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HomeMy WebLinkAboutMINUTES - 10151996 - C10A CLAIM �q} BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15, 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: $45.00 Section 913 and 915.4. Please note al1j J1jtllllmcn a 1) CLAIMANT: Gayle K. DenDaas SEP 2 5 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 94 Grandview Place BY DELIVERY TO CLERK ON September 24, 1996 Walnut Creek, CA 94595 BY WAIL POSTMARKED: Hand Delivered via County Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 25, e 1996 IL BATCHELOR. Cleri� pp�: Depu y 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 �`/p 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 ( his 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:so t. 1 5) g 9� PHIL BATCHELOR, Clerk, B � Ry7��` � , Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 1B; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. r Dated: (� 7) 9 9� BY: PHIL BATCHELOR b� Deputy Clerk CC: County Covr.sel County Administrator -- - STATEMENT A'& M QUALITY TREE SERVICE 441 Grchard View Avenue Martinez, CA 94553 510.932.3316 or 228.2444 Date RECEIVE® SEP AIM TERMS• 'CLERK BOARD OF SUPE fSORS i CONTRA COSTA CO PLEASE DETACH AND RETURN WITH YOUR REM TTAN $ S DATE ` INVOICE NUMBER/DESCRIPTION 1 CH ES i CREDITS I BALANCE BALANCE FORWARD i i ] ere 15 a, a� b�11 -�� . ra►� work on 4 �mt cla-moot 4orx br jrtA4, 56nj rcirnbucstmcn� me e CGayle enDaas 94 Grandview Place Walnut Creek, CA 94595 9��ges�y_ A &M QUALITY TREE SERVICE %an' k -You y ffi jn i� ~ fp'S �A y� (�1 t f w �� W � � ` ...r^"'�'�� 9 � � -�, �, yrr— � �� �, ;a ,�, z, �r� :. �' y�.„ C` . ""�-- '..,;� , �`� =�w 1 � � � � t f � t � � � ' � t �.id+wF i��.F:. . z C( w CLAIM q BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15, 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: $1,073.12 Section 913 and 915.4. Please not­�,�VZD CLAIMANT: California State Automobile Association in representation of Bergman Leon SEP 2 5 1996 ATTORNEY: Claim 07-K26946-6 Date received COUNTY COUNSEL Se 'INE CALIF. September 'T,c/o Julia D lehavavia BY DELIVERY TO CLERK ON p 24, 1996 CSAA P.O. Box 4019 BY MAIL POSTMARKED: Hand Delivered via County Counse: Concord, CA 94524-2019 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p gg DATED: September 25 , 1996 BAIL Depuy OR, Cierk� �Q 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: Dated: -/A2.� 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 _/� �^� -c�. , Clerk, _ , Deputy Clerk r MARNING (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:� 171 9 9(-,p BY: PHIL BATCHELOR Deputy Clerk CC: County Counsel County Administrator Clamc to: BOAPa OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIKANT 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. Claim must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this forte. RE: Claim Byn ) Reserved for Clerk's filing stamp l�cJiPoienea &1e, Adomobde_ &oo4d;ae7) ) RECEIVE®_ In reere.Sedd ion a!2r mavi eon ) �� Agai t the County of Co ra sta ) 406 p or ) �-ia-ti� �y /1i5 � ra 1."n� res &er11�r a District) CLERK ONTRA OF SUPERVISORS Fill in n ) O. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ r0 7 3 /cZ and in support of this claim represents as follaws: 1. When did the damage or injury occur? (Give exact date and hour) 2. did the damage or injury occur? (Include city and county) 3. How did th damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or d_stri � se.^vants or employees caused the injury or damage? 3 J U L 19 1996 CALIFORNIA STATE AUTO.ASSN. CONCORD M . Anal: are the names of county or district officers, servants or employees causing the .^.za.age or injury? ._ //� _____ -- _ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. &-2.Q. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE. ITEM AMOUNT icy �} Gov. Code Sec. 910:2 provides: ="The claim must be signed by the claimant SM NOTICES TO: (Atto�^ney)' 4, .:s '-� oI by some person on his behalf." Name and Address of Attorney Claimant l s Signature (Address) ea Telephone No. Telephone NoC�l6to 71- X �� 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 stateprison, by a fine of not exceeding ten thousand dollars ($10,000, or by both sUCh i�,-risonment ar]d fine. . r 7. wnat are the vanes of counzv or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. Hou was the amount claimed above c=puted? (Include the estimated amount of any prospective injury or damage.) $. !lames and addresse�itnesses, doctors and hospitals. �r 9. List the expenditures you made on account of this accident or injury: DATE ITEM` AMOUNT 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 C'�SAf� Claimant's Signature Address. &f)17 ('� 4,/y j �- gel 9 ll Telephone No. Telephone NocE/e)J N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both and fine. C,/0 TRAFFIC COLLISION REPORT SPECIAL CONDITIONS. NO. INJ. H&R CITY JUDICIAL DISTRICT NO. D 42 FELONY WALNUT CREEK WC MUNICIPAL �G- / 3a y� REPORT �'� MISD. CONTRA COSTA / Or-Gy CeP .�— COLL lSqN.QCCURRED ON O PRIVATE PROPERTY MO. DAY. . YR. TIME(2400) NCICS, I OFFICER I.D. LOC. 00712 L ❑ AT INTERSECTION WIT ❑ WET STATE HWY REL TOW AWAY PHOTOGRAPHS BY: J1 OR �.FEET/MILES OFL.�/o ✓� CRY YES NO ES NONE PARTY DRIVER'S LICENSE NUMBER STATE CLASS E P VEH.YR. MAKE/MODEL/COLOR X, S4C LICENSE NUMBER STATE I J' - 1 J DRIVER• NAME(LAST,FIRST,MIDDLE) OWNERS NAME ❑SAME S DRNER PEDESTRIAf` STREET ADDRESS OWNER'S ADDRESS ❑ SAME DRIVER ❑ rO12-4 `w2 - PARKED CITY STATE BIRTHDATE�R SEX ~RACE DISPOSITION OF YE ICIE ON ORDERS OF: OFFICER )MDRIVER ❑ OTHER VEHICLE 6r me7 �Z ' y� i BICYCLIST HOME PHONE BUSINESS PHONE ❑ PRIOR MECHANICAL DEFECTS: NONE APPARENT D REFER TO NARRATIVE OTHER ' INSURANCE CARRIER POWPY NUMBER VKX.AIIDNCdIAKUED DESCRIBE VEHICLE DAMAGE SHADE IN DAMAGED ❑ �J l�0�C 1 ❑ UNK. ❑ NONE �MINOR DIR.O ON STREET OR HIWAY ` SPEED PCF ICC O / PLIC D MOD. D MAJOR ❑ TOTAL TRAVEL LIMIT P CHP ❑ PARTY DRIVER'S LICENSE NUMBER STATE CLASS SAIF P VEH.YR. MAKE/MODEL/COLOR /✓C, LICENSE NUMBER STATE C e DRIVER NAME(LAST,FIRST,MIDDLE) OWNER'S NAME VL SAME ASDRNER 9 19rev 5111t PEDESTRIAN STREET ADffESS OWNER'S ADDRESS $AME AS DRIVER ❑ PARKED CITY STATE BIRTHDATE SEX RACE DISPOSITION OF VEHICLE ON ORDERS OF: ❑ OFFICER DRIVER ❑ OTHER VEHICLE M0. DAY rR ❑ /C.4 BICYCLIST HOME PHONE BUSINESS PHONE PRIOR MECHANICAL DEFECTS: C14ME APPARENT ❑ REFER TO NARRATIVE ❑ ( ) ( ) OTHER INSURANCE CARRIER POLICY NUMBER VIOLATION CHARGED DESCRIBE VEHICLE DAMAGE SHADE W DAMAGED AREA ❑ D UNK. ❑ NONE �INOR DIR.OF ON STREET OR HIWAY SPEED PCF Xx ❑ ❑MOD. ❑MAJOR ❑ TOTAL ✓� TRAVlFL LIMIT ��1 P, ❑ (c-GNcJ CHP ❑ PARTY RIVER'S LICENSE NUMBER SAT CLASS SAFETY YR. MAKE/MODEUCOLOR LICENSE NUMBER STATE EQUIP. 3 DRIVER NAME( FIRST,MIDDLE) OWNER S NA ❑SAME AS DRIVE PEDESTRIAN- STREET ADDRESS OWNER'S ADDRESS ❑ SAME AS DRIVER D PARKEDI BIRTHDATE DISPOSITION OF VEHICLE ON ORDERS O . OFFICER ❑ DRIVER ❑ OTHER VEHICLE A10. DAY rR. BICYCLIST HOME PHONE BU SS PHONE PRIOR MECHANK:AL DEFECTS: ❑ NONE APPAREN REFER TO NARRATIVE OTHER INSURANCE CARRIER POLICY NUIIRIR VIOLATION CHARGED DESCRIBE VEHICLE DAMAGE SH AMAGED AREA ❑ D UNK. D NONE ❑MINOR DIIRR.OF ON STREET OR HIWAY.TVEL ----TPEEDPCF ICC ❑ ❑MOD. ❑MAJOR D TOTAL PUC ❑ SKETCH ` Q TYPE COLL A.HEAD-ON B.SIDESWIPE C-REAR END \ D.BROADSIDE E.HIT OBJECT F.OVERTURNED {� G-AUTO/PED. H-OTHER Jf' I t INDICATE NORTH \ J 1 ( I SPECIAL GOND I.CITY PROP.INV. 2.MUNI LOT&LOT NO. I BICYCLE INV. 4.PEDESTRIAN INV. ,y I PCF ENTER VC SECTION OR .°1ei Ire_ U-UNKNOWN D-DRIVER ERROR \ N I CASE STATUS P-PENDING C-CLOSED \ S-SUSPENDE U FOUNDED \` CLOSED BY ID atI O' INDE E _ P- _?'/p TRA,rR,C (COLLISION CODING PAGE aye, W1 opco"'SIONnut t 24001 Ncc MYOcA OSIIC[II I.0 /AAf<tL11 NO. � OAT 6—TUA 'G CA0071200 _ ,2 � c cwArcAooKcsc PROPERTY Ac D DAMAGEotscitiomoh 06 oArAcc SEATING POSITION cuPANTs SAFETY EQUIPMENT Ad C BICYGLF• 1 MFT_ EJECTED FROM VEH. ,O� I•DRIVER A-NONE IN VEHICLE L-AIR BAG DEPLOYED 0-NOT EJECTED 2 TO••PASSENGERS 8-UNKNOWN W•AIR BAG NOT DEPLOYED DRi VER I•FULLY EJECTED 7-STAWGN REAR C-LAP BELT USED M•OTHER, V•NO 2-PARTIALLY EJECTED l•RFL OCC.TRK_OR VAN D-LAP BELT NOT USED ►•NOT REOU10ED W-YES 2•UW HOWM ••POSITION UNKNOWN E•SHOULDER HARNESS USED 1 2 3 0.OTHER F•SHOULDER HARNESS NOT USED CHILD RESTRAINT PASSENGER 456 G-LAP/SHOULDER HARNESS USED 0•N VEHICLE USED X-NO N.LAP i SHOULDER HARNESS NOT USED R-N VEHICLE NOT USED Y•YES 7 J•PASSIVE RESTRAINT USED ••N VEHICLE USE UNKNOWN K•PASSIVE RESTRAINT NOT USED T•N VEHICLE I PROPER USE U-NONE IN VEHICLE ITEMS MARKED BELOW WHICH ARE FOLLOWED BY AN ASTERISK I•I SHOULD BE EXPLAINED IN THE NARRATIVE PRIMARY COLLISION FACTOR TRAFFIC CONTROL DEVICESTYPE OF VEHICLE 1 Z 3 MOVEMENT PROCEDING LIST NUMBER([)OF PARTY AT FAULT Z 3 6 A VC SECT*N VIGLATED: O o A CONTROLS FUNCTIONING +ii A PASSENGER CAR 197A.WGN. COLLISION T[s +o B CONTROLS NOT FUNCTIONING- B PASSENGER CAR W I TRAILER X A STOPPED • B OTHER IMPROPER DRIVING' - C CONTROLS OBSCURED C MOTORCYCLE/SCOOTER B PROCEEDING STRAIGHT D NO CONTROLS PRESENT/FACTOR, D PICKUP OR PANEL TRUCK C RAN OFF ROAD C OTHER THAN DRIVER- TYPE OF COLLISION - E PICKUP/PANEL TRK W I TLR D MAKING RIGHT TURN D UNKNOWHR' A HEAD-ON F TRUCK OR TRUCK TRACTOR E MAKING LEFT TURN • E FELL ASLEEP* y B SIDESWIPE G TRK/TRK TRACTOR W/TLR. F WAKING U TURN C REAR END H SCHOOL BUS G BACKING WEATHER I MARK I TO 21TEMS) D BROADSIDE I OTHER BUS H&LOVING/STOPPING �[ A CLEAR E HIT OBJECT Y J EMERGENCY VEHICLE I PASSING OTHER VEHICLE 6 CLOUDY F OVERTURNED K HWY.CONST.EOUIPMENT J CHANGING LANES C RAINING G VEHICLE/PEDESTRIAN L BICYCLE K PARKING MANUEVER D SNOWING H OTHER'. MOTHER VEHICLE L ENTERING TRAFFIC E FOG l VISIBILITY FT. MOTOR VEHICLE INVOLVED WHIM N PEDESTRIAN M OTHER UNSAFE TURNING F OTHER-: A NON-COLLISION O MOPED N ZING INTO OPPOSING LANE G WIND B PEDESTRIAN 0 PARKED UGHTING x C OTHER MOTOR VEHICLE P MERGING A DAYUGHT D MOTOR VEH.ON OTHER ROADWAY OTHER ASSOCIATED FACTOR O TRAVELING WRONG WAY DUSK•DAWN E PARKED MOTOR VEHICLE (MARK I TO 2 ITEMS) R OTHER.- DARK.STREET LIGHTS - F TRAIN A rC ucno.l rlouToom CITlo D DARK-NO STREET UGH75 G BICYCLE 8140 B DARK- STREET LIGHTS NOT A H ANIMAL: B rc"CTIo"rauTlom Msn[o FUNCTIONING• (]TMs ROADWAY SURFACE SOBRIETY-ORUG I FIXED OBJECT: C VC KCnoN VQlATI10%. Crti0 PHYSICAL A DRY pTc[ (MARK t TO 2 ITEWS) B WET ,OTHER OBJECT: cljm7j-eA HAD NOT BEEN DRINKING C SNOWY-KY D D SLIPPERY(MUDDY,DILY.ETC.) E VISION OBSCUREMENT : B HB •UNDER INFLUENCE F INATTENTION- C HBO W •NOT UNDER FLU.' ENT1oINATTENTION-ROADWAY CONDITIONS G STOP E O TRAFFIC D MOD.IMPAIRMENT UNK' (MARK I TO 2 ITEMS) PEDESTRIANS ACTON E UNDER DRUG MFLU.' x A NO PEDESTRIAN INVOLVED H ENTERING/LEAVING RAMP F IMPAIRMENT-PHYSICAL• I PREVIOUS COLUSION A HOLES.DEEP RUTS- CROSSING IN CROSSWALK G IMPAIRMENT MOT KNOWN B LOOSE MATERIAL ON RDWY.• B AT INTERSECTION J UNFAMILIAR WITH ROAD H NOT APPLICABLE K DEFECTIVE VEH EOUIP.: CMD C OBSTRUCTION ON ROADWAY C CAOSSING IN CROSSWALK•NOT T[[ I SLEEPY/FATIGUED D CONSTRUCTION•REPAIR ZONE AT KTERSECTIOM SPECIAL INFORMATION E REDUCED ROADWAY WIDTH D CROSSING•NOT IN CROSSWALK L UNINVOLVED VEHICLE I I JA HAZARDOUS MATERIAL F FLOODED' E IN ROAD•INCLUDES SHOULDER M OTHER': G OTHER% F MOT IN ROAD 3e V N NONE APPARENT H NO UNUSUAL CONDITIONS G APPROACH/LEAVING SCHOOL BUS 0 RUNAWAY VEHICLE JC,.G�'= f�T. /✓I !3n � �i en-�G'`�'!'Pn c/Y .o/_ .l c r�'� rz.. F L/1/ ����,e Cy s�•� c.2a.� �/,(rSo.�..,.,I ��: ^�G •T� -fL�+.*�.' i r��s/�[ CG /YJ,r �l/I t1/u 6D)N�.sf _ /,�s (J/ nr ,L 1/A �i�r rim.! r i �� // Gars i.r t/e.i .s< lei y/.l ��.." �>l�T Y. a� ���I!-'��i .,n.r �./ a� t//.�. ��,rt r��..•s ,C?e��i> >�r� bra 2n.., nL' d/� E� V/R-s el rr rt"// X,' ./�.�,. &p/ =...te `_& i /yl u G REPARERS NAME I.D.NUMBER MO. DAY YR. REVIEWED BY: O. DAY YR. � c� r�N 7< --?7e7 l -.r-9G INJURED ! WITNESSES / PASSENGERS RAGE OITS OF CO-UTIME(2400)� N-IC MHMYEpCA 0071 ZOO OfRC[111.Q.�� wNMR C EXTENT OF INJURY ( "X" ONE ) INJURED WAS( "X" ONE ) WITNESS PASSENGER R[IIT SEAT SAR['TT ONIT ONIT AGE SEY NUYSER ROS. MAP. SJ[CTm FATALSEVERE OTHER VISiKL.. COMPLAINTINJURY INJURE INJURI OR PAIN ORIVER PASS. REO. SICTCUCT OMLR �g O ea � ❑ ❑ I ❑ I ❑ ❑ ❑ I D ❑ ❑ ftAMt l ADDRESS ( U LY,TKAN5FURIED BY. TAKEN TO: DESCRIBE INJURIES '�IF'•: tJY I ❑• I o ( ( I D f ❑ I I o 1010101 ❑ I o I I I I NAM LAZ 1.FM J T7PJME ADDRESS (NJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES o• I`: ❑ I I ❑ I ❑ i ❑ I ❑ I ❑ I ❑ Iola I ❑ I I I ADD:,;S S 1 I ►N7UP-> ON:Y)TRANSPORTED BY: TAKEN . DESCRIBE INJURIES I 0� 1 ❑ I I I ❑ I ❑ I ❑ I ❑ 1 ❑ 1 ❑ ❑ 1 ❑ [ Ell 11 I i �c DI5T.T7AST.MiiJUL TtLtFHUNL ADDRESS (INJORED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES 0# _ 1._o—L. ❑ 1.o�❑ 10 I ❑ I ❑ I ❑ I 0 o i —,4AMt(LAbr.F1Rs MIUUL ADDRESS (INJURED LY) TAKEN TO: DESCRIBE INJURIES n, i I I D I ❑ ❑ ED ❑ ❑ ❑ o of - - ADDRESS (INJURED ONLY)TRANSPORTED BY: TAKEN TO: DESCRIBE INJURIES n�2�7 �i I wa •t tE 555-P0.3(Rev.41M) ie+ "J° f NARRATIVE/ SUPPLEMENTAL WALNUT CREEK, CONTRA COSTA PAGE a/!' DATE OF OAIGINAL INCIDENT TIME (240D) NCIC NUMBER • CASE a 00712 RECLASS-CLASSIFICATION MO. DAY YR. SL CASE FD UNFOUNDED NDING NARRATIVE E3 SUPPLEMENTAL STATUS � /J ❑SUSPENDED( Q CLOSED cfo//,-n da `/OY� /6 "Al 2/�. i�/� .� !o� /O"e D/ /A,", 'LI, ,lcwAr i� 7'►r �s /�+s !,�/ / /r✓0924 Ale 609,2/4tf SS�I ��• '//�G� ��� �sY/OP.✓,� ,t/ f.G' /1..�1 ii ✓Js.d ,� l�.A /�.s (l/ 6. /A'//J✓C ,lo �iA /t>�s� /.ems /J/ �n�� .r1 �^��� Ui�.� t�a . �j 7 / i�C Al r s i//�r � �i,.A gf 8.c A >V A, 9. 10. i e.i O r..a 12. /// fi��V �,/�✓ s 2 .1/.a� .�� C✓�r� .S.�a �r .� .1(iv�sC 2�. �..n,.,��e /pit✓ 13. '�J,) /1�Id�✓A r /�.F! ,L >�r^.r `A C� f�./ C l /7 t r✓ G� fI 14. _ f xe, , -4 o6ot-I )/er"I%. Ac -Ze r' t,/ C-e-"e 15. All to-on'AS /moi/w Low 16. 741n: .✓ _// I�.�R.7 d/ r�/il.- //f //fL.../ /moi�.0,/ 17.1/rtnf� .>�r,V✓r•. YTt.. �i%/�.r�6.A .�.1./ u✓iC...J d/,J 16. 19. 20. / 422 r/o 1614-al 4J"Al a' is_ k )e,"P- 21. 22. �C'✓w,f F /YTTX! /n s�.rLJi f_G`J/r�r+ ✓�/ _ �'7�/ 6Z,-A* 117 c sJ % .,� /-T 23. 24, 25. 26. / ` 111 7---1,) % ( ���5 ✓iA 27. !/ 28. 29. 30. 31. 32. 33. 34. 35. PREPARER'S NAME I.D.NUMBER MO. DAY YR. REVIEWER'S NAME MO. DAY YR. 565.Pg.4 (Rev.4/89) P340 4,0 V 3 1 California State Automobile Association inter-Insurance,Btlreau "' 7706 � INS URED$NAME - CLAIM 134�Iw MAN1 LEON �. DATEJ_0F LOSS 3 f.?L. )-6 PAY $45. 00 66. 06 0 ) CLAIMANT'S NAME SUFFIX+� �^ I;RE'�Cy1�AN, LEON m. POLICY—TYPE KIND OF LOSS _ 02f Through 151 v0. AUTCI U BankotAmartcaN7asA 12tQ z IN PAYMENT OF: ��C�? t L"'C?'3134' San Francisco Commercial Benking m - ADJUSTER NO. 345 Mon cisco, Street D.O. I�N-rL At;f2 i�1i"iN�1" llCl"' San Francisco,CA 94164 1 CON 132 1 1/3t 8>')t3 00/100* *FORTY FIVE �: ` ml PAY TIN: 3b-304173;3 m. EN1'E F2E=R I�IE REN-{--..A CAE - ' AUTHORIZED SIGNATURE KIM CARIdEY 33bb N I=LA I N `i r '. CA 94596 NOT NEGOTIABLE TO WAL NU t'. 'CREEK THE ORDER OF. M.O.COPY _ urance':gureau :'034- California. � �._� ,. x Q34 California.State Automobile Assoc►ation Inter ns DATE tib=2a - . �•"`"`.»•."°® WSURED'S NAME L,F-4..e�''J' r n. r�1'� ..M. CLAIM X3t"'�EGC"It�1Nl PAYS ' 250. VV 0(!i DATE O�F`LOS rS'''�- c a--ter 694:6"-b O r:J-'\,t.a-` � - CLAIMANrrT��'S�}N�A^M�E� L["('IN SUFFIX IJRE. -MAN1 C::::..1.7 r mp POLICY—TYPE KIND OF LOSS V Through 7'-_x35 0 TO COL. Bank ofAmacomNTBSA x210' z . � .� Francisco commercial Banking IN PAYMENT OF:7^1 13 f i San m CON ADC314NO. .. L :DEI) R�I�y l U f�.��i��N I� .. 345 Montgomery Sheet I D.O. CIN ,1.'7(..3 t_�� tJ' :San Francsco CA 94104 b'. !G C7 F=IFTY� ;Q0/.1C}4 *Two F�IUNpREI?, - 31i M rr PAY J C'n .. o:c.. 't 91 L1«"N �3 r�1'"ti 1�1A1 AUTHORIZED SIGNATOR �! 3<E�rf 447`'SHAW RD , CA' .94. b NOT N GOTIABLE',;.., I, r �, TO WAL f�IUT:CREE4C . THE ORDER OF v �r i Y 1 r M.O.COPY _ r rr } ,Ir:,:';'�::1:' 4 r.l r.X lrrl rl Y• 4i�• .. ' stir rti rF?r : Jrrltil�v i l�� ' rrf rjrk r. r?f'�X1( . J Pity: 4 f 1l tit,'C f 1 . Rental Agreement 0039622 — 2334 ,. Amount .r Rate ® � 1,...,.... Description ` ,71 .97 � 23.99 5,94 �q. f q 2266 NORTH MAIN STREET94596 3 DAYS 8.25 .r WALNUT CREEK SALES TAX°4 ��-•' Bill To: 1 12787 48.812514.8 0128.087 21729 ----<- a AAA INS-CONCORD ATTN: CHAVARRIA*JULIE* P. 0. BOX 401994524 CONCORD CA Date In l�'�jt� �<7, Date Out 6/14/96 H 6112/96 ome Phone Qp "9. 510-933-7343 Renter LEON .BREGMAN Office Phone Address 447 SHAW RD' State Zip SN. City CA 94596 WALNUT CREEK State Expires Driver License CA 5106199 N9707344 77.91 DOB TOTAL CHARGES 32.91 5/06113 LESS AMOUNT RECEIVED Additional Driver . _ , 45.00 Name _ry NO OTHER DRIVER PERMITTED state Expires Amount Due Age Driver License Fed "Tax ID # #lP.O. # Billing Inquiries Call 36-30417.33 • License No• Claim #/Policy 530-210-9550 Color 3Pense CL#07K26946-6 Information TAX NOT TO EXCEED WHTE Billing NO SALES Unit # insured $i5.00 PER DAY • Model Wp83g6 BREGMAN* 96 CORD Date of Loss Type of Loss $ 350.00/DAY INSURED En>terpr'rse Type of Car Repair Shop Thank-YO Fol' choosing W TOYOTA COR MIKE'S AUTO PLANNING A SUMMER VACATION? 0 Vin # CALL 1-80d'RENT-A-CAR 2MELM74W8SX680659E TO RESERVE A VEHICLE TOOAYI ■ ■ ■ ■ ti ° ■ � �:�rl}'•��,dip �4 $■„ ■r, p `�`. .. ■ 4 ash�{ �`� iT. ' m l � '.r'�;r,;}7::•,;.,,:7 r�}'.,r l`{cr'n`r'r�I.. . tr t 5. G7. 96:u t 034 039 ` fy /dry r. `Ttd f7�V.7 ri r �,s., rklSti _t ,5+`•+v 1 1�,�,ii� 1 t' rh}{+ _ ,I t DATE. ')6-'N'.E aUforrnaState Automobile AssociationYinter Insurance ure pt Y� Qb t I {i a.✓`®: }�= rx r i r 4 t 4 ,. t�xi a t f tF {r tN ( 6 t] ri!"'I1 EON"' { r t PAY 't,Ct 45, c2.1 O U DATE�yOFLL�LOSS \t [U CLA! 7 A�'{:7 ���yq��y { �''• - , r t GIAIM 'CI�:47 C'!f'rN i, i--F,QN tt-35 {` 1 , pyo m r 1� •{ "' ; SUffIX i - rd4 r, Throu4h - -i` O i •._y'' KINtD OFtLOSS i' r d'�t.• h ` 0, DBenk of AmOri-NT6SA 1210 Z f POLICY'`I Q 4+� 1.«I i r, A T San Fran°tcco G°Sireetmgl Banking {' ` .1N PAYMENT OF: fi i •:` ` 345 Montgomery m 0 G[tl_L..� :tiiN' ��� se fre�ew.cAgdtDd �n iusTER No G'I /I UC} CON Ib1 3 =C)F2TY. 'VE10 c ".VE N n *5L.VE Ln r PAY r'6 2s 349 q'tt y,,i~fcy r�U"!-o 13QDY Inks ICK rr RL m �... ,KE .R i..J ViAUTHORIZED SIGNATURE C l+C 2GU 1 !O. NT ` , NOT NEGOTIABLE FREAi�4' 1G C} TOE CONCORD TH ORDER OF M.O.COPY ----�'. t .:1:•1:1;''rti': / '• y'rr fJ rt tj 5y. r. ,•::: .;.{ 7'S♦}Aflf}!` .� }}a;'.':•l1� ,�•,'J,F.� 3111.'V'1y we I ,. !:ti.: :•t r;':':•:t:h pp.1'..'."�"i fir},r,,y{J,.,'�'��: •. }:fy .{R d' •i' ' ............td!}: J. .r. r �y a` f•Y`, 4 •r•�y r��� .:r F .. .. :'L• .rix' 5 J3 r' .t`•'!,the`+ff` v{": «� r S+4W h e. '{v, f 1 ''y.-.• fah`•'?:^'`J {rV" Y.iri ! �,h'`s'+'/•U"f fit' ' t:}rti if.�• �.rP'?;h�" °!y�z .1 J 5.. . �•rrr.• •^dY'• rr i P'. cwf, R. Y� 4 rr r Jyy '.frr. t i :r:• f� �r.�ly� :r }r{ ? ytev ' • - }r r,; 11 �rr1r[4�W�'�'.;�`> x: t. ; . `Y'' 4•Y .'{.•.•:. rFi}ffry.h•Mrr�31'`•�..^,r'" r"1• fy,•'. J `t tit { .. ... r r r.jr�w•�� �.: � f r? rye ; (fr yf F : r - ?: ;:•. t f�rf�v'hF fh{:'tl A�,vii " .-'•:': f '.y t 1 .arc y Jr • r '•, f rr �� ti r ,• r,, r r tiry r �+,� vrt lrt x r r r x rofiA fr � ImageMate MEFF# : 1066 Page : 1 Claim# : 07-K269466 Name : BREGMAN Slide 1 : 5588 O .EST Date: 06/12/96 12:22 P.M. Estimate ID: 5588 Preliminary Profile ID: AAA MIKE'S AUTO BODY 2001 Fremont S,;restConcord CA 94520 ('50) 686-1739 Damage Assessed By: DON HERBERT Claim Number: 07-K26946-6 Insured: LEON BREGMAN Mitchell Service: 910750 Description: 1989 TOYOTA COROLLA LE 4D SEDAN VIN: JT2AE93EXK3161841 License: 2KZH625 CA Mileage: 20,739 Color: GREY MET 168 Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Type Operation Description Part Number Amount Unit Unit 1 AUTO BODY OVERHAUL FRT COVER ASSY 1.9 # 1.9 2 001210 BODY REMOVE/REPLACE FRT BUMPER COVER - QUAL REPL PART 151.00; INCL 1.9T 0 AUTO REFIN REFINISH FRT BUMPER COVER / . 2,3 3 001820 BODY REMOVE/REPLACE FRT BUMPER STRIP MOULDING 52711-12110 / 29.02 INCL 0.3T 4 003060 BODY REMOVE/REPLACE L PARK/CLEARANCE LAMP ASSEMBLY 81620-12410 ,55.95 INCL 0.3T 5 009620 BODY REMOVE/REPLACE L FENDER PANEL 53802-02030 94.43 1.0 # 1.OT 6 AUTO REFIN REFINISH L FENDER OUTSIDE C 2.3 2.3 7 AUTO REFIN REFINISH L FENDER EDGE C 0.5 0.5 8 009810 BODY REMOVE/REPLACE L FENDER ADHESIVE MOULDING 75624-12470 7.22 0.1 0.2T 9 011890 BODY REMOVE/REPLACE WHEEL COVER ORDER FROM DEALER 62.901T 10 021960 REFIN BLEND . L FRT DOOR OUTSIDE C 0.9 /,2.1 11 022550 BODY REMOVE/INSTALL L FRT BELT MLDG 0.3 # 0.3 12 022770 BODY REMOVE/INSTALL L FRT DOOR ADHESIVE MOULDING 0.2` 0.2 13 900500 BODY •REMOVE/INSTALL CLEAN & RETAPE 0.3* 14 022940 BODY REMOVE/INSTALL L FRT DOOR REAR VIEW MIRROR 0.3* 0.3 15 023170 BODY REMOVE/INSTALL L FRT DOOR TRIM PANEL 0.4 0.4 16 023620 BODY REMOVE/INSTALL L FRT DOOR HANDLE 0.3 # 0.3 17 023860 BODY REMOVE/INSTALL L FRT DOOR LOCK CYLINDER & KEY 0.2+ 0.2 18 AUTO REFIN ADD'L LABOR OPR CLEAR COAT 19 933018 REFIN ADD'L LABOR OPR MASK FOR OVERSPRAY 5.00* 20 936008 ADD'L COST PAINT/MATERIALS 83.1 '' ��1 T . Judgement Item # Labor Note Applies C Included in Clear Coat Calc Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 5.0 49.00 245.00 Taxable Parts 400.52 Refinish 5.0 49.00 5.00 250.00 Parts Adjustment 5.001, 12.48- Labor Subtotal 495.00 Sales Tax @ 8.25% 32.01 Labor Summary Totals 10.0 495.00 Total Replacement Parts Amount: 420.05 ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 5588 Mitchell Data Version: JUN-96_A Copyright (C) 1990-1996, Mitchell International Page 1 of 2 All Rights Reserved Date: 06/12/96 12:22 P.M. Estimate ID: 5588 Preliminary Profile ID: AAA III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 83.10 Customer Responsibility: 0.00 Sales Tax @ 8.258 6.86 Total Additional Costs: 89.96 I. Total Labor: 495.00 II. Total Replacement Parts: 420.05 III. Total Additional Costs: 89.96 Gross Total: IV. Total Adjustments: 0.00 Net Total: 1, 1 '� This is a preliminary estimate. Additional changes to the estimate may be required for the actual repair. Body Shop: MIKES A.B.VDM ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 5588 Mitchell Data Version: JUN-96_A Copyright (C) 1990-1996, Mitchell International Page 2 of 2 All Rights Reserved i ImageMate •MEFF# : 1066 Page : 2 Claim# : 07-K269466 Name : BREGMAN Slide 2 : ter, Slide 3 : z Ym e' b i s ImageMate 'MEFF# : 1066 Page : s Claim# : 07-E269466 . Name : §22GMAN Slide 4 : - �<��. - s� y� Slide 5 : . � - < f ImageMate `MEFF# : 1066 Page : 4 Claim# : 07-K269466 Name : BREGMAN Slide 6 . a` Slide 7 . %3 i i ImageMate -MEFF# : 1066 Page : 5 Claim# : 07-K269466 Name : BREGMAN Slide 8 . Ram IIID �= F Slide 9 : I 2 ImageMate £FF# : 1066 Page : G claim# : 07-K269466 _ Name : 2#EGMAN Slide 10 : - � \ ? CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA `Q) October 15, 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: $1900.00 Section 913 i LsPVye all "Warnings". CLAIMANT• California State Automobile Association SFP 1996 Thomaston, Helen M. ATTORNEY: 01-4B73091 COUNTY COUNSEL Date received MARTINEZCAUF. ADDRESS: 3060 Hilltop Mall Rd. BY DELIVERY TO CLERK ON September 26, 1996 Richmond, CA 94806-2494 BY MAIL POSTMARKED: Hand Delivered via: Risk MQmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. September 30 1996 JAIL BATTCHtyLOR, Clerk GATED: p e u 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 `�(� BY:- � Deputy County Counsel T 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 0 DER: 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. l - Dated: e� /'—/ggfOPHIL BATCHELOR, Clerk, By"n 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 Da.s. shown above. Dated:�C- /7, 199(o BY: PHIL BATCHELOR b� eputy Clerk CC: County Counsel County Administrator °%off,° California State Automobile Association `�°' - Inter-Insurance Bureau September 20, 1996 =h RECEIVED Julie Alemock Risk Management,Contra Costa County r�p 2 6 651 Pine Street, 6th Floor Martinez, CA 94553 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Re: Our Insured: Thomaston, Helen M. Our Claim No.: 01-41373091 Date of Loss: 07-03-96 Your Insured: Contra Costa County Dear Ms. Alemock: This is notice of our subrogation interest arising from this loss. We have arranged settlement with our insured. Please make your payment directly to the California State Automobile Association Inter-Insurance Bureau(CSAR-IIB). Attached are itemized bills to substantiate our subrogation claim. Repair Bill 1900.00 Loss of Use 0 Tow/Storage 0 TOTAL 1900.00 Si 'rely, Alan R. Sapp Claim Representative 510-223-8080 extension 256 3060 HILLTOP MALL RD.•RICHMOND,CA 94806-2494•P.O.BOX 6060•SAN PABLO,CA 94806-6060•(510)223-8080 F1114(5-93) LLL/// `y4y 8 f i �` - � 1'}rr-<.ZY}"-'�n1.�.,t®a nar,::,+_.i,,a"L:I-k5S.��1+_�. ''*—.-x) *irs_•..r� c �e,k:1r.,..,,,:- dfati��wde`:.' •'"S r`}ar+ �,µt--;"`��. f'i�s'INwSrr U(:x.`:"�"i. �3 h��.�T....:a s -"us,�'by-*fk-.sn��4.�,lsf't.et✓zrsS,C ; e;�..4 CLAIM 69 X0utomobile A # 134V,lj! tA. Fs ��C DATE OF,LOSS L "a t1 ^"-;.'• i "p —' • a,`i�O7 O� r�C� Y 0d 'Y•i.77 SVT � he t.h �SNIWE-';'t' ". �,,� r .r �. �3s. } xs t � � t ? DATE fi HUMASTON HE �` { POLICYT=YPES KIND OF LOSS � AUTO t OL SUFFIX r, r � (, + .' �1 I~ e z r� �1��;CLAIMANTS NAME y r � t 4�t � PAYkf�*,� fpr j f FiCiMRSTON, HELEN Mti _ 1;650: 00 0 D O. ADJUSTER NO ,,• IN PAYMENT OF. SPA a t f. 17403/16759 Cl t7'�EU CULL ESTTf~iA7E m5 1 a ''�, ,'} r Bank of America NTBSA k s rtil >i i. tro •�..t } ,tr;t`` f �* ' :1; San FranciscoCommeraalBanWng O� 1210 a .:,,'q 3•? '+ r.. �. t 7' ... :�San FratacplsW CA 94104 t ^rRrr, x 'K i'.�.{.• PAY knMiE THOUSAND S I X HUNDRED F T F7 Y (70/10p3s m€ .. k .-.' F; 7� �J a IN a4 C27313b9 a, �' AFiEY'S � .� 1` " AND'FtELE N THOMATCJN TotJ.:7�0.. D ... _• ..,. - ,THE',".'p^y NOL SAN PABL-0 ...AVE ' AIITHOR2ED SIGNATOR /� p {�.+ �r- T h� ORDE.!'I1zI LJ lw G11Mh9r r: of A 945b4 r 1 OT NEGOTIABLE T K�;� P 'r q$ y d ak a ul t. � n h J s Edi ,�d S+C� r N 2 h t M,F L - _lid d� 01-4 - .P '�• z 11.,_`.,:-:. ' 'r-r...'. � Cali fomfa State Automobile Assc�ciatfon Inter Insurance y O 1 4B7309 1 - THbMRSTON HELEN .M DATE OF LOSS r -" _ 5 Rs CLAIM INSURED'SNAME,-.< 9 --._� 8 12=9b' . _ DATE AUT0 �`t?L O1 S THOM#4STC�N HELEttt M �.y R POLICY TYPE KIND OF LOSS -o r z CLAIMAN'T'3 NAME t{�7'?.+ i ` 0 00 v-+ SUFFIX i e r, _ r ,as sit rG... .:.y> r; PAY .a,.v r x.e xr:,. .m 2 SPA 1 587/16759 ED'UCTIBLF REI BURS t D O . ADJUSTER NO - IN PAYMENTeX• Ta -�' '1 'wi D O HUNDRED FSI FTY{ 40%100 Frof Amerka Ni83A 4 — comnbraal k 11 35 1210• 'Z-3: as r: r inra M°^°A w '% 5 z `- r y�'*a'x L -U F.r.� r ,, .g'ra �" �xa,�7t:+- � �,E�.,�'�a t j,; ria x,.:' t :rSen FranNsao CA 94104.n'•' �r� k; �r'.C�"f4 aPa' 1''-3'PAY z• +r`-: j z i s e v5 <r t; >; r -"'S. ;,:` .�[ `? _ti k [ .is Z w j'si i i ',*n...r k+ +S`.. e w x.,,r q..c°'�! :2 fn. 7 I N 94 1731369 - e. •s+ r �' " �f'{. s ti rs. - mm ATHEVS>`„BODX FSHOPmll „'3ra a <nr =t=„ :ar t:=S `:;w n ;'� �,, & w7y� r r'} i."8,c<r RT, m�. r 72b SAN;PABLO AVE 'rkr< kS , at r x n , t o tr I r h kr z r i } m,7^> + 4 q ce m 9 C AFP I HOLE ., yy EFi NA f (J'lA ”` r .�• rTHEr's ro a A".. s mow' ,,Sr-0 s>:y, ` b s "`..y�*+..'os.�caw y`fi.iw • 'i `' ,.,y r,3Y h.AUTFIOR4�D SICIMTUREp:q :ORDER 5`•tts n Y Tot 5 ar '� ' t;,rr*"' r y:�. <�. �-4-'X+,•�! rte, i.,ain�,:,.[ t .7" .ktr 4. 4,..t` : .�:5+;S..r�5„a, ' z.4-sir �S 4 �NEGOTIABLEI 3 �• i �� > ..� r .� �. ,� >, � , , � � NOT�I i esu r Mt ( of"3 §r ,�l' ate.+•= int g7� +.. i. a b�5, �.:r. f +il S +w X •e7 '; '' a.t 1 k yea N :.. [ S•F _� 'r rr a� r,SA x? L l s^ w f• res[•�r�k�'f .:'3v}s ked a,.� j =�:'`94 -h;, +,. f x `s;;: d e �^..,-5. Q.M.Q.•"aCC+P ts:. Y".'-x� �+„•�" #r� .• " t s , 3 +,� ',��yx d }'k �"� :"•:' Y,' xy Z.,.t y{ �.�4 r{i 3„�, q,�, �, ;,,�s. �`�� ;f{'r a ,�a"';�r", :. ��1 i"tl Y,:..s i���.-;b. �r1 ..a!Aty-i`u 'fit,_�r.."t rS•�K".'"t .�.x. r r -.,,.t§y R?1,.;,r rf ,s �F�"..r� r, ,.aF'�' ;r.. ':r1 "�' ,2 v,.w x?. ,.i s-t: �"S-2 -:!_=1 _ ._. tz L.;4�^.:'f..r F'%d K -s-: vx,..._.�2 r,7...s�.s> rJ a,.a�+�..�4'.,Cx vd:. �s'14T'-a�, �i�C' :' i .i:�i.s• � ';; 4�•+c^:..;',Fr^ r >^-ki i. S^� ,�`'s t1,1:rN.t z '�;4��, _. _ � n/t �* =l�A.�4-�..��ftS 17..¢3 tva% fk.a.,'�.n-r .� ��r �� .a u 3 •t Yt}," `4r�, 'Y} .� ''${{S,, �t Y��F��'' •.T... .i�.�a.7'n-^:'X 4.;b�:iT Kh.+i�f t�-.?.:'��� 1�;�'1'a' �.� { ��. f C ( COMPLETE BODY AND FENDER WORK i, SINCE 1947 FREE ESTIMATES ESTIMATE OF REPAIR COSTS INSURANCE WORK OUR SPECIALTY �+ DDD ,,',U Date_ ��✓�/— 7 Phone �?i'� Z/y�7 L 1!/� Ilo ilo/ SH op Name n .{�__UU OOOJJJ 720 D SAN PABLO AVENUE Address A930 461b t1-1A 3 PINOLE CA 94564 51 -7 City � � y LYNN ALEXANDER PHONE FAX 510 a 141663 1 Yea D.O.M. Make Model �4,✓i'?� Style L4,01 An License No. Body No. Serial No. Claim No.)l—NL77-02-1 Insurance Quan. WORK TO BE DONE Labor Material 1 ^ 2 y �� 3 7 8 9 10 14VG� 11 12 13 14 15 16 17 18 19 20 REFINISH MATERIAL RUST PREVENTION MATERIAL BLEND&MATCH GRAVEL GUARD n MATERIAL TOTALPARTS PRICES SUBJECT TO INVOICE LABOR HRS. / L X$ - HR=S PARTS »� The above is an estimate based on our inspection and does not 0 LIST S LESS %DISC. cover any additional parts or labor which may be required after the work has been opened up. Occasionally after work has started. SALES TAX S Gy fL(_3 worn or damaged parts are discovered,which are not evident on PAINT,MATERIALS ds NET ITEMS $ the first inspection. Because of this the above prices are not guar. anteed and are for immediate acceptance only. TOTAL REPAIR COST $ Accepted by Owner or Agent �•�� �•f�•-. .* Photo P� e '�"'6 • California State Automobile Association Inter-Insurance Bureau .1 NSD VEH I CL_E l01INSUREDl tii iM.A l 11i1: HELENi� El CLAIMANT �f i—�+L;' ;i0y-1 0 _i�;=;—=�h. 01 D',DDC-E 95 4D qED !LC`y(?Oc+ FILM NEGATIVE 1Lj�j1iE4 N F=C1'ti b1 C':i-1 L_ 00250 POLAROID `--PA 18100 DATE .0 r 'j, �; •��� I Lerr' HOUR yy • 0V A.M. BY L A 3 Yj BBqq�Q� LOCATION •� L �e cN\ a� MAKE OF CAN--Y,\EA v LICENSE NO. L(eS o o 6 . DATE HOUR A.M. ❑P.M. By �r LOCATION - - r MAKE OF CAR—YEAR LICENSE NO. � t DATE HOUR _A.M. BY .� r _ LOCATION ,l l MAKE OF CAR—YEAR LICENSE NO. r 1 a10�Pev.3-911 Photo P �e Cafifornia State Automobile Association Inter•Insurance Bureau _ j NSD VEHICLE INSURED THOMASTON; HELEN M ❑ CLAIMANT _ Oi-487309-i 07-03-96 01 DODGE 85 4D SED ILCS-006 NEGATIVE i B3BE46E8 C i 39267 COL 00250 FILM ❑POLAROID SPA !B100 DATE JUL 19 '36 HIOl6 HOUR • 0D ❑A.M. - BY JUL 19 7B6Alan LOCATION f ow MAKE OF CA —YEA LICENSE NO. IF LGS 600 DATE HOUR II A.M. ❑P.M. BY 1 LOCATION i MAKE OF CAR—YEAR LICENSE NO. as DATE HOUR A.M. BYAr 6AAA goo r LOCATION MAKE OF CAR—YEAR LICENSE NO. F: + oi,Re 13 91) Photo P� e mow`° ""`ted California State Automobile Association Inter-Insurance Bureau j NSD VEHICLE 61INSURED THOMASTCIN; HELEN M ❑ CLAIMANT 01-4B7309-1 07-03-96 01 DODGE 85 4D SED i LC:S006 IN NEGATIVE iB3BE46E8FC138267 COIL 00250 FILM ❑POLAROID - SFA 18100 DATE J U L 19 Y8r,- p� _ WGtl3 HOUR . 0D ❑A.M.JUL BY 19 F1'Q!a w 9 LOCATION MAKE OF CAP—YEA LICENSE NO. ! SGS 06 6 DATE HOUR ❑A.M. ❑P.M. BY LOCATION . , MAKE OF CAR—YEAR LICENSE NO. DATE HOUR ❑A.M. BY INA • LOCATION MAKE OF CAR—YEAR LICENSE NO. F14a0(R7 9.91) �~`�, California State Automobile Association Inter-Insurance Bureau I NSD VEHICLE INSURED T HOMASTON; HELEN M El CLAIMANT _ 01-4B7309-1 07-03-96 01 DDDGE 85 -4D SED 1LCS006 it NEGATIVE I B3DE46E8FC 138267 COL 00250 FILM POLAROID - - SPA 18100 DATE JUL 19 -R5 HOUR • OD A.M. P.M. BY JUL 19 vV HIQI$ LOCATION L •O• �V I r Z e c�ltiea b MAKE OF CA YEA LICENSE NO. � T LAS 00 6 ;= t liV l LICENSE NO. F1430(Rev.9.9t) Claim For Damages In accordance with Section 910 of the California Government Code, this is to formally place you on notice of our subrogated claim for the loss described below. Date: AUGUST 5 19 96 RISK MANAGEMENT JULIE ALEMOCK CONTRA COSTA COUNTY SAN PABLO , California 1801 SHELL AVENUE MARTINEZ, CA 94553 Claim is hereby made and filed against the CONTRA COSTA COUNTY as follows: Insured/Claimant's: THOMASTON, HELEN M. California State Automobile Association Inter-Insurance Bureau ADDRESS OF CLAIMANT(SEND NOTICES TO THIS ADDRESS) P.O. BOX 6060, SAN PABLO, CA 94806-6060 REFERENCE FILE 01-07309-1 DATE OF OCCURRENCE JULY 3, 1996 PLACE OF OCCURRENCE 3884 SAN PABLO DAM ROAD, EL SOBRANTE, CALIFORNIA NATURE AND AMOUNT OF DAMAGES(IF UNDER$10,000)INCLUDING ESTIMATED AMOUNT OF ANY PROSPECTIVE CLAIMS FRONT BUMPER, REAR BUMPER, DECK LID, TAILLIGHTS, FRAME - REPAIR ESTIMATE $1,650.00 ITEMS MAKING UP SAID AMOUNT AND BASIS FOR COMPUTATION OF AMOUNT CLAIMED COLLISION REPAIRS PER ESTIMATE NATURE OF DAMAGES(IF OVER$10,000)-NO DOLLAR AMOUNT TO BE SHOWN(§910(f)GOVT.CODE) N/A COURT HAVING JURISDICTION(CHECK ONE) Mylunicipal Court ❑ Superior Court NAME OF PUBLIC EMPLOYEE(S)CAUSING SAID DAMAGE(IF KNOWN) GREGORY PETER STAFFELBACH Facts and Details of Occurrence/Transaction: OUR INSURED HAD SLOWED TO MAKE A RIGHT TURN INTO A BANK PARKING LOT WHEN SHE WAS REAR-ENDED BY A VEHICLE DRIVEN BY GREGORY PETER STAFFELBACH. OUR INSURED WAS THEN PUSHED INTO A VEHICLE WHICH WAS STOPREE ,EXITING THE PARKING LOT. California St-=:A-Ahutomobile Association Inter-Insurar. 3' reau By: F1668(Fier.7-90) ALAN R SAPP :' -• �_ � Assignment of Claim and Subrogation Agreement<*>- sp California State Automobile Association Inter-Insurance Bureau In consideration of the payment to the undersigned of )M the sum of ❑ a sum estimated to be ONE THOUSAND SIX HUNDRED FIFTY AND 00/00 Dollars, being the full amount of loss and damage insured against under an automobile insurance policy, number 4B7309-1 issued to the undersigned by the CALIFORNIA STATE AUTOMOBILE ASSOCIATION INTER- INSURANCE BUREAU, said loss and damage having occurred on or about the 3RD day of JULY 19 96 , the said undersigned hereby assigns and transfers to said Bureau HER said claim in the above amount plus HER additional claim for damage resulting from said accident, not a total covered under said policy of insurance, in the amount of$ , constituting ❑ a total estimate claim in the amount of$ 1,650.00 Said Bureau is hereby subrogated in MY place and stead to.the extent of the above amount of the said total claim and is hereby authorized and empowered to sue,compromise or settle in MY name or otherwise to the extent of said total claim for loss and damage,and to endorse in my name any check made payable to me therefor,and collect and receive any money payable thereby. The undersigned covenants that SHE ha S not released or discharged any such claim or demand against such party or parties and that SHE will furnish to said Bureau any and all papers and information in HER posession, necessary for the proper prosecution of such claim. Dated at � �-r� this day of 19 . WITNESS F1433(Rev.12-89) y c� -4 CLAIM Q BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15, 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: $3,014.54 Section 913 and 915.4. (9= i1Wings". CLAIMANT: Cheryl Holmes r_O 1) 11 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZCAUF,, ADDRESS: 124 Goldenrod BY DELIVERY TO CLERK ON September 23.,_ 1996 Hercules, CA 94547 BY MAIL POSTMARKED: September 20, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 24, 1996 (aIL Bep� yLOR, Cier 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: �° � 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:_196t- PHIL BATCHELOR, Clerk, / -v_ji ate- Deputy Clerk YARNING (Gov.•code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * 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:_ -/�� /9940 BY: PHIL BATCHELOR b ,,,.��J'i�-c�aCcr Deputy Clerk CC: County Counsel County Administrator Clair to: BOARD OF SUPERVISARS OF CONTRA OWrA COUM INSTRUCTIONS TO CLAIMANT A., Clai:.s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for injury to person or to Personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 6911.2.) B. Claim must be filed with the Cle k of the Board of Supervisors at its office in Room 1069 County Admfnfstration 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 Sew. 72 at the end of this Torr se � g � � e REs Claim By ) Reserved for Clerk's filing stamp Cheryl Holuies ) RECEIVE[ Against the County of Contra costa ) SEP 2 3 1996 or ) District) CLERK BOARD OF SUPERVISORS (Fill: in n._me CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 3..014.54 and in support of t.'�is claim represents as follows: 1. When did the damage or injury xcur? '(Give exact date and hour) 7ipril 14, 1996 Apr. 7:48 T,-.m. 2. Where did the damage or injury occur? (Include city and county) Juvenile Hall, Martinez Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required) There was a plastic pipe attached to a sprinkler head sticking approximately � inches up from the ground. after I. was injured they were barricaded then - the sprin1cler pipes were removed. 4. What particular act or omission on the part of county or district officers# se_*"vants or employees caused the injury or damage? .Yegligence - see 14 3 01V•1!_) -5. +gnat are the mores of county or district officers, servants or employees causing ;,he da:-age or injury? County �,andscaper or p.2aintencc Department 6. What damage or injuries do you claim resulted? (Give Hill extent of injuries or damages clAimed. ttach two +estimates for auto e. spor re pain in the knee & Joint that intensifies when driving long •distances,cold weather and .use of stairs. 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ,014.54 iMedicai Expenses „,x,000.00 Unforeseen. future medical problems 3. Names and addresses of witnesses, doctors and hospitals. Doctors Hospital. of Pinole 9. List the expenditures you made on account of this accident or injury: 4WITFN �4/14/96 YFR�H5ERPARY Group �N�� 6 414/96 Bay Imaging" „:80.00 6/6/96 Dr. Snyder 4/15/96 Dr.-Heun<, r ; 30.00x'57.00 ee * ee * * W* Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SAID NOTICES TO: (Attorney) or by some per.on an his behalf." Name and Address of Attorney aimant's Signature Addre-w) Telephone No. Telephone No.5 l a eeaar0 * fes * * eft W Wee 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 tpth scwh im-prisoruient and fine. 0C: clerk .of 'the Board of- Sixper-risozs v�""��t- �M�ic.���,�a..b. l�'�'�t ��•rrc� �i ws�r' G�IV MUGTORT: $09P OF PINOL$ ' iM7ORCdgIp�NQ P .0.101 32001-01 Z2 PASADENA CA 91110 s "�"""'� i tcave .wca cwt I Baa.-Al it 1�tIiRlNlylTt �6AERii111 >:IDMR 3h pQ1Am![AL!. IIC. ^I ■ b • 's 6RNNETY ROLME3 ` 124 GOLDENROD -a 4 991 I HERCULSS CA 94672 b" o i d 1 a uv CD. a Datul m a youirim a BfJN+.tiitE Q swum nNAL&#Pl as +v Y 0250 PHARMACY 4 39' 96 20380 RADIOLOGY DIAGWOBTIC 31 49,7130 � 0*60 EMIRGZNCT ROOM i 152128 s 1, 11 13 —0051 6 � T r -3i rp i MYCp B�rIRf1AD81 LIQ N pim—i Aymwm w car#Aow Vo- 0 LANORZRB K&W INT22 y Y l 5t Sb W6IFEDONAIC arm E101fD11 ?we it IIDtAIIMCE�04l14l0. u—OL tOa KW"]j_H 43 110ya6lttis 98LLOYos%ma f•B1/u"LOt"M 1 Ns N G $ A 4 G ,-- x wkowlea sr iaoos 75• !2411 "° ' :Fu ee Rrrihulao 5 N 'SII-Tiff at;" a 9fu atIQi111M0 ib r+ GURU '2330 LABONSIS R&W ! INTSB P920 . 220 CANPU9 LA3TX �j,. BCItStIN CAiONIMA �1•t+so .s. An .s 1 _�--- c X7'A JUN 25 '96 09:55AM DMC P.2/2 - DOCTORS-- HOOP OF PINOLE P .4.80X stool-al2Z PABADBNA CA 91110 • ,96-37Z0659 i7 C/ CHERYL E -HOLMES PT# 0033589z8 F/C 80 ADMITTED 04/14/96 DISCHARGED -04/14/96 CHARGE# DESCRIPTION QTY HATE CHARGE 4903570 73564TC KNEE.COMPLRTR Z 0414 416 .40 5009065 00000 XRAY CALLRACH * 1 0414• 80 . 90 6100'522 'Z7602 - ER VISIT LTD '1' Q414,. '152 .28 . 53Z7678 00099 = 'HYDROCODIACT 6 4 0416: • , 33 . 96 b ' TOTAL C,HARCHS .683. 94 TOTAL DUE 683. 64 �t+ LLI o '- "; J J L w 0 m ■ w 1 _ x r N 4 — UJ UJ • .i • � �d(�;�� t. Y 4 1 Ira' r:c 1 1 • r w u 11 — W cn LW OrL L. r� 1 • r .. • 11 w `F.,r 4�i�, {���tii:� � •mss� { i �. r • C..+ 7 h7,w .p fY y �. • rl IT tx S. -r1� I ! - d F•7/ � � iL' rale Y.•�t< 1�1 ir� ! � �6�� � MHOLF EAERGEl W MEDICAL, iROW 43i% SiSK. MW SUITE 1-& .KM li MOi wF.S* CHlE TL - GJ "OftST0 CA` 953%6 '�lK� i�%9-41 ii~02Ki3i •' • �,7S7:�QS�!?.i .. �+�� - -• -• �s- AMouMT `04149 ► i 19054 SUNUVAMIDAY CALL Ee95 la:o0 104146% 4 99283 JEW4LM&pjoWftMW&ftjff 150.04 � 929►31� lRiib- - - - - - �,_r111111fff f JdAW IPIMOLE GA `184.DD ¢t as putts' ffas s aES fai r11r _ RMAs - _ :; 09/32/96 �VTT 3 "assn mi aria _-- v NOWTH BAY CHI PRACTIC mpc „gya ocuoa►nahe►�s�+ouo►+ 5cmy I. HEUN, D.C., INC. m, irs rcA�NoawvirrEtY - 2300 SAN PABLO AVENUE PINOLE,CALIFORM A 94564 1374_0 8r25re� PHONE:(510)724-2,200 DvWA pwBww wo DmbOum t3MW0FM0ffiaW0+” cab* AP AWHUY.PolarkfAflEN■R Mrs Cheryl M M" ` � x Pm 124 Goldenrod Her uses, CA 84547 j=Wgt *CALL THF-STAFF FOR MORE 1NPORMATMN REGARDING DENCMRGIE AMOUNT PAID S ro>r�u� *a�eo+ro�eracaou�rr�errrnC�rv��,e►�utma rpr�k�rne�wstet�vt w►nr raurr�.Wr�+* 4116/04 Est:b Pt PJM llmitad Cheryl Holmes Scott J. Henn 30.00 alna.8ent A ConWrAWd8I t1Mo... Cheryl NoIM44 4130186' M ctmwk Payment 'Cheryl Holmes 301.00 0.00 . - e�,.�.,� o_oa �o o.y� o_ao �au■Yr Q.Dt3 RC1 flays O.DtI 1Z0 Days 0.60 itsO+Dars a-tis Q.Ot N4�rr�wnw�:PtuccSrMt/rCT7C - SCariT).+3EUN /9C. 11 '_ . 2200 SAAB PABLOAV-cMLJF • PINCN-Fr CALIFt]RMA 943" ■ 1510)9,24-220 04!19196 PATINT FINN RIAL M,of p OT WMIN pqp 1 TIME ONCAL ■W Ac=wft UM - 23001 Alt 9®a. A mt set. top 0 Vl Or'# Prowdwe all* i✓nift Mount om ealres. rr.riw. 1.twwo I CA Mwov" 6 NRM.lWTt 131 94114 atria VI«IT - CMP 3 601.9 1.00 75.0 od/1TAS #Am"tr* (1) Geront AdAmmm,! •ill.a 031su" Chu* 1s11Mnt elm Mt1Wt -M.91 Ov"M o I I.wm 131 9'4313 OFFIN MIT - cm 1 M.T 1.aa 9T.a tr611�/iii oewr pwpo" a-Id veep Otbor -ta.01 MTAW rale ACMMT zOM RAVNWI r SOM ABJM 16.09 EUM2 : 13P.00 2.00 iT.41 ............ ............ ......... ........... 9A.lM! .OE 1'.Ig.00 4T.a r7� Clair: to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person • or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause • of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this r fo l41FylF R£: Claim By ) Reserved for Clerk's filing stamp Cheryl Holmes ) RECEIVED Against the County of Contra !osta ) SEP 2 4 ;19,96or ) ,District) CLERK BOARD OF SeRVISORS Fill in nasi ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 37014. 54 and in support of this claim represents as follows: 1. 'When did the damage or injury occur? -(Give exact date and hour) Kpril 1491996 Apx. 7:0e P.m. 2. Where did the damage or injury occur? (Include city and county) Juvenile Hall, Martinez Contra Costa County 3. How did the damage or injury occur? (Give full details; use extra paper if required) There was a plastic pipe attached to a sprinkler head sticking approximately $ inches up from the ground. After I was injured they were barricaded then _the-"sprinkler pipes were removed. ------------- - ---- --- - 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Negligence - see # 3 5. wnat; are -ne n--")es of counLv or district officers, servants or employees causing the -a;:ge or injury? County Landscaper or Maintence Department 5. , What damage or injuries do you claim resulted? (Give full extent of injuries or damAges claimed. AAt ch two estimates for auto die. Spor is pain in the Knee & Joint that intensifies when driving long distances,cold weather and .use of stairs. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) "09014.54 Medical Expenses 92,000.00 Unforeseen. future medical problems 6. Names and addresses of witnesses, doctors and hospitals. Doctors Hospital of Pinole 9. List the expenditures you made on account of this accident or injury: 4/1 ITEM AMOUNT 4/14/96 YTR. TEsE��PRARJ,' Group y.YK:86 4/14/96 Bay Imaging ' $80.00 6/6/96 Dr. Snyder 4/15/96 Dr. Heun 930.00 957.00 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 kQ4aimantls Signature � (Address)_ d, �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 'Doth such im-priso:uaent and fine. CC : clerk ;off the board Qf pervisor:s. `o 5. wnat are ane names of county or district officers, servants or employees causing the damage or Jtn jury? C ounty Tandscaper or "aintence vel artrient 6. What damage or injuries do you claim resulted? (Give full extent of injuries or d es claimed. Att�;ch two estimates for auto e. Spordic pain In the knee & Joint that intensifies when driving long distances,cold weather and .use of stairs. 7. How was the amount claimed above computed? (Include the estimated amount of any pros ctive injury.or damage.) 1 , 14.54 ';ea3_cal -Expenses 2,000.00 Unforeseen future medical problems $. Names and addresses of witnesses, doctors and hospitals. Doctors 1ospital of --1-mole 9. List the expenditures you made on account of this accident or injury: ocpsem_ ouY ' C/ 4/S'6 r 1211 �iT2i� - r u �r. 4/14/S6 1;ay Imaging Y80.00 6/6/:0 Dr. ;nyder 4/15/0'6 T:r. _TT .eun X0.00 57.00 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 aimant's Signature Address, Telephone No. Telephone No. lW� 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 ($10,000, or by both such imprisonment- and fine. C0 : clergy; ,of the :�oard Of Su-perviso.cs ws�.c- UUCT093-: UDSP OF PINOL$ ° i rAnWrr nl�w0 P�.W.tpdlC 31041-{112 8 PASADNNA CA 51110 7"11'a rcova faca 1baa wr,�a n - 1Z W K A 1l6aerltn+crE IS6EJC'te14S 11 aim lifA x E01fdU.!p�Om W. � b a' AL— ASNNBTH AOLKES 124GOLt3ENRflD 41 99, HERCULHS CA 94672 b i a i d r 4P BLV Ga 43 DUCMIMM N PCMIFAM '41 MW.MM fr mmu twig at rprAtc+VAM y P00cOYEIe a"m �o f 4850 4 38' 96 ! 03$0 -RADIOLOGY DIAL-NOSTIC 3 417120 � 0454 EM$RGRUCIT BOOK I 162 8 i . 16 I' t, rf 6 f 1 1 i '000t, 6831 5* s9 PAM 4+l7Hxi1pB1 N0 M"M fl%Vkt rt6 56 ESr Wm Ott! R LIMIERS Neer 1 INTS2 Y ns se iNeuiiEaex+lrx prrrp eater•ifp-wG�-u►re9 ae anpcfritl4e ae u4up4NC€aeotlPin VOLAES K3LbTIlSZB all 0 YWArWWAMWPaT"amm PM a Lug i sufto 1si LGumm 1' RANSWIT REGIN11311—MG74 J A PAN m40 c0 �, •=,a ry� •••- s MAOM6.on. »ii'AGrs zb 92411 . 1 Pr FtELAtYcy vR d �Plus� ;$330 LABORERS H&W f INT88 880 CAMP US LAUX SUISLIN CA 34695 -9 + A•1474 1 L iaNerr .. ... .,lLy 1-� c.�-J JUN 25 '96 09e55AM DMS P.2/2 • DOCTORS - HOSP 4F PINOLM P .O.SOX 31001-0128 PASADEVA CA 91110 17 CHERYL S •HOLMES PT# 003338928 r/C 80 ADMITTED 04/14/96 DISCHARGED '04/14/96 CHARGE# DESCRIPTION QTY •DATE CHARGE 4903570 736&*TC KNE$ .COMPLRTE Z 0414 .: 416 . 40 6009069 00000 XRAY CALLBACK * 1 0414. 60 . 90 SIQUSZZ 'Z7502 . ER VISIT LTD '1. 04b4... 182 . 28 6327676 00099 ' 'HYDROCOD/ACT 5 4 04M . - 33 . 96 TOTAL CRARGES .583. 64 TOTAL DUE 683. 54 • w � 1O Ifs ¢ _ d D) Q Q` r LU '' L •'7 • 'd. W = C 3�� f 4 r: •, - _ � Q Q fie > tiD ca e�1 Vin,v�a:�''` � � � � Z ►" y W . „w -','4: jib vR�. - L L7 �qq: 1� O O =.2 Ell 1u q C3 tWCI W a !A Q C16 cc -•�.::�Vzea40 ++, �S y J r 4JOaIn YY -77 Q eto ljl -_` ` - �' •`"a o'r""'a�' .,; 'T a ,'.'1. Q D IC X3 p.t'SI•t1�'4•F 4•C'�� W y fi i. _ �ffi tftd�i - Inco Q F W a s n M r w In a ' all, a u OIld a` Y t3 so M 1. o Z 8w y 4- :90 4 4t_z Rt w - d W0x z W �O v ,cc 'e d mz o¢ v rn . Z UJ w w a aw oL. 133 W y A,,�• 4. 0 J Q _ Cd0 c7 fiJ w JK z 0 - Z -a wI is r}rct - try +D CL Qks N PIWOLE EMERGENCIP MEDICAL Oftlo IP �. 36so $IS1[, ituo SHITE i-.A-.RA 17 HftNESq CHERYL IIDOtSTo CA- 95316 - :,PkOUE02 SWI"9-4144 - ',T= 7-4)1"8920- oA78 OPS DIAgno816' AMOUNT 041496 4 9FO54 SUMAY11PLIDAY CALL Fe85 Mpoo 041496 4 99263 Er,6LVATIQIMAl1AffMEW #* 15E1.O0 ss 92411 9160-. " f • IT6L OF PINdLE AdAir PIIME CA °1s4.Oo PN9lICIA11" I _ , AS iS 30 DAwc Kt "IRS a E'RES , di.E FAR rATMOUIs � '�O0L46LAS MO :; •PLAM aF SOME ��9rta art dIrM1F5MF1091Iy 05131/96 M . �v:- •LL:f��' a - • - i � &a C"WCPNACnC UM SM PAKO AVDKX PttvtXE.GUPOMUk W64 1474-0 41Q D 14 6 Dv" PHONE.,(S101 724-2200 s MpLOn �- Ir Mm t*nM MdWM 124 Qddsnsod Homwes. CA MLTW STAFF FOR NOW WFORMAIM RINGHARM AMOMS tp pvyy�q�pr y.�prm Ygi/tA00pll���e arr�ar+ua+�n�1Hr't� orrc�w Amort Jnr+Mtn nrr�.M+'r t 4116194 R +00 !t AliM6 'ha. t 1� tllt�rs.. cat mcbmw +115©�44C2tMX O!l.QO 0.00 i cuw,�►..e t+as aro oar, QLCO goo"* 6x.00 960%U 0.00 120 OWN OAO Immos" 0.60 6.4 INN �4+rn+wutivc�►ituoc� iCcyr J. *(JR4„O-C_,Ike- • 2J tf SAw I%8L0*4Ji 6 • PIW%.f!+l'AL A 9"" 1310 72442 06/n/96 PATIENT FIMAYCIU HISTORY BY 07 SERVICE Pala 1 P l omit MEDICAL ~ Acca nta 73003 - 23003 Alt Dataa Acct Date oath N Masa! orf Praeed i Dias 1lni to Amount rwrasyrrrwraroor�rrrawr.rrw�r�rrrrrparrrrrawwrwwwrrrrrrs�raaaaRam=s:aesd_errrrrrr�rwrwraawrarerr a 003 NOLIaYe.CNRSTL Prwion Satance : 0.00 03/04/45 a "MMEs.ChM STI. 181 94214 OPFICE VIRIT - COMP 2 686.9 1.00 95.00 03101% Check Paroont 3-04i►1185 patient -10.00 03/17/45 AdJM*V nt (1) Qiral Adjustment •+24.06 05/24/95 Cheek Paynellt 912514 Pat fant -40.92 06/061% 0 WxMEH.CNERTL 131 99213 OFFICE VISIT - COW 1 934.7 1.00 S7.00 O6/IV% other Pevwt 6-06 VISA atihar -19.00 TOTAL$ FON ALCM MT 23003 PAYMENTS 60.42 ADJUM a 24-06 CHARGES ; 132.00 2.00 47.00 RSFUNDSi 0.00 90.42 34.06 132.00 47.00 CLAIM (CL) BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October /,S; 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 Supervisor$ (Paragraph IV below), given pursuant to �� Amount: $350,825.00 Section 913 and 915.4. Please note all ings" CLAIMANT: Jack Huston-Simmons, a minor, by and through his guardian ad litem, S F P 7 7 1996 Leslie Huston Ricks COUNTY COUNSEL ATTORNEY: Robert E. Barnett MARTINEZCAUF. Attorney at Law Date received ADDRESS: 712 Empire St. BY DELIVERY TO CLERK ON September 24, 1996 Fairfield, CA 94533 BY MAIL POSTMARKED: September 23, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 27, 1996 IVIL BAATTCVELOR, Clerepu II. FROM: County Counsel TO: Clerk of the Board of Supervisors tK f This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on, ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 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: D` &* ° 15_j PHIL BATCHELOR, Clerk, �q-�,�,�..t_�/"� aO�- , Deputy Clerk 41ARNING (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 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: Ie- c�/ -7� J /9cp BY: PHIL BATCHELOR b Deputy Clerk CC: County Counsel County Administrator iCE PERSONAL INJURY ATTORNEYS, AN ASSOCIATION OF SOLE PRACTITIONERS 712 Empire Street Robert Barnett Fairfield,California 94533 Michael Mattice Telephone(707)425-0671 r RECEIVED 02400 September 23 , 1996 57 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Clerk Board of Supervisors 651 Pine Martinez, CA 94553 Re: My Client Jack Huston-Simmons Date of Loss 6/11/96 Dear Sir/Madam: Please file the enclosed Claim Against the City and County of Contra Costa and return an endorsed filed copy in the envelope provided. Thank you for your cooperation herein. Very truly you , ROBERT E. BARNETT REB/yd Enclosure(s) —� claim ',o: B0 SUPERVISORS OF CONTRA COSTA &> I1nTS'TRUCTIONS TO a ADw;T WIT' 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 1911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at-the end of this �: i f f f � • * • � � f � f � f i • f f � f • f • ! i $ B • • i B f • f f i � 8 • * # BE: Claim B.y ) Reserved for Clerk's filing stamp iACK H STUN-SIMMONS . a minor. by.) and through his Guardian ad Lite , RECEIVE ,. . Aga Inst the County.of Contra .Costa _) or ) 2 419A6 District) CLERK BOARD OF SUPERVISORS Fill in name ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 3 5 0 , 8 2 5 . 0 0 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) June 11, 1996 3. khere did the damage or injury occur? (Include city and county) California Street, Rodeo, CA Contra Costa County 3. Now did the damage or injury occur? (Give full details; use extra paper if required) Sidewalk was unfinished on. steep downgrade near school. Sidewalk ended leaving holes and .ruts.which cbhstituted a dangerous condition of public property. See attached photos of area. 4. What particular actor omission on the�part of county or district officers, servants or ea>ployees caused the injury or damage? Failure to complete sidewalk, failure to warn of damages, inadequate maintainance of area between sidewalks. (over) 5. What are the names of Inty or district officers, sers or employees causing the damage or injury? Unknown S. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Broken right arm, left knee derangement 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) medical bills : c$825:00 (initial;Kaiser visit) General damages : $350, 000 8. blames and addresses of witnesses, doctors and hospitals. 1. List of doctors : Kais-er-"-Hospital (Martinez) R. Lieberman, M.D. M. K. Portnoff, M.D. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 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 ROBERT E, BARNETT Attorney at Law is Signature 712 Empire Street l"`7 Fairfield, CA 94533 l'7 (Address) 0,,,, T 1S 72 Telephone No. 707-425-0671 Telephone No. a y� =�i1 . 's i • f f f A • f f i • � � f f �� 6 f � NOTICE Sectiea T2 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 010,0000 or by both such imprisonment and fine. I f ST y _ ti 'fb m .. car' P C r 2 •r v C 'Z v A n Z m x •r Ar K1' Ntt � ft � e* 0 m '00 t., 3 N y • jj1 (� n JPA w N W N + CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA (OL) October 15, 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 (Paragrasuant to Government Code ;R3nWd9Z15b.141V= Amount: $1,927,84.00 Section note all "Warnings". CLAIMANT: Kimberly Jones SEP I a 1996 COUNTY COUNS ATTORNEY: MARTINEZ CALIF Date received .ADDRESS: 1745 N. Jade St. BY DELIVERY TO CLERK ON September 27, 1996 Richmond, CA 94801 BY MAIL POSTMARKED: September 26, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted claim. DATED: September 30, 1996 JJIL ReATTC�ELOR, Clerk N. FROM: County Counsel TO: Clerk of the Board of Supervisors (11 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: / /�(D BYeputy 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 ( >/f 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. (( yr Dated: � ' /'I/y9(� PHIL BATCHELOR, Clerk /jam -v/L�`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 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: � /7> BY: PHIL BATCHELOR by— -0- Deputy Clerk CC: County Coarse) County Administrator Claim 'to: BOAR* SUPERVISORS OF CONTRA COSTA OM 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, eause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D.. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims; Penal Code See. 72 at the end of this Torm. * * * * * * * * * * * * * * * * * * * * * * * 0 *' *. * * * * * * * * * * * * * * * * * RE: Claim By ) Reserved for Clerk's filing stamp KIMBERLY JONES RECEIVED ) Against the County of Contra Costa ) SEP 2 71996 or ) Housing Authority of the Count CLERK BOARD OF SUPERVISORS of Contra Costa bistriet) 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 $ _ G_+.,:r �-� �, and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and ho r) 1lq� oo 2. Where did ae damage or injury occur? (Include city and county) 7V5` fi C1 llptl)(q, Cc� 3. How did the damage or injury occur? (Give full details; use extra paper if required) �. � prAj)R f 4. What particul ;at or omission on the part of county or district officers, servants .or emploxees caused the injury or damage?f\(). r (over) ,_ , . •, .. wap 5. What are the names of cq&ty or'district officers, serv* or employees causing the damage or injury? i'\(? C)1\,C SOM-e W'r On (4 SiCle l -� 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. c�,V Y\,(\ gQu�P� 7. How.was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. B. Names and addresses of witnesses, doctors'� and hospitals. p�,N1��s �'���=�5� 1�7.� �Sf- ��55 i�'. `�•����,f 5�G1 1.�21 �� �'1Z� t4XWC4 Z& S+ 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 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 V,WW Cla tis gnature 4— (Address) Telephone No. j 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 offieer, 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 ane 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.sueh imprisonment and fine. -Z---k, C�ICf Jl i R_�- S�1a�-- -- ---- - -`���• j --f=ob- L��K-�.l- R K4Q L .�,�' - -- - ---- - - _ � s - _ oy - - _ U_ __-- -- -- Z fi i Aku y --------------- --- ------ - ------ --------- - ---------- hn4p5 67 A-ir ;Y� .ir 23 r (f7, M �? tokn tp a1 d�,l d 'Y• U to 00 a � U tip = v� p T y N R x kn t � � z 7 . C 10 CLAIM (al} BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15' , 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: $50,000.00+ Section 913 and 915.4. Please n'Jt19T CLAIMANT: Shawn M. Keller �;p 4 1996 ATTORNEY: Tyler A. Shaw, Esq. & Meyers Law Offices Date received COUNTY COUNSEL Jacoby Y M�TINlLIF. ADDRESS: 100 California St. , Ste. 700 BY DELIVERY TO CLERK ON September 996 San Francisco, CA 94111 September 19, 1996 BY MAIL POSTMARKED: P I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. QH g H DATED: September 24, 1996 B1 IL Deputy OR. C1erl II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ��}'`1 l 0 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: (� e- /Tj PHIL BATCHELOR, Clerk, 66it-�-Q— , Deputy Clerk 40ARNING (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:�� �7J BY: PHIL BATCHELOR y �j -e -'�-010'�`�1 Deputy Clerk CC: County Coinsel County Administrator JACOBY§ 1:�:Y� EKSOFFIRECEIVE® flCl�C c S& Z 31996 CLERK BOARD OF SUPERVISORS I CO SENT VIA CERTIFIED MAILS RETURN RECEIPT P 553 655 092 NtRA COSTA CO. September 19, 1996 Clerk of Contra Costa County Board of Supervisors County Administration .Building, Room 106 651 Pine Street Martinez, CA 94553 Re: Our Client: Shawn M. Keller Our File No. : 025101 Date of Loss: 04-22-96 Dear Legal Department: Please find enclosed the original claim form against the County of Contra Costa and three photocopies. Please file the original for each and mail back an endorsed copy for our records. A self addressed stamped envelope is enclosed for your convenience. Thank you in advance for your cooperation. 4Sincerung Legal Assistant /dlf Enclosures 100 California Street• Suite 700•San Francisco, California 94111 *Telephone: 415/399-8951 • Facsimile: 415/399-1939 C,16( CLAIM AGAINST CONTRA COSTA COUNTY Please submit: Clerk of Contra Costa County Board of Supervisors County Administration Building, Room 106 651 Pine Street Martinez, CA 94553 RE: Claim By ) Reserved for Clerk's filing stamp Shawn M. Keller ) ) RECE]V_� Against the County of Contra Costa and the West Contra Costa Unified) 1 -..SO 3 ` School District 'CLERKBOARD OF SUPERVISORI CONTRAP LOSTA GO. JAS � Dor The undersigned claimant hereby makes-r_aN�cxlaim -against the County of Contra Costa or the above-named �Distr•ict in excess of $50,000.00 according to proof, and in support of this claim represents as follows: ---------------------------------------------------------------- 1. When did the damage or injury occur? (Give exact date and hour) April 22, 1996, at approximately 2 : 00 p.m. 2. Where did the damage or injury occur? (Include city and county) De Anza High School, 5000 Valley View Road, City of Richmond, County of Contra Costa, California. 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimant, a special education student with disabilities, was injured while operating wood shop machinery at De Anza High School. 4. What particular act or ommission on the part of county or district officers, servants or employees caused the injury or damage? The County of Contra Costa and West Contra Costa Unified School District and their agents and employees, negligently supervised, trained, instructed, oversaw, and managed claimant; and negligently' supervised, trained, instructed, oversaw, managed, employed, constructed, designed, owned, modified, purchased and/or planned the premises, equipment, machinery, curriculum, CLAIM AGAINST CONTRA COSTA COUNTY PAGE 2 OF 3 CLAIMANT: SHAWN M. KELLER instructors, and/or other students; and failed to warn claimant of the dangerous conditions and defects of the premises, equipment and machinery which negligence directly and proximately caused claimant to sustain severe personal injury according to proof. S. What are the names of county or district officers, servants or employees causing the damage or injury? Including but not limited to Victor Perata. Discovery is continuing. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. ) Including but not limited to amputated left thumb and other injuries according to proof. Discovery is continuing. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) In excess of $50, 000. 00 according to proof. Discovery is continuing. 8. Names and addresses of witnesses, doctors and hospitals. Including but not limited to Kaiser Permanente, 901 Nevin Avenue, Richmond, California. Discovery is continuing. 9. List the expenditures you made on account of this accident or injury: Including but not limited to medical expenses. Discovery is continuing. G,`d CLAIM AGAINST CONTRA COSTA COUNTY PAGE 3 OF 3 CLAIMANT: SHAWN M. KELLER Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant or by some person SEND NOTICES TO: Tyler A. Shaw, Esq; on his behalf. " ----------------------------------4Tyle jk -------------- Name and Address of Attorney Tyler A. Shaw, Esq.JACOBY & MEYERS LAW OFFICES100 California St. , Suite 700San Francisco, CA 94111 laimant r Tel: (415) 399-8951 i i NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officers, 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. " PROOF OF SERVICE I, Dorothy Fung, declare that: I am over 18 years of age and not a- party to the within action. My business address is 100 California Street, Suite 700, San Francisco, CA 94111. On September 19, 1996, I caused to be served the within NOTICE OF CLAIM AGAINST CONTRA COSTA COUNTY by placing the original and true copies thereof in an envelope with adequate postage, and depositing same via certified mail item number P 553 655 092 in a U.S. Mail receptacle, addressed as follows: Attn: Clerk of the Contra Costa County Board of Supervisors County Administration Building, Room 106 651 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 19th day of September, 1996 in San Francisco, California. i Dorot ung r } - � S .2 4 • �� , '1 F -•r ✓ '7 � `x' to S :. � y„ .a {{ � ',� r t� t s t '� � ea •' .{ .. `' 4'S� items � ",. 5+ x {'r kyr IX e t 1 9 i t.r W J gyp} 'f Y G+ x 'k � 1 CLAIM �4} BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15, 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: $600.00 Section 913 and 915.4. Please note all,115MMOVIXID I CLAIMANT: Ana Ledis Leon OCT 0 1 1996 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 1865 Powell St. #6 BY DELIVERY TO CLERK ON September 30, 1996 San Pablo, CA 94806 BY MAIL POSTMARKED: September 28, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Bl�: JpJNIL BATCUELOR, Clerk DATED: October 1, 1996 Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors 914 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim isnot timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 10 /�1p 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: ,t• �5l 99� PHIL BATCHELOR, Clerk, 8,1iz-�� �/ — 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 nil 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 asshown above. Dated: 46-;&W� 7 /99(G, BY: PHIL BATCHELOR by Deputy Clerk CC: County Ccirse' County Administrator Claim to: BOAPM OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Glai:s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for-death or for inJury to person • or to personal property or growing crops and Which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of. action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 1o6, 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 See. 72 at the end of this R£: Claim By ) Reserved for Clerk`s filing stamp 01 r)CL L -e Le_©✓'1 ) RECEIVE®, Against the County of Contra Costa SEP 3 01996 'Irzt A5 t� District) CLERK 80ARD OF SUPSRV ORS Fill in name ) CONTRA COSTA CO. The Lmdersigned claimant hereby makes claim againss the County of Contra Costa or the above-named District in the sum of $ Loa.. and in support of this claim represents as follaws: -` 1. When did the damage or injury occur? -(Give exact date and hour) 74, 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) - ! . �k c✓"�7 it �ctrr y 4 s ee-j ,r y c a r- 4. ..-, d �,-� s w e.P-e 4. What particular act or omission on the part of county or district officers, servants or employees caused - - �- the injury or damage? L 1Jh r» / �2►'SJiO/) )e- o- lce-r" 1nSr57ee�J _/ha�� hQc �4r're���/ 0,r- ) n fih� bus ozone . L hu �f o� �� cYroe,!::7/ � � :�► y � �._u��, c�� Anel LUW5 fAheof7"e leaoe tvhe ► fih, 5 �ce_i-- paifecP ,ne: ovwt rYIZ �or M�� Z=� /{��7eiJ ���uid�f �ro�u�e .M y [�, li1�t ,`_.GI / ice, C�2 acne 1,ve-r'e ofket-- peak /� 5 >Lof 09el u s aO0 uue ct// m �! • �tcfGrJ2.Y� /�Of ei�c�,,% 9;- 4r,, y �IV. 4 r/11a , a n 6 wf -M, �. wnat; are the nanies of county or district officers, servants or employees causing I"e R the ^.a age or injury? IJa _ .�A , S �v d s ��+t'� f� •�� a� ,RaII ��°�. '0,7 /r� y e a r t u tis 7 nc�� cc�' lae, '5 TO eO o%eo^u i e e- esl, L u>a S L° h CL 1-5 C e/ '4O r 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two es ,•mates for auto damage. pal'; 9LScr�¢p- nJc � �G55 O7 Lva9esj �fcr�9� C �s��r �DcU/n�/ `�C' �f&/Qj1 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) �y `7 3 � • c�Jfo�a9e— Naes o�fd. 7� Su�/"Qirr ,Jc{ $. mes and addresses witnesses, doctors and hospitaiz. —17-61-17-61 -- ; , � Ss Ln 9• List the expenditures you made on account of this accident or injury: DATE ITEM. AMOUNT > Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NXICES-T0: (Attorney) r ! or by some person on his behalf." Name and Address of Attorney Claimant's Signature Address. Telephone No. Telephone No. * iE �t 1E ' 'iF"�F'7F" "i�"�F�F'7F'�F �E' 'W N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill,, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the stage prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such ne- ���� .� ,� � � �_ f ���� a �= �. �� . - ;�: �- • �-�-� c--�. r. �- ,. ,..... E �� � r=- -�- �, �;.__._, �, � `�' `�� � L�� � ` r' rt kt � ��.`� (' � t: �, .,�. ti. r �, ,i� �. ^- '" C,,. �_ \ ` �, t � 'F Q. i 4 1 r , C./0 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October /,S 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 toVDWM Amount: $10,000.00+ Section 913 and 915.4. Please note all rnings". CLAIMANT: Pacific Bell, A California Corp. SFp ? a 1990 COUN ATTORNEY: Sawamura Nishimi & Chu MARTINEZ CALIF. Michael A. Sawamura (SBN 109412) Date received ADDRESS: Court Plaza Building BY DELIVERY TO CLERK ON September 26, 1996 901 H St. , Ste. 210 Sacramento, CA 95814 BY MAIL POSTMARKED: September 25, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: September 27, 1996 IVIl �epuJ�VylDR, Cler��� _ ���,�---- 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: ZI/ 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:A 11�6 !�- / 9'10 PHIL BATCHELOR, Clerk, Byy/1- -� ti-ate , Deputy Clerk YARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * 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: �CZ /7, J 9 q BY: PHIL BATCHELOR b aoeputy Clerk CC: County Counsel County Administrator C Id 1 SAWAMURA NISHIMI & CHU MICHAEL A. SAWAMURA (SBN 109412) 2 Attorneys at Law Court Plaza Building 3 901 H Street, Suite 210 Sacramento, Ca. 95814 RECEIVED 4 Telephone: (916) 441-2685 Facsimile: (9 16) 441-5776 s 0260% Attorneys for Claimant 6 PACIFIC BELL, a California CLERK BOARD OF SUPERVISORS Corporation CONTRA COSTA CO 7 SUPPLEMENTAL CLAIM OF PACIFIC BELL, A California 9 Corporation, 10 Claimant, V. 11 BURLINGTON NORTHERN RAILROAD 12 CO. (DE) , BURLINGTON NORTHERN INC. , ATCHISON, TOPEKA & 13 SANTA FE RAILWAY CO (KS) , SANTA FE PACIFIC CORP. , 14 AMTRAK, NATIONAL RAILROAD PASSENGER CORPORATION, 15 SOUTHERN PACIFIC RAIL CORPORATION, UNION PACIFIC 16 RAILROAD COMPANY, UNION PACIFIC CORPORATION, MARK 17 WILLIAM JONES, BARBARA NUE, GARY BURKE, COUNTY OF CONTRA 18 COSTA, CONTRA COSTA WATER CANAL, IRONHOUSE SANITARY 19 DISTRICT, DIABLO WATER DISTRICT and DOES 1 TO 100, 20 Inclusive, 21 Respondents. / 22 TO: EAST BAY REGIONAL PARK DISTRICT, CITY OF OAKLEY and OAKLEY- BETHEL WAST WATER DISTRICT: 23 [RESPONDENTS BURLINGTON NORTHERN RAILROAD CO. (DE) , 24 BURLINGTON NORTHERN INC. , ATCHISON, TOPEKA & SANTA FE RAILWAY CO (KS) , SANTA FE PACIFIC CORP. , AMTRAK, NATIONAL 25 RAILROAD PASSENGER CORPORATION, SOUTHERN PACIFIC RAIL CORPORATION, UNION PACIFIC RAILROAD COMPANY, UNION PACIFIC 26 CORPORATION, MARK WILLIAM JONES, BARBARA NUE, GARY BURKE, • COUNTY OF CONTRA COSTA, CONTRA COSTA WATER CANAL, IRONHOUSE 27 SANITARY DISTRICT, DIABLO WATER DISTRICT and DOES 1 TO 100, Inclusive, having already been served with this claim] 28 1. I You are hereby notified that Pacific Bell, a California 2 Corporation ("Pacific Bell") , whose address for purposes of the 3 matters set forth in this claim is 2600 Camino Ramon, Room 2NOOT 4 San Ramon, California 94583, claims damages and losses from the 5 Respondents, and each of them, in an amount, computed as of the 6 date of presentation of this claim, in excess of $10, 000. 00. 7 Said claim is filed with your respective agency through these 8 attorneys of record. 9 Notices concerning the claim should be sent to said Pacific 10 Bell 's attorneys, SAWAMURA NISHIMI & CHU, Attorneys at Law, 901 H 11 Street, Suite 210, Sacramento, California, 95814 . 12 Other than MARK WILLIAM JONES, BARBARA NUE and GARY BURKE, 13 the names of the other public employees causing the Pacific 14 Bell 's damages are unknown. 15 This claim is based primarily on Workers Compensation 16 benefits paid, property damages, loss of use, and other losses 17 sustained by Pacific Bell as follows: 18 1. At all times herein mentioned, Pacific Bell was 19 and now is a corporation organized and existing under and by 20 virtue of the laws of the State of California. 21 2. At all times herein mentioned, Pacific Bell was 22 the employer of James Frederick Zwetz ("employee" or "Pacific 23 Bell 's employee") , a resident of the Brentwood, County of Contra 24 Costa, California. 25 3 . Pacific Bell refers to, and by such reference 26 incorporates herein, each and every, all and singular, of the 27 allegations of its employee' s Claim, separately served herein, to 28 the extent it alleges a Claim against the respondents. 2 . 1 4 . At all times herein mentioned, Pacific Bell is 2 informed and believes and thereon alleges that respondents 3 BURLINGTON NORTHERN RAILROAD CO. (DE) , BURLINGTON NORTHERN INC. , 4 ATCHISON, TOPEKA .& SANTA FE RAILWAY CO (KS) , SANTA FE PACIFIC 5 CORP. , AMTRAK, NATIONAL RAILROAD PASSENGER CORPORATION, SOUTHERN 6 PACIFIC RAIL CORPORATION, UNION PACIFIC RAILROAD COMPANY and 7 UNION PACIFIC CORPORATION (hereinafter collectively referred to 8 as "railroad respondents") , are, and at all times mentioned 9 herein were, corporations or other entities doing business in the 10 County of Contra Costa, State of California. Said railroad 11 respondents also are, and at all times herein mentioned were, 12 common carriers who owned and operated railroad lines in the 13 County of Contra Costa. Said railroad respondents also owned and 14 operated a number of locomotives, trains and other rolling stock, 15 which were operated by and through their agents, servants and 16 employees. 17 5. At all times herein mentioned, Pacific Bell is 18 informed and believes and thereon alleges that respondents MARK 19 WILLIAM JONES, BARBARA NUE and GARY BURKE and DOES 1 through 50, 20 inclusive, are, and at all times mentioned herein were, 21 employees, servants, and agents of the railroad respondents and 22 in doing the things herein alleged, were acting within the scope 23 of their authority as agents, servants, and employees, and with 24 the consent and permission of said railroad respondents. 25 .6. At all times herein mentioned, Pacific Bell is 26 informed and believes and thereon alleges that respondents COUNTY 27 OF CONTRA COSTA, CONTRA COSTA WATER CANAL, IRONHOUSE SANITARY 28 DISTRICT, DIABLO WATER DISTRICT, EAST BAY REGIONAL PARK DISTRICT, 3. i OAKLEY-BETHEL WAST WATER DISTRICT, AND CITY OF OAKLEY: 2 (hereinafter referred to as "government respondents") , are, and 3 at all times mentioned herein were, public entities and/or public 4 agencies in the County of Contra Costa. 5 7 . The true names and capacities, whether individual, 6 corporate, associate, or otherwise, of respondents Doe l through 7 100, inclusive, are unknown to Pacific Bell, who therefore files 8 a claim against said respondents by such fictitious names. 9 Pacific Bell is informed and believes, and on that ground 10 alleges, that each respondent designated herein. as a Doe is 11 legally responsible in some manner for the events and happenings 12 described herein, and proximately caused damage to Pacific Bell 's 13 employee as herein alleged. Each reference in this complaint to 14 "respondent, " "respondents, " or a specifically named respondent 15 refers also to all respondents sued under fictitious names. 16 Pacific Bell prays leave to insert the true names and capacities 17 of the fictitiously named respondents when such are ascertained. 18 8 . Pacific Bell is informed and believes and thereon 19 alleges that the railroad and government respondents were the 20 owners, managers, users, operators, engineers, conductors, 21 lessees, entrustors of, and/or were otherwise responsible for, 22 the railroad track and private railroad crossing at or near the 23 Iron House Sanitation, approximately 130 feet north of S/R 4 , in 24 the unincorporated district of the County of Contra Costa. 25 Pacific Bell is further informed and believes that at all times 26 herein mentioned, each of said respondents owned, managed, 27 operated, and controlled the portion of the tracks and right-of- 28 way of the railroad extended in a general east-west direction 4. 1 over, on, and across a private roadway extending in a general 2 north-south direction in Contra Costa County, California. 3 9 . At all times herein mentioned, Pacific Bell ' s 4 employee had the right to be present on property of the railroad 5 and government respondents and was otherwise lawfully on the 6 premises of said respondents. Said employee also operated 7 Pacific Bell 's vehicle in a careful, prudent, and lawful manner. 8 10. Pacific Bell is informed and believes and thereon 9 alleges that each respondent is either a California public 10 entity, a California corporation, a corporation under the laws of. 11 a different State or nation, a general or limited partnership, or 12 an individual, and Pacific Bell will ask leave to amend this 13 pleading to set forth the true capacity of each respondent when 14 the same has been ascertained. 15 11. At all times mentioned herein respondents, and 16 each of them, were the agents, servants, insurers, joint 17 venturers, and employees of each other, and were acting within 18 the course and scope of such agency, service, insurance, joint 19 venture, employment, .and authority relationships, and with the 20 knowledge, permission, and consent of each other in performing 21 the acts herein alleged. 22 FIRST CAUSE OF ACTION 23 (Negligence) 24 12 . Pacific Bell hereby incorporates by reference as 25 though fully set forth herein, each and every allegation of the 26 preceding paragraphs. 27 13 . On or about March 27 , 1996, Pacific Bell 's 28 employee was employed by Pacific Bell and was injured in the 5. �,lv 1 course and scope of said employee' s employment when said employee 2 was driving a white 1988 Ford 350, 1 ton, 4WD Pick-up ("vehicle") 3 southbound on a private roadway described above. Pacific Bell 4 was and is the owner of said vehicle. At that same time, Pacific 5 Bell is informed and believes that respondents MARK WILLIAM 6 JONES, BARBARA NUE and GARY BURKE were operating a train 7 consisting of an engine and four passenger cars along the 8 railroad track described above. On or about the time alleged 9 above, at the railroad crossing described above, said respondents 10 negligently and carelessly operated, used, repaired, maintained, 11 and controlled the train, so that it ran into and against Pacific 12 Bell ' s vehicle, inflicting personal injury to the employee and 13 property damage as hereinafter alleged. Thus, Pacific Bell ' s 14 employee sustained injuries to said employee' s body and sustained 15 general damages as more particularly set forth in his claim. 16 Further, Pacific Bell ' s employee incurred, and will incur in the 17 future, medical expenses and wage losses, as well as a loss of 18 earning capacity. 19 14 . Respondents, and each of them, had the duty to 20 construct, manage, maintain, inspect, supervise, alert, warn, 21 control, entrust, possess, contract, subcontract, or otherwise 22 provide proper warnings of and safeguards for potential dangers 23 to persons who may come in contact with the railroad tracks, 24 roadway, and premises at or near the railroad crossing described 25 above. At the time and place referred to herein, the respondents 26 and each of them negligently and carelessly failed to inspect, 27 maintain and/or furnish an automatic signaling device, or to 28 instruct or require its employees to sound a horn, locomotive 6. I bell and whistle or a proper horn, locomotive bell and whistle or 2 other device at or near the crossing, and thus failed to warn 3 motorists of the approach of the train to the crossing, 4 especially in light of the sharp angle of the track in the 5 proximity of the crossing. Respondents, through its agents and 6 employees acting in the discharge of their duties and within the 7 scope of their authority, did not furnish and maintain these and, 8 as a result, Pacific Bell 's employee was injured. 9 15. The railroad respondents placed their employees 10 and agents in control of the train without reasonable inquiry as 11 to their fitness, training, experience, or competency to operate 12 trains and locomotives, and without having exercised reasonable 13 diligence or care to know or ascertain their fitness to act in 14 such capacities, and without reasonable grounds to believe that 1S they were competent to so act. Said respondents thus failed to i 16 use reasonable diligence or care to know, ascertain, or be 17 informed, as to the fitness, care, knowledge, training, 18 experience, or skill their employees and agents, or of the want 19 in that regard on their part, and continued to employ or retain 20 them without such knowledge or information. 21 16. At the time and place referred to herein, 22 respondents MARK WILLIAM JONES, BARBARA NUE and GARY BURKE 23 negligently and careless operated the train in that they failed 24 to sound a horn, locomotive bell and whistle, or a proper horn, 2S locomotive bell and whistle or other device at or near the 26 crossing, to warn motorists in any way whatsoever of the approach 27 of the train to the crossing and, as a result, Pacific Bell 's 28 employee was injured. At the time and place referred to herein, 7 . 1 said respondents as agents or employees of the respondent 2 railroads, acting in the discharge of their duties and within the 3 scope of their authority, negligently and carelessly controlled, 4 entrusted, maintained, and operated the train by causing said 5 train to be propelled at an excessive and dangerous rate of 6 speed, above that which would have been safe or prudent under the 7 circumstances existing at the time and place referred to herein, 8 at the express or implied direction of the railroad respondents, 9 especially in light of the condition of the crossing, 10 restrictions to visibility and the lack of adequate warning of 11 the train' s approach. Further, Pacific Bell is informed and 12 believes that said respondents failed to keep an adequate or 13 proper lookout for vehicles on or approaching the crossing, 14 including Pacific Bell 's employee's vehicle, and carelessly and 15 negligently failed to stop the train before colliding with said 16 vehicle. 17 17. At all times herein mentioned, the railroad 18 respondents knew of the existence of -a highly dangerous 19 condition. Notwithstanding this knowledge, said railroad and 20 government respondents failed to take adequate safeguards to 21 prevent accidents and harm to users of said private roadway, and 22 also failed to install crossing gates, flashing lights, or any 23 other effective warning signals. The railroad respondents' .24 failure to take corrective action displayed a conscious and 25 callous indifference to, or disregard of, probable harm to 26 motorists using the crossing described herein, including Pacific 27 Bell ' s employee. 28 18 . At all times herein mentioned, respondents, and S. 1 each of them, failed to perform the foregoing duties and 2 negligently and carelessly designed, installed, constructed, 3 operated, used, managed, maintained, inspected, supervised, 4 controlled, contracted, subcontracted, designed and owned said 5 railroad crossing and permitting it to be in a dangerous, 6 defective and hazardous condition for an unreasonable time, or 7 otherwise creating a risk of injury to motorists using said 8 crossing. said respondents were further negligent and careless in 9 that they failed to exercise ordinary care in order to avoid 10 exposing persons thereon to an unreasonable risk of harm, as well 11 as failed to warn persons of said risk of harm. Further, said 12 respondents had notice of the existence of the dangerous 13 condition in sufficient time prior to the injury to have 14 corrected it and/or said condition was created by said 15 respondents ' employees. Thus, the damages and losses that 16 Pacific Bell has suffered, and will suffer, are due to the 17 negligent, careless, reckless and unlawful operation and 18 maintenance, by said respondents, inclusive, their agents and/or 19 employees of the respondent, as well as the negligent, careless, 20 reckless, and unlawful maintenance, supervision, control, hiring, 21 management, training, instruction and entrustment by said 22 respondents of said property, premises, operators, employees and 23 others responsible for the maintenance, management, operation, 24 training, instruction and entrustment of said property and said 25 trains. 26 19. At all times herein mentioned, and at the time of 27 Pacific Bell employee' s injuries, Pacific Bell was a lawful and 28 permissible self-insured employer pursuant to, and under the 9 . 1 requirements of, the California Labor Code. At all times herein 2 mentioned, Pacific Bell had, and now has, in effect a 3 comprehensive disability benefits plan for its employees. 4 20. As a direct and proximate result of said 5 negligence, carelessness and other acts of the respondents, and 6 each of them, and as a direct and proximate result of the 7 injuries of Pacific Bell 's employee, which were proximately 8 caused by said negligence, carelessness and other acts, Pacific 9 Bell has been required to and has expended to, or on behalf of, 10 its employee sums of money and benefits, all as is required by it the workers ' compensation laws of the State of California, and 12 said sums so paid were and are necessary and reasonable. Pacific 13 Bell has also been required to and has expended to, or on behalf 14 of, its employee short-term disability benefits under the 15 employee benefits plan paid to the employee for periods during 16 which said employee was unable to work as a result of his 17 personal injuries, and said sums so paid were and are necessary 18 and reasonable. 19 21. As a further direct and proximate result of the 20 negligence, carelessness and other acts of respondents, and each 21 of them, and of its employee ' s personal injuries, Pacific Bell is 22 informed and believes, and on that ground alleges, that it will 23 be required to pay further sums for medical and disability 24 benefits, together with other benefits provided by the workers' 25 compensation laws of the State of California and by Pacific 26 Bell 's employee benefits plan with its employee. Pacific Bell 27 will ask leave of the Court to amend this claim to show the true 28 amount of each such expenditures as they are ascertained. 10. 1 22 . As a further proximate result of the negligence of 2 defendants, and each of them, and the collision resulting 3 therefrom, Pacific Bell 's vehicle was damaged beyond repair. 4 Pacific Bell is informed. and believes that the value of the Pick- s up is in excess of $10, 000. 00. 6 23 . As a further proximate result of the negligence of 7 defendants, and each of them, as herein alleged, plaintiff 8 Pacific Bell has lost use of its vehicle, and was damaged thereby 9 in the sum in excess of $10, 000. 00. 10 SECOND CAUSE OF ACTION (Premises Liability) 11 24 . Pacific Bell hereby incorporates by reference as 12 though fully set forth herein, each and every allegation of the 13 preceding paragraphs. 14 25. Respondents, and each of them, are, and at all 15 times herein mentioned were, responsible for the maintenance, 16 operation, inspection, repair, supervision, and control of the 17 premises in which employee's injuries took place. 18 1 26. Respondents, and each of them, did so negligently 19 perform their duties so as to allow a dangerous condition to 20 exist and to maintain the railroad crossing in a dangerous and 21 unsafe condition for vehicles traveling on the roadway and across 22 the track. Said dangerous condition was allowed to remain in 23 existence for an unreasonable time. 24 27 . Respondents, and each of them, had a duty to 25 Pacific Bell 's employee to perform with reasonable care and to 26 warn of potential defects. 27 DAMAGES 28 The damages and losses sustained by Pacific Bell, as far as 11. 1 known, as of the date of presentation of this claim, consist of 2 damages to Pacific Bell ' s vehicle and other personal property, as 3 well as workers compensation benefits, disability benefits, and 4 medical payments made to, or will be made to, or on behalf of 5 Pacific Bell 's employee. 6 This claim as of the date of this claim exceeds $10,000. 00. 7 The amount claimed, as of the date of the presentation of 8 this claim, is computed as. follows: 9 A. Workers compensation benefits, short-term disability benefits, salary and other benefits paid to and on behalf of 10 Pacific Bell ' s employee - $ [Exceeds $10, 000. 00] ; 11 B. Future benefits and costs of future workers' compensation, short-term disability benefits, salary and 12 other benefits- $[Exceeds $10, 000. 00] ; 13 C. Medical benefits and payments - $ [Exceeds $10, 000. 00] ; 14 D. Future Medical benefits and payments - $ [Exceeds $10, 000. 00] ; 15 E. For prejudgment interest at the legal rate; 16 F. For costs of suit and a reasonable attorney fee, as 17 well as fees pursuant to Labor Code Section 3852 - $[Exceeds $10, 000. 00] 18 G. Property Damage and loss of use - $ [Exceeds $10, 000. 00.] 19 H. Estimated, approximate, prospective damages as far as 20 known - $ [Exceeds $10, 000. 00] 21 TOTAL ESTIMATED, APPROXIMATE, PROSPECTIVE DAMAGES - $ [Exceeds $10, 000. 00] 22 Jurisdiction over this Claim would rest in the Superior 23 Court of the State of California, and the exact amount of said 24 claim is in an amount to be proved later. 25 26 27 28 12 . 1 This claim is presented, and signed for, by Claimant's 2 attorney of record. SAWAMURA NISHIMI & CHU 3 4 5 Dated: By: Y Zorneys HAEL A. SAWAMURA 6 For Claimant Pacific Bell, a California 7 Corporation 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 13. 1 PROOF OF SERVICE BY MAIL, EXPRESS SERVICE CARRIER &/OR FAX - CCP §§1013 (a) , (c) & 2015 .5; FRCP Rule 5 2 SAWAMURA NISHIMI & CHU 3 Court Plaza Building, 901 - H Street, Suite #210, Sacramento, Ca. 95814 Telephone: (916) 441-2685; Facsimile: (916) 441-5776 4 Attorneys for Claimant: Pacific Bell, A California Corporation 5 Court : Superior Court of California, County of 6 Case Number: Case Name: Pacific Bell, et al . v. Burlington Northern 7 Railroad Co. (DE) , et al . 8 I, the undersigned. declare: 9 I am employed in the City and County of Sacramento, California. I am over the age of eighteen years and not a party to the within cause; my business address is 901 H Street, Suite 210, Sacramento, California 10 95814, which is located in the county where the mailing, fax transmission and/or other forms of delivery described below took place. 11 On the date set forth below, I served, along with a copy of this proof of service, a copy of the 12 following attached document(s): 13 SUPPLEMENTAL CLAIM OF PACIFIC BELL, A California Corporation 14 on the party (parties) in said-cause by one or more of the following methods set forth below: (See Attached for List of Party Served) 15 BY MAIL: I am readily familiar with the business practice at my place of business for 16 collection and processing of correspondence and documents for mailing with the United States Postal Service. Correspondence and documents so collected and processed is deposited with the United 17 States Postal Service that same day in the ordinary course of business. The above-described document(s) will be deposited with the United States Postal Service on this same date in the 18 ordinary course of business, the envelope will be sealed and placed for collection and mailing on this date following ordinary business practices at Sacramento, California, addressed as set forth 19 below. 20 BY EXPRESS OVERNIGHT SERVICE CARRIER: I delivered to a courier authorized by California Overnight, or another express service carrier, to receive documents, a copy of the above-described 2 1 document(s), in an envelope designated by the said express service carrier, with delivery fees paid or provided for, addressed as set forth below. 22 BY FAX: I transmitted from a facsimile transmission machine whose facsimile number is 2 3 (916) 441-5776 the above-described document(s) to individuals listed below. Said facsimile transmission was reported as complete without error by the facsimile transmission machine 2 4 immediately following the transmission. 2 5 I certify and declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct, and that this declaration was executed on the date set forth below at 26 Sacramento, California. 27 A0 A4 Dated: 28 1 %CKANTELL 1 . 1 Attachment to Proof of Service 2 3 1) EAST BY REGIONAL PARK DISTRICT 450 Walnut Meadows Drive 4 Oakley, California 94561 5 2) OAKLEY-BETHEL WASTE WATER DITRICT P.O. Box 1103 6 Oakley, California 94561 7 3) COUNTY OF CONTRA COSTA (for itself and the unincorporated City of Oakley) 8 Board of Supervisors 651 Pine Street, Rm. 106 9 Martinez, California 94553 10 4) RONALD D. FOREMAN FOREMAN & BRASSO 11 807 Montgomery Street San Francisco, California 94105 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 . r m �,yy >�k � �'Y g �"r 3`,•¢�� r.�x�Wlow K�s.c �h<` `5*ko—sum t.'sv''a' -f" zv'.�� >. {'Sri s<.•j"¢,. SMs, z r . rks F''T+.,�s t,y '§+x.'t,- 7 z,? 4 -r £ 0i,641A MAP x • k7S • • • •• n ' r f r�- ... �r Se7 ?P}•' �N}F k _ x'H"' i; R.t,, ��'' *e�+�+E v��.�eA� Tc�+}a tCYT fi� � �S S. E � � '2•:� 4"- h c ctrl Ogg 'c cz.% vTow A Fr' IG 5 b f 4 `? ; Ib ., C./o CLAIM X0.1 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA October 15,1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boar: 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 Amount: $10,000.00 (estimate) Section 913 and 915.4. Please note Mcarnings". CLAIMANT: Pacific Gas & Electric Co. OCT 0 1 1996 File #9611416 COUNTY COUNSEL ATTORNEY: MARTINEZ CALIF. Date received ADDRESS: PG&E BY DELIVERY TO CLERK ON October 1, 1996 c/o Thomas Samaniego P.O. Box 8329 BY MAIL POSTMARKED: Hand delivered via: Risk Mpmt. Stockton, CA 95208 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED• October 1, 1996 �aIl b�puyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (� This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /0 0 4 1.24 BY: (/U 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. 1 Dated: 99COPHIL BATCHELOR, Clerk, �@y�,t.o�.e `J"�-�` , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the sail 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 as 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: &c � /7 7 1-Mo BY: PHIL BATCHELOR bye Deputy Clerk CC: County Ccirse'. County Administrator claic to: BOAM) OF S.JPMISORS OF CONTRA COSTA CWM INSTRUCTIONS TO CLAIMANT A. Clai:.s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before•December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims.rVlating to causes of action for-death or for injury to person • or to personal property or growing crops and uhich 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 caixse of action must be*presented not , later than one year after the accrual of the cause of. action. (Govt. Code 5911.2.) B. Claims must be filed with the Cierk oY the Board of Supervisors at its office in Room 106, Coumty 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 FA BE: Claim By ) Reserved for Clerk's filing stamp RECEIVE® Ft" 96 /W/0 Against the County of Contra. Costa ) OCT _ ( IPA or -IA IJ t U i oms �� District) CLERK BOARD OF SUPERVISORS Fill in n.� CONTRA COSTA CO. Zhe undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum aof. $ lb 0b0 0�6 and in support of this claim represents as follaws 10}177,�/ ,91( iAJf/o[ee, fazm S r� 1. When did the damage or injury occur? (Give exact date and hour) au a8, i996 C � �s - 2. Where did the damage or injury occur? (Include city and county) del%16 �� 77Y If W �s N� 3. How did the dama a or i jury occur? - (Give full deta' • use .extra paper if require )COIJ 4�i'0 4 U� ��8r.lc �JOR�S e lJ 4)1i:i� Dt1m J 7 �D�D, 4- 50,6",J7;eA�Ta&. tURS l7R 1 �,u p ick, rTfil i t W*jr J i r T ,q H°.vE L,r,J,- C cro�S 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? j. wnat are `„ne names of counLv or district officers, servants or employees causing the _a a—ge or injury? Oat 61 Its Wr Pwbltc(do)ks Xlg"T/e-ni�nce - &,VP,2 6314 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7'wo QS' Jd, r Ales MWe, broRM . Tq6MAIA 1_"ales/,t POtE 7A- -P c AIF. / P#A-5c - /2..K.✓ I)OOJA. 7.00 %1,WrS ovy' of Fouft, '(O?nple . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) limber �lou✓s� e��.� ry1� �dld�s� /m,p4i1s /, t� r' �6u� Qc, �d la otAil' u1" o d U/KW' n M1�t U;;. ... U17-1,r7 7q5'2-, 7g5'Z, $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM` AMOUNT U Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) " orb some son on hi behalf." Name and Address of Attorney It /16 Al 11 Cla' is Si ture Addres Telephone No. Telephone No. _ L422 T W W 9 T V F W T NOTICE Section 72 of the.Penal Code provides: "Every person vho, with intent to defraud, presents for allowance or for. ,r n , payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill,, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such i^ ? 1S�'11'.?�. -and rine Pacific Gas and Electric Company Credit and Collection Center G� , ,' T P.O.Box 8329 h GG' �. Stockton,CA 95208 �6 SEP ./8 Plf 1: S4 September 16, 1996 OE rf =t�f=J;1 DEP T, Contra Costa Public Works Dept. 651 Pine Street 6th Floor Martinez, CA 94565 Gentlemen: This refers to an incident on August 28, 1996, when your contractor, Cooper Trucking, was operating a dump truck ,with .it' s bed up, they caught a phone line and broke two of our power poles located at Byron and Hwy 15 south of Delta Road in Knightsen. The conditions under which this damage occurred indicate you may be legally responsible for the damage to our Company' s property and, in our opinion, we have the right to recover from you the cost of repairs which are presently being determined. If you have insurance coverage, please provide the name and address of your insurance carrier, as well as your policy number in the space provided below. We will then forward our bill for damages to them. If you do not have insurance, we shall forward our bill to you for payment . Please call me at 800-945-5251, Extension, 7470 if you have any questions . Sincerely, Thoma aniego Claims R presentative TJS:vls A/R No. : 9611416 D&C No. : 1606102 ------------------------------------------------------------ ( ) Submit invoice directly to me for payment . ( ) Submit invoice to insurance carrier. Insurance Company: Agent : Address : City: State: zip: Phone: Contact Name : Claim/Policy No. : Insured' s Name : AR No. : 9611416 o cl C7 a or i +i w t�fy` f� rt 7tt ST r++ r w..r r• rl CLAIM C /v BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA (4 October/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: $,950.00 Section 913 and 915.4. PIe =, CLAIMANT: Ken Vonderach ,:> 57 Vilenza Ct. SFP 9 7 1996 ATTORNEY: Danville, CA 94526 COUNTY COUNSEL e; Date received MARTINEZ CALIF. September 25 1996 ADDRESS: BY DELIVERY TO CLERK ON 's"; BY MAIL POSTMARKED: SeDtPizll t— 29, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH B H DATED: September 27, 1996 BML Deputy OR, Clerk�� _ II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: `/ 7� 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. BOA7) This DER: By unanimous vote of the Supervisors present ( 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:, ) 7Co PHIL BATCHELOR, Clerk, /S-e �j�-Q — Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: '7 J T9 BY: PHIL BATCHELOR a 'Deputy Clerk CC: County Course! County Administrator Clair to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of actio,n. 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 RE; Claim By ) Reserved for Clerk's filing stamp ��✓ �/�,Noc-2,�i/ = ; RECEIVED Against the unt of Contra Costa ) SEP 2 6 to or ) ; CLERK BOARD OF SUPERVISORS District) C0`dTRA COSTA R Fill in name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ f'SO• " and in support of this claim represents as follows: 1. When did the damage or injury occur? "(Give exact date and hour) a-vc y y� /.f s 6 2. Where did the damage or injury occur? (Include city and county) ���9/�l//GGA GOVT/ G'�1fi� C°O!/i✓T� ally, 3. How did the damage or injury occur? (Give full details; use extra paper if required) , f Y 41iA'45' AvlfS -Z-/V ro .�.v c°�.�.�c=.��� y .�.��U' G fir"1` �- T/fe-" E'/t/B�iv.�'�.v9 TMJ �/� ✓�i��T' 7- 4. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? .T-mp 101109s/e Z--,et- j. wnat; are the m—nies of county or district officers, servants or employees causing theda:�be or injury? / 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. i 16f7 T!�/G 044 V7' f- O!/G TU - /faGC 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATA. ITEM AMOUNT Y w VI Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND-NOTICES TO: Utto_rney) or by some person on his behalf." Name and Address of Attorney Claimant's Signature Address. Telephone No. Telephone No. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or ,by both risn`„ and fine_ •ter 4:) - 1 ,•ho i 4` +,Mt. :t :�-'}.� �:)�.�i.l}i.rr -i:n el'" 'I't.` .t' .1!'"',1.` ,hF - t il:rj:1. � ;'•4 -11"•t 't �'�i� '•1. •tit+.'`' .5 4, r's:'. '' oiiD '+ 4LIFaFil�i1A .t.' ,r u'C:�fT•,fp.: - `•r., '�," '•]. .•I►�gIM •'i!'� .1 '1'. p.ry.1.`i Cf,+. a�..:w� -vL^; �,J' ;.'e�. •`t.•:ir''��" ..�'�.: ,�: 10.�G0'r1='.�✓• i �: � , 'r. '.x"5:1... '�`�Yl'y'rl;:j(C 1'!,b,� '4y.i,: `.Y.i..' � •• ,:,1�'-i l'Vl• !Cb�i•.r:(�"','`t,?,::,'cel( `:,.. ,,j•` �.�` :r\,' C..: !�' ..\, •:1.• ,�,;.1 `t7�..j�l- _ ``'f'. 1.'�' - :phi:'1•t+',:.•.-.- -„�fr,�=t.'>�'k'.•a 'qY' - vb. •`J\``'�' :�`•.,,L, . -'J�r Fr{ '•1 �,•:7':•.�. ✓'.I,h� ISI. -,d,i •.X�. I��s' '1 l�•g irC O WAR NYY'TEAMS ,& CONDITIONS ON'REVERSE,SII�E �,!'�' a •i 10 DAYS • NO RETURNS ON SPECIAL OPDFR P,4R75. . cocriA,l f)fU d'i OAD7 rgC`N IJV anVaNrC a 9A96pFSTnJ^ �`' n;_�r'".,; 1 '+► NO 8,ETIJRNS ON ELEC)5811CAL qq HYDt?Af)LIC ITEMS � ALL CLAIMS r�RE�UIiAIF�GdOD�MBBF BE�QCG•OfNP�N(FO brY THIS INVOICE DAl'E,EIrV6FRED YOUR OHD�H IVO, DATE SNIPPED, INVOICE DATE INVOICE " k :': NUMBER �:�:'::SEP°•95 `. 4. SEIs,96 3328 _ **QUOTE** a ACCOTINT. NO.* $20 H PAGE 1 OF 1 a KEN a T .q 0 *#- VIA, SL M, BA NO. TERMS F.O.B.POINT 28 CASH CONCORD CA ... .. — SGRtRTt ..::::;.:'_::.: : trt5: Er ******* I N V O K E Q U O T E PARTS DEPARTMENT HOURS PARTS 800.00 MONDAY THUR FRIDAY 8:OOAM TO 6:OOPM SUBLET :SATURDAY 9:OOAM TO 5:OOPM FREIGHT 0.0.0 ],'HANK YOU FOR YOUR RUSINES _SALES TAX 66.00 X TOTAL 866.O Q.,.— CUSTOMER COPY T0 'd £982689 QLI03N07-�-MWg .9--25-1996 10-01AM FROM EAST BAY BMW 5104638903 P. 1 INVOICE East Bay BMW THE ULTIMATE 4355 ROSEWOOD DRIVE DRIVING MACHINE PLEASANTON, CA 94588 TELEPHONE (510) 463-2555 PARTS AND SERVICE HOURS MONDAY THRU SATURDAY 7:30 A.M. TO 6.00 ATE ENTEREDYOUR ORDER NO, DDA ATE SHIPPED INVOICE TE INVOICE ...... 5 SEP 9ff 25 SEP 96 NUMBER 3010 0:03 **QUOTE** S ACCOUNT NO. 10 s r, E'Gi(;l. 1 (!h Y o GA;iFI >t!`TAIL SALE " � L I NDA __. D P T T O O IIP VIA SLSM- BIL NO. TERMS F_O.B.POINT ASON- Wi. CASH I PLEA5ANTON r CA 22 e.o. PART NUMBER DESCRIPTION LIST NET AMOUNT »a ano S 2 2 0 L5-w32--9-409-82 3 ALLOY WHEEL 420.00 420.00 840.00 x N V 0 1 C F ca U 0-- T :: *****t* ED U KNOW? Iq nOTrZT&IAJ ri fA LI 19dre WE A ONE YEAR WARRANTY -SUBLET FE THE }RACK OF THIS INVD.lCf--- FREIGHT () )R COMPLETE: DETAILS SALES TAX 69*3 $909.30 CUSTOMEptCCpv PLEASE NOTE. THIS INVOICE MUST ACCOMPANY ALL RETURNS. ITEMS RETURNED AFTER THIRTY(30) HAYS WILL HAVE A 20% HANDLING CHARGE DEDUCTED FRONT THE SALE PRICE. Z7J Lzp Cd cr a Fn LIS 11:F,- Y `e x f�T.�r 1P A.r•, � A. i,d". a ..✓" ���'��� taro.! 'rsi.. •' ' esu.. z• - rd s;,/p ,.;:c. psi s `•,%, r,`t;'r h j •nl��.'sK' 4. • r +.i ��z} %{di;�y�{ �-��,yy'i�� i'�i�� ,1s,�' �..��r;1• �'�y� S,e '{'� t i��>y i �'�V;'+•�r Ks�+�,'��rr !� 'S�F i'�pT'�i � �r��q$� ��:���`,��'S : l' t i '�fli�,. f`i 9�rt ( F}��, �• �A gg55rr..!!Tao- .jOil � ,.� � +• '��• :1�;C tit• �'`� �: •r •�I 4• v -•c .�`�'��art 1';,. r,•,'-;P't•.�1 f��vT:��CN��,Q+�n�t�4''a1t�{�•. 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