� szv s CLAIMANT: Thompson Electric, Inc. ATTORNEY: Mary B Yudien, Esq. oac Smith, Merrill & Peffer Date received Cout4Ty GGsi.1t,ISEL ADDRESS: Two Annabel Lane, Suite 200 BY DELIVERY TO CLERKFON�EZGAl_6 0mber. 30, 1 AAS San Ramon, CA 94583 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p Bg DATED: December 1, 1995 Bail Deputy OR _ClerR II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: a`_�— S' J BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present ( y) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: HIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court sctioa un this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: J —/p —/9q6 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim lo: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 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 Tom—. RE: Claim By ) Reserved for Clerk's filing stamp THOMPSON ELELIRIC INC; RECEIVE® Against the County of Contra Costa ) NOV 3 0 or ) District) CLERK �PE� 8 Fill'in name ) concTa�►COSTA co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 53,718.79 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) THOMPSON ELECTRIC, INC. provided electrical services, product and equipment to re-construction of the fire damaged Superior Court earlier this year.- ---------- 2. ear:----------2. Where did the damage or injury occur? (Include city and county) Contra Costa County Superior Court 725 Court Street, Martinez, CA -- place of work done. 3. How did the damage or injury occur? (Give full details; use extra paper if required) THOMPSON ELECTRIC, INC. has rendered $53,718.79 in services, product and equipment on Contra Costa County's behalf and has not been paid. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Non-payment of monies owed. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Don't ]mow. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. $53,718.79 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) On invoices of services, product and equipment provided by THOMPSON ELECTRIC, INC. on the County's behalf. 8. Names and addresses of witnesses, doctors and hospitals. Robert Neumann, THOMPSON ELECTRIC, INC. , c/o Mary B. .Yudien, Esq. , SMITH, MERRILL & PEF'FER, Two Annabel Lane, SuiteL.200, San Ramon, CA 94583 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT $53,718.79 Vii¢ j Gov. Code Sec. 910.2 provides: 2 "The claim must be signed by the claimant SEND NOTICES TO,:,,,,"(-Attorn�• .�,•��.�•,,;:, ! or b some person on his behalf." Name and Address—f'Attohrie, Mary B. Yudien, Esq. Clwant's tore SMITH, MERRILL & PEFFER MARY B. UDIg for TH SON ELECTRIC, INC. Two Annabel Lane, Suite 200 Two Annabel Lane, Suite 200,- San Ramon, CA 94583 Address San Ramon, CA 94583 Telephone No. 510/866-1000 Telephone No. 510/866-1000 * * * * * * * * * * * * * * * * * * NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CLAIM , BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 9 , 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $200,000.00 Section 913 and 91 F.', Pease-note a k1��°warnings". CLAIMANT: Paul Webb DEC 15 95 ATTORNEY: Tyler A. Shaw, Esq. COUNTY COUNSEL Jacoby & Meyers Date received MARTINEZ CALIF. ADDRESS: 100 Bush St . , Ste . 700 BY DELIVERY TO CLERK ON December 4 . 1995 San Francisco, CA 94104 BY MAIL POSTMARKED: November 30, 1995 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH BATCHELOR. DATED: December 5 , 1995 Blit _ClerkO 0 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (l/( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: J 2—S _S BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: / - 9 — /99(, PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the•sdvice of an attorney of your choice in connection with this matter. If you want to consult an attorney, youshould do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Gated: BY: PHIL BATCHELOR by_,[1.1.�.(,fOo, Q,j. 11a eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY a IN=CTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County; the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this Toren. RE: Claim By ) Reserved for Clerk's filing stamp Paul Webb ) RECEIVED Against the Co my of Contra Costa j _DEC �� .995 District) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 200 . 000 . 00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) October 20 , 1995 , at approximately 9 : 30 p.m. 2. Where did the damage or injury occur? (Include city and county) In a walkway between 2931 and 2941 Terrace Way, Martinez , Contra Costa County, California. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Due to the negligence of the Contra Costa Housing Authority, claimant fell into a hole in the walkway injuring claimant. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure of the Contra Costa Housing Authority to provide adequate lighting, adequate warning, and to fill up a 3-foot wide, 2-foot deep hole in the walkway between 2931 and 2941 Terrace Way and thus created a hazardous condition. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Including but not limited to: Contra Costa County Housing Authority; Contra Costa County and the division of Contra Costa County responsible for the maintainence of the housing property. 6. What damage or injuries do you claim resulted? (Give full.extent of injuries or damages claimed. Attach two estimates for auto damage. Claimant sustained injuries including but not limited to: two fractured ribs to the right side, pain on 'the lower back and the right leg, and blood blister on the right toe. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Discovery is continuing. 8. Names and addresses of witnesses, doctors and hospitals. Including but not limited to: Witnesses: Stephanie Shepard 2931 .Terrace Way, Martinez , CA. Terri Tucker 416 Henrietta, Martinez , CA. Merrithew Memorial Hospital, Alhambra Avenue, Martinez , CA. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Including but not limited to: 10/20/95 Merrithew Hospital--E/R DISCOVERY IS CONTINUING 10/23/95 Merrithew Hospital--E/R 11/03/95 (Orthopedist) Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) orA some er on his behalf." Name and Address of Attorney �-P4 66A�," 7, Jacoby & Meyers Tyler A. Shaw, Esq. Clai is 'Signature) Jacoby & Meyers 100 Bush Street, Suite 700 San' Francisco, CA 94104 Address Telephone No. (415) 399-8951 Telephone No. * Ir i N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. 4A:CIOIBY� 1�'iEYEKS LAW OFFICES PERSONAL INJURY UNIT 100 Bush Street,Suite 700,San Francisco,CA 94104 415/399-8951; FAX:415/399-1939 PROOF OF SERVICE I, Olivia M. Chan, declare: I am over the age of eighteen years and not a party to the within action. My business address is 100 Bush Street, Suite 700, San Francisco, CA 94104 . On November 30 , 1995, I caused to be served the within Notice of Claim by placing a true copy thereof in . an envelope with adequate postage, and depositing same via certified mail, item no. P 473 557 326 in a U. S. Mail receptacle, addressed as follows: Clerk of the Board of Supervisors Room 106, County Administration Building 651 Pine Street Martinez, CA 94553 I declare under penalty of perjury under the laws of. the State of California that the foregoing is true and correct. Executed this thirtieth day of November, at San Francisco, California. We use recycled paper. C%j 7 . a: A� §% -NJ . ' c \ s ro : *vs \ § \ �4 - ?) _ o / z rcl 2 ~q _ 3 - 0 4.) » # m Q @ . @ / / 4 m 2U / � .� gaeN 2 00/ r / , � a4-) © 0 ® ® Ln (z? r-4 / . 7 & � � . Ln . m . � % C \ 2 ) f/ I \ =$« $ 44), , Emf t &£ k 2 §CDI 2 If k ��