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MINUTES - 11191996 - C21
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 19, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The Copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $200,000.00 Section 913 and 915.4. Please note CLAIMANT:Kelly Bennett OCT 17 196 ATTORNEY:Law Offices of Michael C. Cohen COUNTY M NTY COUNSEL UNSCALIL Date received ADDRESS: 1814 Franklin St. , STe. 506 BY DELIVERY TO CLERK ON October 17, 1996 Oakland, CA 94612 •hand deliveredvia Risk M 8r MAIL POSTMARKED: � gmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 17, 1996 =a?L �p��iyLOR, 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: 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: NOV 19 1996 PHIL BATCHELOR, Clerk, By ��,u�-e-�� 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 anvil to file a court action on this claim. See Government Code Section 945.6, You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: NOV 2 1 199b BY: PHIL BATCHELOR by � 'Deputy Clerk CC: County Cc.;rSe': County Administrator LAI V OFFICES r-,r,r Of �' `- "" F - MICHAEL C. COHEN A PROFESSIONAL CORPORATION �� U i �� 1814 Franklin Street,Suite 506 Oakland,CA 94612 FAX No. (510)832-6439 Tel.No. (510)832-6436 (510)83-COHEN October 10 , 1996 RECEIVED County of Contra Costa Off ( PSUPE�RISORS Attn: Claims Dept . 1801 Shell Avenue CLERK BOARD OMartinez, CA 94553 CONTRA Re : Our Client Kelly Bennett Your Employee Gregory P. Staffelbach DOL July 03 , 1996 Location San Pablo Dam Road Dear Sir/Madam: Enclosed please find a claim against the County of Contra Costa in the sum of $200, 000 . 00 . On or about July 03 , 1996 your employee Gregory P. Staffelbach negligently operated• a motor vehicle causing injuries and damage to our client Kelly Bennett . Please respond as soon as possible concerning this matter. Very truly yours, LAW OFFICES OF MICHAEL C. COHEN Eric W. Allen, Paralegal ' t RECEIVED e OCT 1 7 KE - rn CLERK BOARD OF SUPE VISORS` CONTRA COSTA CO. CLAIM AGAINST THE COUNTY OF CONTRA COSTA, CALIFORNIA Kelly Bennett presents a claim for damages (Name of Claimant) against the County of Contra Costa, California, Employee : Gregory P . Staffelbach in the sum of $200 , 000 . 00 Clci iia t ' s Address • 3 .35 El. Portal Dri`esP 109 D, El Sobra nt-e CA 94803 Address of party presenting claim, if other than above : LAW OFFICES OF MICHAEL C COHEN 1814 Franklin St . , Suite 506 Oakland, CA 94612 510-832-6436 . Date of Occurrence : On or about July 03 , 1996 . Place of Occurrence : San Pablo Dam Road near Appian Way, Contra Costa County, CA. Said Claim Arises from Following circumstances Gregory P. Staffelbach, Negligently operated a motor vehicle causing in Ly and damage to Kelly Bennett' s person and property. Description of nature and extent of damages or injuries : Bodily injuries and property damages . Dated: September 24 , 1996 X L.--,),W OFFICES OFFICES OF MICHAEL C. COHEN attorneys for claimant r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November' 19-; _1996 Claim Against the County, or District governed by) BOARD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $225,000.00+ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Mt. View Sanitary District ATTORNEY: David J. Levy, Esq. Schwartz, Levy & Lavin Date received ADDRESS: 2121 North California Blvd. , BY DELIVERY TO CLERK ON September 18, 1996 Ste. 1010 Walnut Creek, CA 94596 BY MAIL POSTMARKED: September 17, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH LD eputLOR' Clerk DATED: September 19, 1996 y II'. FROM:: County Counsel TO: Clerk of the Board of Supervisors ( f� This claim complies substantially with Sections 910 and 910.2. ( D 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: L _ Dated: CY � BY: / Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County A inistrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present CIS) 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: Nov 19 19% PHIL BATCHELOR, Clerk, By 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 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: Nov 21 1996 BY: PHIL BATCHELOR bL v` _� Deputy Clerk CC: County Coinsel County Administrator RECEIVED SCHWARTZ., LEVY & LAVIN ATTORNEYS AT LAW SEP ` (� 8 A PROFESSIONAL ASSOCIATION SEP !■ 2121 NORTH CALIFORNIA BOULEVARD,SUITE 1010 WALNUT CREEK, CALIFORNIA 94596 15101 934-6082 CLERK BOARD OF SUPERVISORS FACSIMILE 15101 934-1507 CONTRA COSTA CO. MARCHMONT J.SCHWARTZ OF COUNSEL BEVERLY J.LAVIN September 17, 1996 DAVID J. LEVY KENNETH H.LAVIN CERTIFIED MAIL RETURN RECEIPT REQUESTED Clerk, Board of Supervisors 651 Pine Street Martinez, CA 94553 Re: Claim of Mt. View Sanitary District Our File No. 603-005 Dear Sir: Enclosed for filing and presentation to the full Board of Supervisors please find the claim of Mt. View Sanitary District. Yours very truly, Schwartz, Levy & Lavin A Professional Association David J. y DJL/car Enclosure cc: Mr. Valentin Alexeeff, Director--w/encl. Contra Costa County Growth Management and Economic Development Agency Thomas B. Bruen, Esq.--w/encl. Bruen& Gordon 603-005/Supervisor/ltr/DJL/car RECEIVED Mt. View Sanitary District se # 8 Contra Costa County P. O. Box 2757 CLERK BOARD OF SUPERVISORS Martinez, CA 94553 CONTRA COSTA CO. CLAIM-AGAINST THE COUNTY OF CONTRA COSTA To: Honorable Chairman and Members Board of Supervisors County of Contra Costa State of California Mt. View Sanitary District(herein referred to as "Mt. View") hereby makes claim against the County of Contra Costa for a sum in excess of Two Hundred Twenty Five Thousand Dollars ($225,000.00) and makes the following statements in support of the claim: 1. Claimant's post office address is: Mt. View Sanitary District P. O. Box 2757 Martinez, CA 94553 2. Notices concerning the claim should be sent to: David J. Levy, Esq. Schwartz, Levy & Lavin 2121 North California Boulevard, Suite 1010 Walnut Creek, CA 94596 3. The date and place of the transaction giving rise to this claim are as fol!--ws: Effective on August 5, 1996, the Board of Supervisors granted exclusive garbage franchise rights to Pleasant Hill Bayshore Disposal, Inc., for the area in Contra Costa County within Mt. View Sanitary District. 4. The circumstances giving rise to this claim are as follows: Mt. View is an autonomous special district in Contra Costa County, California, created I 504-008/Claim/DJL/car pursuant to the Sanitary District Act of 1923 with the power to collect waste and garbage within the District and to enter into contracts for the collection and disposition of garbage. For over fifty (50) years, Mt. View has set collection rates and administered and supervised the collection and disposition of garbage within the District by entering into an exclusive garbage franchise agreement with a qualified contractor. Mt. View has granted Pleasant Hill Bayshore Disposal, Inc., the exclusive franchise to collect garbage in Mt. View from March 29, 1990, through the year 2011. The said franchise agreement provides that Pleasant Hill Bayshore Disposal, Inc., shall pay a franchise fee of$15,000 a year to Mt. View. Without the concurrence or approval of Mt. View, the County of Contra Costa acting through its Board of Supervisors knowingly, willfully and tortiously induced Pleasant Hill Bayshore Disposal, Inc., to breach its contract with Mt. View and encouraged Pleasant Hill Bayshore Disposal, Inc., to enter into an agreement with Contra Costa County for the exclusive garbage collection franchise within the same area of Mt. View Sanitary District, all to the permanent damage of Mt. View. 5. Claimant's claim is in an amount that would place it within the jurisdiction of the Superior Court. 6. The name of the public employee who is most knowledgeable about this claim is Val Alexeef£ Dated: September 17, 1996 Mt. View Sanitary District By David J. Levy ttorne or Mt. View Sanitary District 2 504-008/Claim/DJL/car « \ I ± z r ¥ § \ } % > § ! ( \ 2 \ \ \ \� w f A \ 2 ® < r § ; 0 . \ $ 2 m - ' Ln � � � � p � � % / .� t.h .y T CD - 7 top) I� . • ;/ : i. tt CLAIM BOA;: Or SURERti:SS,=.S Or CON-S.= C^57A COUNTY. CALIFORNIA— - November 19, 1996 Claim Against the County, or District governed by) BOAk`ACTION the Board Cf Supervisors, Routing Endorsements. ) NOTICE TO CLAIMANT and Boa-: A:tion. All Section references are to ) The copy of this document mailed to you is your notice of Califo►ria Gove-nment Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below). given pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all CLAIMANT: Leonard James Miller OCT Z 1 1996 ATiORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 4400 Jenkins Way BY DELIVERY TO CLERK ON October 17, 1996 Richmond, CA 94806 BY M41L POSTMARKED: October 16, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 21, 1996 OIL LATCC4ELOR, Clerk � -- PUTy II. FROM: County counsel TO: Clerk of the Bard of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Bard cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a lite claim (Section 911.3). ( ) Other: Dated: 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 0x) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Bard's Order entered in its minutes for this date. Dated: ®v 19 1191 Deputy Clerk PNIL BATCHELOR, Clerk, By \t ' ,C�� � . 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 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 Bard Order and Notice to Claimant, addressed to the claimant gas show," above. Dated' N O g 2 119% BY: PHIL BATCHELOR by��f �/ a Deputy Clerk CC: 'Covnty Cc.r.SeCownty Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA OOUNTY INSTRUCTIONS TO CLAIMAA*T A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19879 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec.- 72 at the end of this ea � a � � � aa * aaa * * �taaasaa � � • a • * faaaasaea • a � � a * RE: Claim By ) Reserved for Clerk's filing stamp LEOc na 5�MFl� MI )ter � LCIEREKBOARD ECEIVED Inst the County of Contra Costa ) OCT 1 7 or ) Lpa k Rq COST i* C o cavy OF SUPERVISORS District) NTRA 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 $ lJ1Npy5F9mn.car__Z and in support of this claim represents as follows: .t-,-ki5 .rlm�Z, 1. When did the damage or injury occur? (Give exact date and hour) Oro ArP ( .aclvlSa 3r1� �.� pfbo�.� ���� Prn, (S4-rL4P-oqq I19L M 2. Where did the damage or injury occur? (Include city and county) T".114"y occ ure k i� }V\6 Lav,04orI Q_0oK, T%4 De 4-etj i oP. y IN )�142rlAiE7_ � 4,� 3. How did the damage or injury occur? . (Give full details; use extra paper if required) p'l��s� SSE �T7"�GH�Q �S1-IFE'r n �Y-PIg Tt+a4k Yo t4 4. What particular act or omission on the part of county or district officers, servants cr employees caused the Injury or damage? Ne,t t�e,1e© 'ic o� tJ0 S.up V1S! ©nJ e � ���aZ, ZOor�, w► 1-�1 i0m9,T� 000 1013 �y.oL W. 4-o -0-ALk �e, .E (over) . li 5.1 What are the names of county or district officers, servants or employees causing the damage or injury? -f- Fj,5 Z 415k i F P t)-F Coo+tZ fl- (?014-4- �ok iv 01` d� ok t�R�`i`�u��' SII S ;pt �I�s►�e �`�, L�r+�� y Qti�w. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. �'�,1� °1;.se . YJ�i aJ.� �.J_ �.C. a Y i'l t►1 OSS fl-f St C- p ( cAttic 0 �3�n3• 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) OtL .N � ��o1► a�`�l �MAlS a.No Q� yV\`I In.PP�c ��fy- , re641',jj �"D zL�7is fN )fir ny 8. dames and addresses of witnesses, doctors and hospitals. ALL e.p"9-u�-q.prrEN3, £)'LF-V I,D" i'•.�r t'�- JNtF114�,, e4,Q ��y��S who L►vFs �a 1Nm4le NobL r- —) Y10A ' `2 14 P R- �4Q.� i 15A 9d+IOC� P'/e—r Addre.t, urJk►uavl-'l T u 2t iAVELF *3 k AU\Aif—o MPWw5 d. PEW AJOW 00-7 Z /A) CDC. 44? 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMDUNT 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 ��4 Claimant I s Signature Address r/ Telephone No. Telephone No. a-3 3 7 afafaa �rI T wrafafe * s fa " 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 ($1,00+)), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($1090009 or by both such imprisonment and fine. - AIp_ \rlvola fllr o om a��: +��t . a►� Je t lor1 �i�ei l i f y - iz NJ N b'E, Z t'er'�p ^�}h��e_ w0171C1►�� .0 +v PJ-J>e-a - ab0 P.o A-� office,J .� �,�_G�_ ,at - -- __ ..- - --- Q �3-' �� .`�,I� - Ch�r�- Ore,----r►JS�1nJG��✓;�y � . QA-iSGd� da'`'y - -- - - -�,zkcoN'�' d-�' - yin -- ie%� - /►^'�..� J�r►� il 6�U 170 �- ►_1 - �ir'�_ �Q,q �, y 2�1d 'k--. 150 _ 4- roµ ae cam„ ell O to -51 � CLAIM BOAC 0r SU%ER�ISC=.S 0r CON'«.:. C^STA COUNTY, CALIFORNIA November 19', 1996 Claim Against the County, or District governed by) BOA_RC� ACTION the SoarC c' Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Boa-: action, All Section references are to ) The copy of this document mailed to you is your notice of Calico-ria Gove"nment Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $9,204.14 Section 913 and 915.4. Please note all 6111i�mavlm CLAIMANT: Craig & Melissa Miller Or,T 2 2 1996 ATTORNEY: Minder & Muro COUNTY 2251 River Plaza Dr. #290 Date received MARTIN Z MARTINEZ CALIF.GAL1F ADDRESS: Sacramento, CA 95833 BY DELIVERY TO CLERK ON October 21, 1996 BY MAUL POSTMARKED: October 18, 1996 I. FROM: Clerk of the Bard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED:_ October 22, 1996 �IL 9�pu'yL�er1:�� � `�"``�— II. FROM: County Counsel TO: Clerk of the Bard of Supervisors (X) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Bard cannot act for 15 days (Section ( ) Claim is not timely filed. The Clerk should return claim an 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: Gated: 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 Bard's Order entered in its minutes for this date. Dated: N 0 V I PHIL BATCHELOR. Clerk, By L�,l��in�_ ,,_.,� Deputy Clerk MARNING Nov. 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 !AILING 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 file united States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to the claimant as shown above. Dated: NOV 2 11996 BY: PHIL BATCHELOR by �L a wl Deputy Clerk CC CoJnty Ccjrse- County Administrator CLAIM FOR DAMAGES VIF-CE V E®. COUNTY OF CONTRA COSTA OCT 2 11 Board of Supervisors F SU Clerk of the Board CONTRAOCOSTACO�SORS , 651 Pine Street Room 106 Martinez, California 94553 1 . CLAIMANTS ' NAME AND ADDRESS: Craig and Melissa Miller 354 Bellflower San Ramon, CA 94583 2 . ADDRESSES TO WHICH NOTICES ARE TO BE SENT: MINDER & MURO 2251 River Plaza Drive, #290 Sacramento, California 95833 3 . DATE AND PLACE OF INCIDENT: April 20, 1996 565 Silver Oak Lane Danville 4 . DESCRIPTION OF INCIDENT: Sewer overflowed into claimants ' residence . 5 . AMOUNT OF CLAIM: Attached hereto is a list of damaged items and the cost incurred. DATED: (0[rall MINDER & MURO By Mark Muro Attorneys for Claimants y; 0,04 No. items Description Age Amount 1 Couch 10 599 1 Chair 10 199 13 Bath Towels 1-4 130 5 Hand Towels 1-4 25 1 Braun Mixer 2.5 70 1 Food Processor 2.5 40 1 Queen Mattress&Box Spring 1 599 1 Fisher Price Toy Car .5 30 1 Bouncer Seat 1 20 1 Rocker Seat 1 30 1 Exersaucer .5 50 1 Wagon .5 9 1 Elmo doll .5 14 1 Musical rabbit 1 13 1 Bear w/baby bear .5 10 1 Fisher Price Rings .5 5 1 Fisher Price Blocks .5 5 1 Fisher Price Wire Ball .5 5 1 Fisher Price Baby Matt 1 30 10 Baby books .5 30 1 Crib&Mattress 1 399 2 dolls 1 15 1 infant wash tub 1 10 1 diapers 13 1 Playskool MEL chair 1 70 1 bassinet 1 40 1 Musical Sesame St.Infant Gymn .5 18 1 Crib Bumpers 1 23 3 Wicker aarbage cans 1 30 1 Toy piano,Bambi toy 1 20 Lost rent from condo rental 1 mo. 1175 PG&E 4/8-5/17 261.26 San Ramon Marriot at Bishop Ranch 4/24 131.52 Summerfield Suites,Belmont 4/25-5/4 1565.90 Checker Van&Storage of Oakland,Inc.Moving 5/7/96 160 TCI start up fee 77.54 Pacific Bell 81.92 Lease Penalty 3200 Total $9,204.14 I PROOF OF SERVICE 2 1. I am over the age of 18 and not a party to this cause. I am employed in the county where the mailing occurred. The following facts 3 are within my first-hand and personal knowledge and if called as a witness, I could and would testify thereto. 4 2 . My business address is : 2151 River Plaza Drive, Suite 290, 5 Sacramento, California 95833 6 3 . I served the foregoing documents: CLAIM FOR DAMAGES on each person named below by enclosing a true copy in an envelope addressed as 7 shown in Item 5 : 8 a. depositing the sealed envelope with the United States Postal Service with the postage fully prepaid. 9 b. X placing the sealed envelope with postage prepaid for 10 collection and mailing on the date and in the place shown in Item 4 following our ordinary business practices . I 11 am readily familiar with this business practice for collecting and processing correspondence for mailing. In 12 the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course of 13 business with the United States Postal Service in the place shown in Item 4 . 14 C. By Personal Service - I delivered by hand to the offices 15 of the addressee following ordinary business practices during ordinary business hours . 16 4 . a. Date of Deposit: October 18, 1996 17 b. Place of Deposit : 2151 River Plaza Drive, Suite 290 18 Sacramento, CA 95833 19 20 21 22 23 24 25 26 27 28 1 1 5 . Name and address of each person served: 2 County of Contra Costa Board of Supervisors 3 Clerk of the Board 651 Pine Street, Room 106 4 Martinez, CA 94553 5 X I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 6 I declare that I am employed in the office of a member of the bar 7 of this court whose direction the service was made. 8 Executed on October 18, 1996, at Sacramento, California. REBECCA ANN HOHLOCH k A41 _. 10 (TYPE OR PRINT NAME) (SIGNATURE OF DECLARANT) 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 2 s � � , r M Z v� 0 t • W , • Lo ` N • • C� r O r� -, „ • ' 1lr .� l "`3 • ` r et 7 a o n o c,Ar r G K" aw�re $. ro �� R R M R• r R R R y CLAIM BOA;: Or SU,EPti'SC=.S Or CON.i-I '^STA COUN'Y, CALIFORNIA November 19, 1996 Claim Against the County, or District governed by) BOA;'" ACTION. the Board cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: Action. All Section references are to ) The Copy of this document mailed to you is your notice of Califo-ria Gove-rment Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $615.00 Section 913 and 915.4. Please note all •Wa M191ztL SfZ;MM) CLAIMANT:Robert H. Meyer, Jr. OCT 2 2 1996 ATiORNEY: Date received MARTINEZCOUNTY CALCOUNIFL ADDRESS: 3303 Berkshire Dr. BY DELIVERY TO CLERK ON October 21, 1996 Wilson, NC 27896 October 17, 1996 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. A �� C� DATED: October 22, 1996 IL; 1eTpulEIOR. Cllr y II. FROM: County Counsel TO: Clerk of the Bard of Supervisors (�) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 920 and 910.2, and we are so notifying claimant. The Board cannot act for 25 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: �� !tea I"1 b 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 Surd's Order entered in its.minutes for this date. Dated: Nov 19 1996 PHIL BATCHELOR. Clerk. By� - js—��O"— , 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 sit 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 went 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 Citiien of the United States, over age 18; and that today I deposited in thy! united States Postal Service in Nartine:, California, postage fully prepaid a certified copy of this Bard Order and Notice to Claimant, addressed to the claimant as shown above. Dated: �0� 2 1 1996 BY: PHIL BATCHELOR by �—� � C --Deputy Clerk �� ���� CC: Cc-inty Ccorse County Administrator 14 Claic to: BOMM OF SJPERVISORS OF COMM COSTA COUNTY INSTRUCTIONS TO CUIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and'uhich 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 ging FIs 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 xith the Clerk of the Board of Supervisors at its office in Rosa 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 Ser. 72 at the-end of this. BE: Claim By ) Reserved for Clerks filing stamp 1-1 . M(tye.c, , RECEIVED OCT 2 11996 Against the County of Contra Costa or ) CLERK BOARD CO'SOBS District) (Fill in name ) The ,tmdersigned claimant hereby makes claim against the County of Contra Costa or the .above-naiad District;iri the sum of 6 IS .01 and in support of this claim represents as follaws: �T�,r_A,..�.� � reserves �L,¢ ri%�,k- A--e -� r %res i4 4-ob\ev� Cs oll'. resolve.dk io4{�e I. 'When dial the damage or in#ury occur? '(Give exact date and hour) 7'he �c�wca. 6eca e ex)iA _v,�- 29 Suv\e- 19-96, 5p" E.S.T. 2. Where did the damage or injury occur? (include city and county) Eo�ol--sial2. Prapec-lY Iir\L err Z['3(o rClaine Drivel, Plecsc.K� -\IM, Co'v\�re_ Cog�0. Covv��t'y (Go�JGCQ v�� 17o Scty 1'v�V v\ paC1 Tic- 9— �-c, w e-y� 3. How did the damage or injury occur? (Give full details; use extra paper if required) Tk2 ro e��I- li v�2 qe-A CSZ. co tk�. sell. fie. �O wwt CAA-e.r- o ls-�ure so�poc-k- PoSA-S rlFk& v-�0Q2 wc.S_ C �CLWY_4 ptkoVlq w� P1gv� T-pf-t1J4.V wkicln q_XV21rSeAy 4TF- c_.V A JrycNey. 0..Ko, 4. What particular act or omission on the part of county or district officers, servants or emplolyees1 caused 1the injury orTdam age? cukev% -1ltia_ l�- W1L -A e_ve-kvp,?dl 7of`('T �SCoy�a, 1 rc.11 Sys�e,v"`' +k - C_ u AY �l iked �o wltTt�G�Te ' l a� �YeC� S Ob� a��v�4 Gtv\c� Salt et�V4ll loY1 See blocks. �. Wnat are ne n2-'Jes of counry or district officers, servants or employees causing '� da::-- e or i t u .? the _o � - T►.a rn�w _S o� .speees 15 or,"e-Lov7 . uowev�r', Oke r-egfoV4L5cbke- C,U,\-�-Y a�Ev,cY �5 : Public works t5e?e1r A-&X1A 25L ------_ 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. T ke_. P``o P e r k-Y fte �2 wa..S i r s p�. rc b�y olsw.a7-4. dlu e. �-a ckc-X -r-o colla SN . VcLcicus p1a�ti�-s wec-e �s�'co e� c�wek-o ��oc�cJ�i� (no• cls ,•�� 7. How %ras the amount claimed above computed? (Include the estimated amount 'of any prospective injury or damage.) f2,p lacy A r=e-W ca t''�1, �ec i a s = 3-75 00 t &A 4t�o,iJ•oa B. Names and addresses of witnesses, doctors and hospitals. J 61•,h Pyr dw �,c Cs-ia) g2o - �ti z 5" - I cive A le.-v-Xo, c-A o) '+ 67 9. List the expenditures you made on account of this accident or injury: f DATE ITEM AMOUNT 711 J 9 L r enc"'� d �1 Jr e_r 41A 7113�q ' Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SM NOTICES T0: (Attorney) or Py some Rerson on his behalf." Name and Address of Attorney Claimant's Si ture 3303 %-c-e- Dr-�v � Address- W � � ScoY\ Telephone No. Telephone No. �f 19 -Z`-l3 - 7L W A 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 ($10,000, or by both s=h i. rJsonnen., a-nd f ne. Contra Public Works Department J.Michael Watford Y Public Works Director Costa 255 Glacier Drive CCount Martinez, California 94553-4897 Milton F. Kubicek ounty FAX: (510) 313-2333 Deputy-Engineering Telephone: (510) 313-2000 Patricia R.McNamee Deputy-Operations October 3, 1996 Maurice M.Shiu Deputy-Transportation S. Clifford Hansen Deputy-Administration Robert Meyer R/P - Former Southern Pacific 3303 Berkshire Drive Right of Way Wilson, N. C. 27896 W. O. 5575 Dear Mr. Meyer: After our telephone conversation, I requested that David Reza, a Public Works maintenance supervisor, inspect your property at 236 Elaine Drive in Pleasant Hill, adjacent to property owned by the Contra Costa County Redevelopment Agency. After his visit, Mr. Reza confirmed that last winter our maintenance crew regraded and cleared the drainage ditch on the Redevelopment Agency's property. This action was taken in order to correct some flooding problems which had been occurring in the area. Based on this information, I believe that the problem has already been solved, and your tenants should experience no additional flooding from that source. Please contact me at (510) 313-2227 if you have any questions or need further information. Very truly yours, Nancy H. enninger Real Property Agent NW:gpp g:Vealprop\temp\meyer.t10 W � f t 43 5 �4 t m '01 t' C, V"a � 4at'S yAcp 11R :a i � CL Ai M, BOA;: 0r SUPER�:SJ:S Or CON-;.- '_'STA COUNTY$ CALIFORNIA November 19, 1996' Claim Against the County, or District governed Dy) BOA; ACTION the Board cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: Action. All Section references are to ) The copy of this document mailed to you is your notice of Califo-ria dove-nment Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $520.00 Section 913 and 915.4. Please note ail CLAIMANT:Theresa Harned OCT 2 2 1996 ATiORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: P.O. Box 210133 BY DELIVERY TO CLERK ON October 21, 1996 San Francisco, CA 94121 BY MAIL POSTMARKED: October 16, 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a Copy of the above-noted claim. DATED: October 22, 1996 OIL pepu ylDR,_,Clark �/� 11. 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 910.20 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: Q 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. BOAR: ORDER: By unanimous vote of the Supervisors present (� This Claim is rejected in full. ( ) Other: 1 certify that this is a true and correct copy of the Ba rd's Order entered in its minutes for this date. Dated: NOV 19 1996 PHIL BATCHELOR, Clerk, By_�.1- ����- , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only sit (6) months frOw the date this notice was personally served or deposited in the mil to file a court action on this Claim. See Goverment 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 as mow, and At all times herein mentioned, have been a citizen of the United States, Over age 18; and that today I deposited in tAe 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. � �,___�ep Dated- NOV 21 1996 BY: PHIL BATCHELOR by 0" D�j uty Clerk CC: County cc.;rse- County Administrator s Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADIgNrr A. Cla;A. s relating to causes of action for death or for injury to person or toper 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 Mich 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 BE: Claim By ) Reserved for Clerk's filing stamp -r6E-ke5SA- 141412NE0 3 RECEIVE® Against the County of Contra Costa OCT 2 11996 CO�Jrr�ZA (oSTA F,LooO C oNT2yL District) CLERK80ARDOF SUPERVISORS Fill in name- CONTRA COSTA CO. The undersigned claimant hereby makes claim agaimt the County of Contra Costa or the above named District in the sum of -5-AO �' and in support of this claim represents as follows: 1. Schen did the damage or injury occur? -(Give exact date and hour) .41?6asr 2. Where did the damage or injury occur? (Include city and county) t-3 3 3 tvIL-Z-vul 44-55- Rys�O 4PW2 yr To W4e_&ter Cre�6�_, _�v�`cvR� , Cvar2A coSf�} -- - - _-CouNry 3. How did the damage or injury occur? (Give full details; use extra paper if required) SSS 47TACRA46 / i 6#W66b WIK CuT-®,y GE-G. , w112& 571P,40J55 ti 6, WC9_6_s 4. What particular act or omission on the part of county or district officers, '3y uEt�T.4T�tJKJ servants or employees caused the injury or damage? I-0,1Cc_ Aror Ut5r1q14—_- Ivo s(dNs P097TEQ ,gf2E,Q -ri2,av��es�n A� 42�tO fe 1,Qs3-D T-0 lowrH /�1_0416S106 C QG6Ae. P-6"C6, S tVvu c in T 1 E5f! Sr �-1 FErf' (+(GH PA-R. coc-A-►2Y �9D7r9cEn�T ,TU PARt�cc1G Gd T. �. wnat are the names of county or district officers, servants or employees cauaing the da:�.ge or injury? .bar hC.vOW id 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. c-wr w0ectf RC-OuMC�O 3 sTrctfES r 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) HOSR(r4 t 8/Gc f-rad M S. F Cy 6AC—le YL l�T'tq-c KM E N'r 2 S. !games and addresses of witnesses, doctors and hospitals. �w~ $� F G'��6fQ,Q G- I�OSA/Ti4 L 9. List the expenditures you made on account of this accident or injury: DAME ITEM` AMOUNT gP-06 f,(-"AYif4 SE 2Vlc'S' � Yr52p A W:4 iE IE -!E iE:1t "1F !E 1E 1E 1F iE !E 1F iF iF * IF i� 1E IF 1f iE 44,7 Goy. Code Sec. 910:2 provides: "_The claire must be signed by the claimant SEND NOTICES TO: (Attorne )� ',�a`�� � or gib: some erson on his behalf." Name and Address of Attorney l 'Te-er-ZY 14AaeMS-4 /,u,Flea Ar-P- Claimant's Signature P. (0133 S 4-N F- ,+,VCCSca, CtF a _AOK 2 Address_ sftN F1q,4Arccsca, CA- 94//?l Telephone No. Telephone No. IV 15L�t* 7 - S(o F1 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 ciaim, ' bill, account, voucher, or writing, is punishable either by'imprisonmebt 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- ' I r 4 �}fat"°}�.�r�� •�• s <a • JFA N'J�i Y, �,yi:4� . .+}: g.��' 1r �'et 0�1 +arm L x`ae�, ! r*,7v t rr ?< TA:•St's f r - i ;i'tFr r• . >- a •j-�i�'.'Fvk`9 i''ia i. 3 G� i ti?� �+j�.�.~'a' s 0 V/ R ' ". .rS.r q s. Y .� 'St .�'� t'�t'N �""T, `�►' i `,,,�;�`✓E, +r� � ' r� ,t•'4�"5 ./ "�l� .e.,4��yr*' -'ley ,ttt�t '�y!„•, .yF—,ut �j. 1} t i �"� J '. '•,�" r "♦ 1� t �Z 4 .tom aS', .rte i v "'"r z. ',�"'r. ��<8y,i `e+'!�1 $✓ V.yy �- ,��¢`�i'"y'}�+,. f'd'"4'"'-;Sf�� �;„ 5���.•.��'r�F� .�'1S� ,,/�-� �'; . Fr t�� ti_yYjy}•z, ..K v_.Je.—' i '� + 3`' 3 .. "e` yl *�a s, ih+�ft4Yr !fF f,!Y t ` bye�` " �r4y; P"+�- r •, �. :4 k �' V- � 'f \ �. .CA, i •1 I � � w�,�y, tt�}4'e � � �„ r t ...}`;j �� � s� {!.} 'Cyr• !G� "��j }`Ca:Z �./,r � •sem r'_� '� a`J r,yy r r � r � � r • , t / • , (` ,. - '-T.Harned �7sM ( P.O.Box 210133 AlN 7' ) San Francisco,CA.94'121-0133 q� - ------------------------- ------------------------------ -------------------------------- --------------------------------------------------- 1 S.F . GENERAL HOSPITAL Account Number:134181000123 Page No. 1001 POTRERO AVENUE PatientName:HARNED ,THERESA SF CA 94110 ServiceStart:08/19/96 Service End: Statement Date:O 9/0 3/96 Last Statement Date: QUESTIONS? Please Call: (415) 206-8459 Contact: TOTAL PATIENT CREDITS ACCOUNT BALANCE ESTIMATED INSURANCE DUE a 520 . 00 500 . 00 20 . 00 TRANS DATE DESCRIPTION; AMOUNT PREVIOUS BALANCE . 00 08/19/96 1 SUTURE KIT * 51 . 00 08/19/96 1 ER EX/TX RM LEVEL 111 * 120 . 012 08/19/96 1 ER OBSV NONCRIT 4-6 NRS * 349 . 00 H 0 R BO NV 1 000015800 ACCOUNT BALANCE 520 . 00 PLEASE PAY THE AMOUNT REQUESTED. POR FAVOR PAGE LA CANTIDAD QUE UD ADEUDA. **THIS BILL REFLECTS HOSPITAL CHARGES ONLY. YOU MAY RECEIVE SEPARATE BILLS FOR PHYSICIAN/AMBULANCE CHARGES. SAN FRANCISCO GENERAL HOSPITAL OFFICE HOURS ARE M—F/8-5 BUSINESS OFFICE LOCATED IN BUILDING 20 , 4TH FLOOR �Until �insura�ncehaspaid,the PLEASE PAY THIS AMOUNT represents the balance we estimate you owe. nce unpaid by your insurance will be due from you... Thank you. w i Ct y P ,�47 $$ t k, �T J C4 Lr) 4; z Ua � t j ✓•N UA C.0 Jm O � co • h Ncc ru Ir a a 's 3 a 46 ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA November 19, 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), give t Code Amount: $5,000,000.00 Section 913 and 915.4. Pt note all •kla s~. CLAIMANT: Melvin Hale OCT 17 9996 COUNTY COUNSEL ATTORNEY: Coker Ramirez and Rice Attorneys MARTINEZ CALIF. Date received ADDRESS: 525 Marina Vista Blvd. BY DELIVERY TO CLERK ON October 16, 1996 Pittsburg, CA 94565 BY MAIL POSTMARKED: Hand Deliverpd I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. p ggAA N DATED:_ October 17, 1996 Bail Deputy�'Cle /�-'����i�-�` 'r II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Xf 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: !Q 'o�� I � 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: PLOY 19 1996 PHIL BATCHELOR, Clerk, By,����i�-��"�. 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 aril 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 mutter. 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: NOV 21. 1996 BY: PHIL BATCHELOR Clerk CC: County Cc.;,.Se'. County Administrator NOTICE OF CLAIM AGAINST THE RECEIVED (Govemment Code ss 910,. 910.2) gam`"�� lp tU;T' 16 Return to: MELVIN HALE !9% CLERK BOAR OF SUPERVISORS COPY TO: COKER RAMIREZ AND RICE ATTORNEYS CONTRA COSTA CO, 525 MARINA VISTA BOULEVARD PITTSBURG, CALIF. 94565 Phone Number: (510)706-9192 CLAIMANT NAME: MR. AND MRS. MELVIN HALE CLAIMANT'S ADDRESS: 80 WESTLAKE DRIVE Number Street ANTIOCH CALIF. 94059 City State Zip Code NAME AND ADDRESS OF PERSON TO WHOM NOTICES REGARDING THIS SHOULD BE SENT (if different than above): CONTRA COSTA COUNTY SHERIFFS OFFICE ADMINISTRATIVE BLDG PINE AND ESCOBAR ST., MARTINEZ DATE OF THE ACCIDENT OR OCCURENCE: OCTOBER 3, 1996 PLACE OF THE ACCIDENT OF OCCURENCE: HIGHWAY 4 AND BRIDGE ST., OAKLEY, WEST BOUND GENERAL DESCRIPTION OF THE ACCIDENT OR OCCURENCE (attach additional pages if more is needed) : ON 30CT96 DEPUTY SGT. DUNLAP CITED MYSELF MELVIN HALE FOR SAID INFRACTION: REQUIRED TURN. THIS MINOR INCIDENT RESULTED IN DUPUTY DUNLAP DRAWING HIS REVOLVER AND THREATENING TO SHOOT ME. THIS MANNER OF BEHAIVER BY DEPUTY DUNLAP WAS TOTALLY UNPROVOKED BY ME. IT BECAME APPARENT TO ME I COULD NOT AND WOULD NOT CALM DEPUTY DUNLAP DOWN DUE TO HIS ERRATIC BEHAIVER AT THIS TIME. I MADE A REQUEST THAT DEPUTY DUNLAP CALL HIS SUPERIOR OFFICER AND HE STATED, QUOATE(1 AM THE SUPERIOR OFFICER) UNQUOATE. SO I SUGGESTED HE CALL FOR BACK-UP TO CONTROL WHAT COULD BE TURNING OUT TO BE A LETHAL/VOLITILE SITUATION. I PRECEDED SLOWLY BACK TO MY VEHICAL AND LOCK MYSELF IN UNTIL THREE PATROL CARS ARRIVED AT THE SCENE OF THIS INCIDENT. MY WIFE WITNESSED THE ENTIRE INCIDENT SHE WAS IN THE DRIVERS SIDE PASSENGER SEAT AND REMAINED THERE OBSERVING THESE OUTRAGES CHAIN OF EVENTS. NAMES, IF KNOWN, OF PUBLIC EMPLOYEES CAUSING THE INJURY OR LOSS: DUPUTY SGT. DUNLAP, BADGE#40849 OR 5 (LAST NUMBER UNCLEAR) NAMES AND ADDRESS OF WITNNESSES: NAME ADDRESS TELEPHONE 1. ADRIENNE D. HALE(PASSENGER) 80 WEST LAKE DRIVE, ANTIOCH 706-9192 2. GENERAL DISCRIPTION OFLOSS, INJURY OR DAMAGE SUFFERED: PSYCHOLOGICAL TRAUMA DUE TO THE SENSELESS USE OF FORCE AND THREAT ON MY LIFE FROM DEPUTY DUNLAP DRAWING HIS WEAPON ON ME AND THE EMOTIONAL STRESS THIS PUT ON MY WIFE WHO IS PERMENTLY HANDICAPED. I HAS FORCED ME TO TAKE 3 WEEKS OFF WORK TO REHABILITATE. I AM REQUESTING DAMAGES AND FILING CHARGES FOR THE FOLLOWING: INFLICTING EMOTIONAL STRESS/MENTAL AGUISH, ACTS UNBECOMING OF A LAW INFORCEMENT OFFICER, UNLAWFUL TRAFFIC STOP, RECKLESS DRIVING, MISREPRESENTATION AND A VIOLATION OF MY CIVIL RIGHTS. TOTAL AMOUNT CLAIMED: $5,000,000.00 THE BASIS OF COMPUTING THE TOTAL AMOUNT CLAIMED IS AS FOLLOWS: Damages incurred to date: Medical Expences: $TOTAL UNKNOWN AT THIS TIME, TREATMENT IN EARLY STAGES. Loss of Earnings: $APROX 6,000.00, (SF MUNICIPLE DRIVER 13 EARS, CURRENTLY CLAIMING SDI FOR THREE WEEKS.) Special Damages for: PAIN AND SUFFERING, MENTAL ANGUISH, AND EMOTIONAL STRESS. (Attach copies if available) I/We, the undersigned, declare under penalty of perjury that 1/we have read the forgoing claim for damges and know the contents thereof; that the same is true of my/our own knowledge and belief, save and execept as to thos matters wherein stated on information and belief, and as to them, I /we believe it to be tr DATED: " l _�� X �S'ig=LE4rm�� laimant X Received in the City Clerk's Office this day of 11996 Signature * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * FOR CLAIMS RELATED TO INJURY TO PERSON OR PERSONAL PROPERTY,THIS FORM MUST BE FILED WITH WITHIN SIX MONTHS FROM THE ACCURAL OF THE CAUSE OF ACTION. A CLAIM RELATED TO ANY OTHER CAUSE OF ACTION SHALL BE PRESENTED NO LATER THAN ONE YEAR AFTER ACCRUAL OF THE CAUSE OF ACTION. CL A! BOAC Or SU%ER�:SC:S Or CON--'.! :.STA COUNTY, CALIFORNIA November 19, 1996 Claim Against the County, or District governed by) BOA; , ACTION the Boare cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: A.-tion. All Section references are to ) The copy of this document mailed to you is your notice of Califo-ria Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given Pursuant to Government Code Amount: $1,788.98 Section 913 and 915.4. Please note all •` II��� CLAIMANT: Nelcy L. Dwight OCT 2 2 1996 ATiORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. EI Sobrante, CA 94 ADDRESS: 701 Santa Maria 94803 BY DELIVERY TO CLERK ON October 22, 1996 BY NAIL POSTMARKED: October 21, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. October 22 1996 Il ATIHELOR, Clerk �� OL�— DATEO: �: �puty /S'e'",�-_ 11. FROM: County counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sett/ons 910 and 910.2. ( 1 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: fro %3�9�o BY: Deputy County Counsel 111. FROM. Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ()(J 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: NOV 19 1996 PHIL BATCHELOR, Clerk, By �J �s-����i�--��" , 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 say 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. * Far Additivne.l Warning See Reverse Side Of This Notice. AFFIDAVIT OF NAILING 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 16; and that today I deposited in thr United States Postal Service in Martinez, California, posU ge fully prepaid a certified Copy Of this Board Order and Notice to Claimant, addressed to the claimant as show above. � Dated: NOV 21 1996 BY: PHIL BATCHELOR by �/�� �14, ZLle, Deputy Clerk CC: Cavnty Cc.:•.se County Administrator • U\...I-1.J-1 JJU 1"t ...lJ � 1 .VGA VJ c2ai= to: Bolan of SJPFRvism of CaNm o=A axwY INSMcrIONS TO CiAD%xr A. Claiss relating to causes of action for death or for injury to person or to W- sonal ProPertY or growing crops and which accrue on or before December 31, 1987, must be presorted not lata- than the 100th day after the aca-Lmi of the cause of action. claims relating to causes of actin fbr death or for in ury to person • or to personal property or grawiag cu and which accrue on or after Ja=urT 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 actio® must be presented not later than one year after the accrual of the cause of. action. (Govt. Code S911.2.) B. Claims must be filed frith the Clerk of the Board of Supesvisot's at its office in Room 106, Cotmty Administration Building, 651 Pine Street, Martinez, CA 9$553. 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 ane public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal.Code Sea. 72 at the end of this � f � f � * � � � +� � cr � � � ct +� ffir �t � � cre• � e• � cte * �• � � � � # +� � � � +� � BE: Cain By ? Reserved far Clerk's filing stamp Nelcy L Dwight ) AgaMR the C mty of Contra Costa or ) District) MIT in nam)) M2e uodersigoed claimant hereby makes claim against the County of Contra Costa Or the above-named District in the sum of $ 1788.98 and in support of this claim represents as follows: Estimate form enclo epi, - ----- l. Mhen did the damage or injury occur? "(Give exact date and hour) April 25, 1996 8:20 am 2. iarere did the damage or injury o=r? (Include city and county) Sheldon Elementary drivewa ex' 3. How did the damage or injury occur? (Give full details; use extra Paper if required) Van was damaged when I came in contact with a damaged guardrail which is not visable from vehicle. Pictures are enclosed for more detail. I was told by the traffic director that this guardrail is hit or brushed up against at least twice a week. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? N/A 1. 4/25/96 After accident. Marks represent hits made by other automobiles. 2. 4/25/96 Guardrail is not visable from vehicle. 3. 5/22/96 More damage done to guardrail, almost one month later. 4. 6/13/96 It has been like this for about 2 weeks now. Again more damage done. 5. Same as #4 6. 6/13/96 Guardrail repaired. 7. Repaired with pole added. 8. Repaired 9. Pole is now visable from vehicle. ----------------------------------------- First day of school, this year, the pole was removed. Someone has damaged thier car because of this. I will have pictures developed to send to you at your request. If additonal wittness are required please let me know. I can more than likely contact the other indivuals that also damaged thier vehicles. Please let me know if I can be of any other help and thank you for your consideration in this matter. �. •+rat are =.ne names of county or district oSY`leer's, servants or employees cawing L' the --`=age or in jl:ry? N/A 5. khat damage or injuries do you c1,aiim resulted? (Give flab extent of injuries or damages Claimed. Attach WO estimates for auto damage. See estimate forms enclosed. Richt side of Xan anmaWAW ( a ao 7. How uas the amount claimed above computed? (Include the estimated amount of 'any prospective injury or damage.) Refer to estimate forms ensJospd $. !lames and addresses of witnesses, doetars and hospitals. Mr. Lionel Woods 4417 Meadowood 'Lane E1 Sobrante Ca 94803 Mr. Woods was 9. List the expenditures you made an aocount of this accident or injury: DATE ITEM AM= e Would u*a like to *ali a Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SM NOTICES TO: (Attorney) or by some 2gMSn on bis behalf." Name and Address of Attorney Claimants Signature 701 Santa Maria Rd Ca 94RQq Ad ss. k (510)642-1336 Telepbone No. I Telephone No. NOTICE Section T2 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for Mment to any state board or officer, or to any county, city or district board or officer, authorized to allose or pay the same if genuine, any false or fraudulent claim, bill; account, voucher, or mriting, 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 zt.at'e prison, by 2 fine of not exceeding ten thousand dollars ($10,000, or by bath z'-,=h i�,,riso_v - and fine TOTAL P.03 Wk __ 1 �w• Y` t X31 ��,. !t # Wv - iFy • ���s„it ��" 3 '�,i __ j� eft _`? ��t Y �r' • y 4 45 mT NM ZX F E � YS v - _� £ e ,�� �s,�.. FA> F �_ � �' `• 3= � >_; '�-i �JF3 N�t�jd`d3•� fC�"� 7 tr 11 _ 1 y 5 F 2 o — �� ��-- - _- ,• _ _ t-� -'�^! F �'! � i 1. , 47, € vt' � { DAMAGE REPORT VILLAGRAM 04/29/96 at 10 :24 D.R. 29999-0000339 AC108678 Est: E. CICHON AC C URATE AUTO BOD Y FAX (510 ) 236-5593 1095 BROADWAY . SAN PABLO, CA 94806-2260 (510) 236-5576 Owner: NELCY VILLAGRAM Day Phone: (510) 222-8905- Address: 701 SANTA MARIA RD.. Other Ph: ( ) - - EL SOBRANTE CA 94803 Deductible: $ N/A Insurance Co. :ALLSTATE INSURANCE COMPANY Phone: Claim No. : Adj . : 93 PLYM GRAND VOYAGER 4X4 SE 2D VAN GREY 6-3.3L-FI Vin: 1P4GK44ROPX637685 License: 3CNM273 CA Prod Date: 2/93 Odometer: 47598 Power steering Power brakes Power mirrors Tinted glass Body side moldings Dual mirrors Rear window wiper Driver airbag Cloth seats Bucket seats Recline/lounge seats Clear coat paint -------------------------------------------------------------------------------- REPR/ PART NO. REPL DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 FENDER 2* Refin RT Fender (BLEND) 1 1 .2 3 Add for Clear Coat 1 0 .5 4 R&I RT Center molding bright i 1 0 .3 5 SIDE PANEL 6* Refin RT Sd pnl w/wndw (BLEND) 1 1 .3 7 Add for Clear Coat 1 0. 3 8 R&I RT Lower molding standard 1 0. 3 9 REAR BUMPER 10 R&I bumper assy 1 0 . 6 11 ELECTRICAL 12* R&I Mast 1 0 .3 13 PILLARS, ROCKER & FLOOR 14* Repr RT Aperture panel 1 2 . 0 1 . 8 15 DOOR 16 Repl RT Install stripe tape door 1 0 . 3 17* Repr RT Door shell 1 6 . 0 2 .2 18 Add for Clear Coat 1 0. 4 19 R&I RT Molding Caravan w/inser 1 0. 4 20 Repl RT Decal AWD All Wheel Drive r 1 17 .25 0 .2 21 RT R&I trim panel 1 0.4 22 R&I RT Handle, outside black 1 0. 3 23 SIDE LOADING DOOR 24* Repr Door shell w/glass 1 4.5 2 . 7 25 Overlap Major Adjacent Panel 1 -0.4 Page: 1 DAMAGE REPORT VILLAGRAM 04/29/96 at 10:24 D.R. 29999-0000339 AC108678 Est: E. CICHON ACCL7RAr-= AUTO BODY FAX (510 ) 236=5593 1095 BROADWAY SAN PABLO, CA 94806-2260 (510) 236-5576 -------------------------------------------------------------------------------- REPR/ PART NO. REPL DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 26 Repl Molding Caravan w/insert 1 100. 00 0. 3 27* Repl Stripe tape 1 12 . 00 0 . 1 28* COVER CAR 1 5 . 00 0. 3 29* TINT COLOR 1 0.5 -------------------------------------------------------------------------------- Subtotals =__> 134 .25 16 . 3 10.5 0. 00 Page: 2 94 DAMAGE REPORT VILLAGRAM 04/29/96 at 10:24 D.R. 29999-0000339 AC108678 Est: E. CICHON ACCURATE AUTO BODY FAX (510) 236-5593 1095 BROADWAY SAN PABLO, CA 94806-2260 (510) 236-5576 Parts 134 . 25 Labor 16. 3 units @ $52 . 00 847 . 60 Paint 10. 5 units @ $52 .00 546.00 Paint/Materials 10.5 units @ $22 . 00 231 . 00 -------------------------------------------- SUBTOTAL $ 1758 . 85 Tax on $ 365.25 at 8.2500% 30. 13 -------------------------------------------- GRAND TOTAL $ 1788 . 98 -------------------------------------------- INSURANCE PAYS $ 1788. 98 Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk() items are derived from the Guide DR3TE91. Database Date 3/96 Double asterisk(**) items indicate dart supplied by a supplier other than the original equipment manufacturer. CAPA items have been certified for fit and finish by the Certified Auto Parts Association. EZEst - A product of CCC Information Services Inc. Page: 3 COMPLETE BODY AND FENDER WORK SINCE 1947 FREE ESTIMATES ESTIMATE OF REPAIR COSTS INSURANCE WORK OUR SPECIALTY Date ~ Phone 110011 S H O Q C Name 4 n i�/ ��� � �� ��., V 720 D SAN PABLO AVENUE Address PINOLE CA 94564 City LYNN ALEXANDER PHONE FAX 510-741-166301 61 Yea p,0, Make Model �- Style ! License No. 4 Body No. Serial No. / lair No. Insurance Quan, WORK TO BE DONE Labor Material 2 , e e- c p y 130 ( 3 .S 3 4 , , � UC) 5 i 6 7 s v v� 8 �o 9 10 11 12 13 14 15 16 17 18 19 20 REFINISH MATERIAL RUST PREVENTION MATERIAL BLEND&MATCH GRAVEL GUARD MATERIAL TOTAL �j - PARTS PRICES SUBJECT TO INVOICE LABOR HRS. 17--q- X$ HR =$ PARTS The above is an estimate based on our inspection and does not 0 LIST$ LESS %DISC. _$ cover any additional parts or labor which may be required after SALES TAX �� rQ 3 the work has been opened up. Occasionally after work has started, $ worn or damaged parts are discovered,which are not evident on PAINT,MATERIALS&NET ITEMS $ the first inspection. Because of this the above prices are not guar• f anteed and are for immediate acceptance only. TOTAL REPAIR COST $ Accepted by Owner or Agent 3 in L o ro El MM 0 Q J •0 A EF �.1 • x � � D J ... CI y � ,E It C 1 4 m i i o ❑ o M n i • �� o .r r d o st rn v ro T L ro O = y X z xofl o I i N Ej V♦ ro @ @ r m rn V O Tm CD •,� 0, ru i5 L2 C G 1 Q w Ln t A w mea 0 . o E S S E 9 E 9 �2 H 3 = Addressee Copy o Or ,k i U.S. POSTRGEr OOGy�Os°J'� PRIO El 59980NTE.CR OCT 21. 96 qp•�' . --- — —— �� AMOUNT :. POSTAL BERqCC 0000 $1 .10 64''!0 0 8 CLAIM BOA;:. OF SUFERV:5045 OF CONTE. COSTA COUNTY, CALIFORNIA November 19, 1996 Claim Against the County, or District governed by) BOARD ACTION the Board cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: Action, All Section references are to } The copy of this document mailed to you is your notice of Califorria Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10,000.00+ Section 913 and 915.4. please note all W cmaw,11) CLAIMANT: Claudia K. Bogumil, Faith Ann Bogumil and David Bogumil OCT 17 1996 ATTORNEY: Robert B. Galler, Esq. COUNTY COUNSEL Bennett, Johnson & Galler Date received MARTINEZ CALIF. ADDRESS: 1901 Harrison St. , Ste. 1650 BY DELIVERY TO CLERK ON October 16, 1996 Oakland, CA 94612 BY MAIL POSTMARKED: October 11, 1996 1. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above-noted claims. DATED: October 17, 1996 IVIL BeTpuC IyLOR. C1erlf�� �C� --- I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a lite claim (Section 911.3). i I ( ) Other: Dated: BY: Deputy County Counsel II1. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk. By . Deputy Clerk MARNING (6ov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this .4tice was personally served or deposited in the ail to file a court action on this claim. See Governftmt 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 show above. Dated: BY: PHIL BATCHELOR by Deputy Clerk CC: County cc.:rse' County Administrator i4 p criAl y �t P oy O a tr CD Cr � �• 0 -1 O ri (D � t ; C i VA t� LAW OFFICES j1 BENNETT, JOHNSON '� GALLER, A PROFESSIONAL CORPORATION MAIN OFFICE 1901 Harrison Street 16th Floor Oakland,CA 94612 (510)444-5020 FAX(510) 835-4260 October 11, 1996 Fton NarveY Merrithew Memorial Hospital 2500 Alhambra Avenue RECEIVED Martinez, CA 94553 Re : Claim of Claudia, Faith and David Bogumil OCT 16 1996 Gentlemen: CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Enclosed please find an original and copy of a Claim presented on behalf of our above-captioned clients with regard to the medical care received by them at your facility. Please "receipt" stamp the copy of the Claim and return it to this office in the envelope provided. Your prompt response will be sincerely appreciated. Very truly yours, BETT, OHNSON & GALLER ROBERT B. GA;; ER RBG: clh Enclosures NAPA COUNTY RIVERSIDE COUNTY SANTA BAREAR,A 1001 Second Street 82500 Hwy. 111 COSY Suite 295 Suite 5 204 North Vine Street Napa,CA 94559 Indio,CA 92202 Santa Maria,CA 93454 (707)257-2110 (619)342-6697 (805)922-6674 RECENE 1 GOVERNMENT CLAIM FOR DAMAGES oVi l 619% 2 CLERK CONTRAOCOSTA CO SUPERVISORS 3 TO CLAIMEE: County of Contra Costa Contra Costa County Health Services 4 c/o Clerk of the Board of Supervisors 651 Pine Street, Room 106 5 Martinez, CA 94553 6 Merrithew Memorial Hospital 2500 Alhambra Ave . 7 Martinez, CA 94553 8 FROM CLAIMANTS : CLAUDIA K. BOGUMIL, FAITH ANN BOGUMIL, DAVID BOGUMIL 9 2524 Prestwick Avenue Concord, CA 94519 10 ADDRESS TO WHICH 11 NOTICES TO BE SENT: Robert B. Galler, Esq. BENNETT, JOHNSON & GALLER 12 1901 Harrison St . , Suite 1650 Oakland, CA 94612 13 DATE CLAIM ACCRUED: On or about April 11, 1996 14 PLACE CLAIM ACCRUED: Merrithew Memorial Hospital 15 2500 Alhambra Ave. Martinez, CA 94553 16 CIRCUMSTANCES OF CLAIM: Claimant CLAUDIA K. BOGUMIL, a patient 17 of Claimee MERRITHEW MEMORIAL HOSPITAL, and under the direct care and 18 supervision of said Claimee and its agents and employees, was treated 19 negligently during her pre-natal period and her labor and delivery which 20 resulted in the severe injuries to her daughter Claimant FAITH ANN BOGUMIL, and 21 severe personal injuries to said Claimant, CLAUDIA K. BOGUMIL, and her 22 husband and Claimant FAITH ANN BOGUMIL' S father, Claimant DAVID BOGUMIL. 23 Claimee and its staff failed to properly 24 evaluate, care for and supervise the pre-natal period as well as the 25 progression of the labor of Claimant CLAUDIA K. BOGUMIL. As a direct and 26 legal result of the negligence of Claimee and its staff as alleged herein, 27 CLAUDIA K. and FAITH ANN BOGUMIL suffered severe personal injuries, as 28 did Claimant DAVID BOGUMIL. 1 ITEMIZATION 2 OF DAMAGES : The medical bills incurred as a result of the personal injuries to CLAUDIA K. 3 and FAITH BOGUMIL as well as their pain and suffering and emotional distress . 4 Also, damages suffered by DAVID BOGUMIL related thereto. The exact amount of 5 the damages are unknown at this time and will be proven at the appropriate time . 6 The amount of damages claimed exceeds Ten Thousand Dollars ($10, 000 . 00) and 7 jurisdiction over this claim would rest in Superior Court . 8 DATED: October 10, 1996 . 9 BEYTT, HNSON & LER 10 11 12 ROBERT B. LE , E Q. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 r 1 PROOF OF SERVICE 2 I, Cindy Hermanson, am employed in the County of Alameda, State of California. 3 I am over the age of eighteen (18) years and not a party to 4 the within action. My business address is BENNETT, JOHNSON & GALLER, 1901 Harrison Street, Suite 1650 , 5 Oakland, California 94612 . 6 On October 11, 1996, I served the within: 7 GOVERNMENT CLAIM FOR DAMAGES 8 on the parties to this action by placing a true copy thereof in a sealed envelope, addressed as follows : 9 Merrithew Memorial Hospital 10 2500 Alhambra Avenue Martinez, CA 94553 11 County of Contra Costa 12 Contra Costa County Health Services c/o Clerk of the Board of Supervisors 13 651 Pine Street, Room 106 Martinez, CA 94553 14 (Sent certified mail - return receipt requested) 15 /xxx / (BY MAIL) I placed each such sealed envelope with 16 postage thereon fully prepared for first-class mail, for collection and mailing at Oakland, California, following ordinary 17 business practices . I am readily familiar with the practice of BENNETT, JOHNSON & GALLER for processing of correspondence, said 18 practice being that in the course of ordinary business, correspondence is deposited in the United States Postal Service 19 the same day it is posted for processing. 20 / / (BY PERSONAL SERVICE) I caused, each such envelope to be delivered by hand to the addressee noted above . 21 (BY FACSIMILE) I caused said document to be 22 transmitted by Facsimile machine to the number indicated after the address (es) noted above between the hours of 9 : 00 a.m. and 23 5 : 00 p.m. 24 I declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct . 25 Executed at Oakland, California, on October 11, 1996 . 26 �L 27 CINDY VE MAASON 28 a o QD o NIOD tp 01, tp t� Y' 3 w eco x 0 Y' (t Y` ' CLAIM November 19, 1996 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA 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 to Government Code Amount: $107000.00 + Section 913 and 915.4. Please note alj CLAIMANT: Claudia K. Bogumil, Faith Ann Bogumil jam, and David Bogumil O C T 16 9996 ATTORNEY: Robert B. Galler, Esq. COUNTY COUNSEL Bennett, Johnson & Galler Date received MARTINEZ CALIF. ADDRESS: 1901Harrison St. , Ste. 1650 BY DELIVERY TO CLERK ON October 15, 1996 Oakland, CA 94612 October 11, 1996 BY MAIL POSTMARKED. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 16, 1996 tall �pu yLOR , Clerk LIQ 0 II. FROM: County Counsel TO: Clerk of the Board of Supervisors ,ESI This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /o/�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. 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. q Dated: NOV 1 9 199 PHIL BATCHELOR, Clerk, By, �.S—eiu'—�it, a- 1 —" , 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: NOV 2 11996 BY: PHIL BATCHELOR b}_- �� �—� Deputy Clerk CC: County Ccjrse', County Administrator •T RECEIVE® 1 GOVERNMENT CLAIM FOR DAMAGES OCTEOF 1996 2 CLERK BOARD SUPERVISORS CONTRA COSTA CO. 3 TO CLAIMEE : County of Contra Costa Contra Costa County Health Services 4 c/o Clerk of the Board of Supervisors 651 Pine Street, Room 106 5 Martinez, CA 94553 6 Merrithew Memorial Hospital 2500 Alhambra Ave. 7 Martinez, CA 94553 8 FROM CLAIMANTS : CLAUDIA K. BOGUMIL, FAITH ANN BOGUMIL, DAVID BOGUMIL 9 2524 Prestwick Avenue Concord, CA 94519 10 ADDRESS TO WHICH 11 NOTICES TO BE SENT: Robert B . Galler, Esq. BENNETT, JOHNSON & GALLER 12 1901 Harrison St . , Suite 1650 Oakland, CA 94612 13 DATE CLAIM ACCRUED: On or about April 11, 1996 14 PLACE CLAIM ACCRUED: Merrithew Memorial Hospital 15 2500 Alhambra Ave . Martinez, CA 94553 16 CIRCUMSTANCES OF CLAIM: Claimant CLAUDIA K. BOGUMIL, a patient 17 of Claimee MERRITHEW MEMORIAL HOSPITAL, and under the direct care and 18 supervision of said Claimee and its agents and employees, was treated 19 negligently during her pre-natal period and her labor and delivery which 20 resulted in the severe injuries to her daughter Claimant FAITH ANN BOGUMIL, and 21 severe personal injuries to said Claimant, CLAUDIA K. BOGUMIL, and her 22 husband and Claimant FAITH ANN BOGUMIL' S father, Claimant DAVID BOGUMIL. 23 Claimee and its staff failed to properly 24 evaluate, care for and supervise the pre-natal period as well as the 25 progression of the labor of Claimant CLAUDIA K. BOGUMIL. As a direct and 26 legal result of the negligence of Claimee and its staff as alleged herein, 27 CLAUDIA K. and FAITH ANN BOGUMIL suffered severe personal injuries, as 28 did Claimant DAVID BOGUMIL. 1 ITEMIZATION 2 OF DAMAGES: The medical bills incurred as a result of the personal injuries to CLAUDIA K. 3 and FAITH BOGUMIL as well as their pain and suffering and emotional distress . 4 Also, damages suffered by DAVID BOGUMIL related thereto. The exact amount of 5 the damages are unknown at this time and will be proven at the appropriate time . 6 The amount of damages claimed exceeds Ten Thousand Dollars ($10, 000 . 00) and 7 jurisdiction over this claim would rest in Superior Court . 8 DATED: October 10, 1996 . 9 BENNET J HNSON & LLER 10 , l 11 12 ROBERT B . GALL SQ. 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 PROOF OF SERVICE 2 I, Cindy Hermanson, am employed in the County of Alameda, State of California. 3 I am over the age of eighteen (18) years and not a party to 4 the within action. My business address is BENNETT, JOHNSON & GALLER, 1901 Harrison Street, Suite 1650, 5 Oakland, California 94612 . 6 On October 11, 1996, I served the within: 7 GOVERNMENT CLAIM FOR DAMAGES 8 on the parties to this action by placing a true copy thereof in a sealed envelope, addressed as follows : 9 Merrithew Memorial Hospital 10 2500 Alhambra Avenue Martinez, CA 94553 11 County of Contra Costa 12 Contra Costa County Health Services c/o Clerk of the Board of Supervisors 13 651 Pine Street, Room 106 Martinez, CA 94553 14 (Sent certified mail - return receipt requested) 15 /xxx / (BY MAIL) I placed each such sealed envelope with 16 postage thereon fully prepared for first-class mail, for collection and mailing at Oakland, California, following ordinary 17 business practices . I am readily familiar with the practice of BENNETT, JOHNSON & GALLER for processing of correspondence, said 18 practice being that in the course of ordinary business, correspondence is deposited in the United States Postal Service 19 the same day it is posted for processing. 20 / / (BY PERSONAL SERVICE) I caused each such envelope to be delivered by hand to the addressee noted above . 21 (BY FACSIMILE) I caused said document to be 22 transmitted by Facsimile machine to the number indicated after the address (es) noted above between the hours of 9 : 00 a.m. and 23 5 : 00 p.m. 24 I declare under penalty of perjury under the laws of the State of California, that the foregoing is true and correct . 25 Executed at Oakland, California, on October 11, 1996 . 26 27 CINDY R SON 28 r LAW OFFICES BENNETT, JOHNSON CALLER, A PROFESSIONAL CORPORATION MAIN OFFICE 1901 Harrison Street 16th Floor Oakland,CA 94612 (510)444-5020 FAX(510) 835-4260 October 11, 1996 ;tib T; RECEIVED OCT 151996 County of Contra Costa CLERK BOARD OF SUPERVISORS Contra Costa County Health Services CONTRA COSTA CO. c/o Clerk of the Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 Re : Claim of Claudia, Faith and David Bogumil Gentlemen: Enclosed please find an original and copy of a Claim presented on behalf of our above-captioned clients with regard to the medical care received by them from your medical facilities . Please "receipt" stamp the copy of the Claim and return it to this office in the envelope provided. Your prompt response will be sincerely appreciated. Very truly yours, B ET NSON & GALLER ROBERT B. GALLE RBG:clh Enclosures NAPA COUNTY RIVERSIDE COUNTY SANTA BARBARA 1001 Second Street 82500 Hwy. 111 COUNTY Suite 295 Suite 5 204 North Vine Street Napa,CA 94559 Indio,CA 92202 Santa Maria,CA 93454 (707)257-2110 (619)342-6697 (805)922-6674 { ` w td N 0 co H C3 � ' Q x L-j � o o OD fJm i • y t m L1 � o, n nn ¢ L 0 KN0 .1 1r- rr rt ZI N b n ti rr m (D o rr, neo 0n _ � (D tl tD (D n (-t cn U-1 bd rr n woao o � � xrr m p, 0o N a� rt, rr ua � to m (D n V) (D 0 to K m n a° N W 9a N nN �' � N � � O to O O� `ay`4 l �l 1 a t C KCS r Zp N � why ' k n R s10 0 m no Vi to 0 N VA4 j` CL A! 804;.' 0r SUEp,'S�:.S Or CON';! •^c-a COuN"vl CA;IFOaN;A November 19, 1996 Claim ASa4nst the County, or District governed by) BOA... ACTION the Boa,: c' Supervisors, Routing Endorsements, ) NCTICE To CLAIMANT and Boa-: A:tion. All Section references are to ) The copy of this document mailed to you is your notice of Califo-"it hove-nmert Codes. ) the action taker, on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to 6overrment Code Amount: '$958.99 Section 913 and 916.4. Please note all •i�ID3It t% CLAIMANT: Kathleen Marie Triebsch OCT 2 1 1996 ATi ORNEr: OOUNTY MARTINEZCALIF. Date received ADDRESS: 660 Moraga Rd. #1 BY DELIVERY TO CLERK ON October 18, 1996 Moraga, CA 94556 IT MAIL POSTMARKED: Hand Delivered: via Risk Ment. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 21, 1996 OIl �pUTytOR, Clerk II. FROM: County Counsel TO: Ciark of the Board of Supervisors This claim cMlies substantially with Sections 910 and 910.1. ( ) This claim FAILS to comply substantially with Sections 910 and 910.1, and we ere to notifying claimant. The Bard cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late Claim (Section 911.3). ( ) Other: Dated: /u2flaBY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER. By unanimous vote of the Supervisors present (X ) This Claim is rejected in full. ( ) other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: NOV 19 IM PHIL BATCHELOR, Clerk, 11y\_ R / � Deputy Clerk WANING (Gov. code Section 0133 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 My seek the advice of an attorney of your choice in Connection with this matter. If you went to consult an attorney, you should do so imamediately. 'k For Additional Warning See Reverse Side Of mitis Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I as nor, and at all times s+e'Flin sontioned, haws Gsen a citizen of the United States, over age 18; and that today I deposited in the united ,taus POttaS _4ryic3 in w mine:, California, postage fully prepaid a certified copy of this Bard rir`dzr and ;iotice io l&iM"It, addressed to t the claimant as shown above. Dated 2 1 BY: PHIL BATCHELOR b} , -cs Deputy Clerk CC: Ccvtty Cc.,,se' County Administrator CLAM BOA;: Or SUpERti'S::.S or CON-;! :^S74 COUNTY, CALIFORNIA November 19, 1996 Claim Against the County. or District governed by) BOARS ON the Board cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: A:tion. All Section references are to ) The copy of this document mailed to you is your notice of Califo-ria Gove-"mt Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $958.99 Section 913 and 915.4. Please note all •�603a j� CLAIMANT: Kathleen Marie Triebsch OCT 2 1 1996 ATi ORNEY: COUNTY COUNSEL Otte received MARTINEZ CALIF. ADDRESS: 660 Moraga Rd. #1 BY DELIVERY TO CLERK ON October 18, 1996 Moraga, CA 94556 BY MAIL POSTMARKED: Hand Delivered; via Risk Memt. 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 21, 1996 PIL �pylOR, 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 subs Lntially 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: 122 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 (/X ) This Claim is rejected in full. ( ) Other:. I Certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: NOV 19 PHIL BATCHELOR, Clerk, Deputy Clerk 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 1 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: NOV 21 is BY: PHIL BATCHELOR b) Deputy Clerk CC: County ccrre` County Administrator Date C1 -n Filed: Ron Harvey Bo lny Number: SEPI 1996' Contra Costa County Detention Facilities INMATE REQUEST FOR PERSQNAL PROPERTY REIMBURSEMENT Y {MCDF E] MDF 0 WCDF C/TILT S�SrCTTON .TS TO BE COMPLETED BY INMATE/CLAIMANT NAME: P ADDRESS: TELEPHONE: (HOME) _ �� (WORK) S_ SSC How did the loss or damage occur? des_ J DESCRIPTION OF LOST OR DAMAGED PROPERTY: IteM (Describe fullyZ original Purchase Price and Date of Purchase C3\ C p Q'm C) rl C 1 C J qq I I p HCl t.4-!onVIY L.'i t 1316108 Fh 1840 WILLOW PASS RD. CONCORD,CA 94520. (510) 682-0818, 1.79. (.?( %.A iginai- Director of Support Services Yellow - Inmate DET 071:FRM Rev. 8/22/,94 CLAiM BOA;: Or SUFERti:S-.�=.S or CON-;I '^S+A COUNTv, CALIFORNIA November 19, 1996 Claim Against the County, or District governed by) BOA;! ACTION the Boarc cf Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Boa-: Action. All Section references are to ) The copy of this document mailed to you is your notice of Califo•ria Gove"mMent Codes. ) the action taken On your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: indemnity/contribution Section 913 and 915.4. Please note al CLAIMANT: Yoshio Tomimatsu OCT 2 2 1996 ATiORNFY: :-Marc P. Bouret, Esq. COUNTY COUNSEL Haims, Johnson, MacGowan & Date received MARTINEZ CALIF. ADDRESS: McInerney BY DELIVERY TO CLERK ON October 21 , 19A6 490 Grand Ave. Oakland, CA 94610 BY MAIL POSTMARKED: October -18- 1996 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a Copy of the above-noted claim. DATED: October 22, 1996 �IL IAT . Clerk 11. 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 930 and 910.2, and we are so notifying Claimant. The Bard cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed tate and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: 01 Dated: a 1"'.4o BY: Deputy County Counsel II1. 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 O This Claim is rejected in full. ( ) Other: 1 certify that this is a true and Correct copy Of the Board's Order entered in its minutes for this date. Dated: Nov 19 Is PHIL BATCHELOR, Clerk B � • y /�-e' i�--Q�— . Deputy Clerk MARNING (Gov. code section 913) Subject to Certain exceptions, you have only fix (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, i For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 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 t1W 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 NOV show above. Dated*. Ia2 1 1996 BY: PHIL BATCHELOR �9 by a-GtrDeputy Clerk CC: County cc.:r.se" County Administrator to: BOARD of SQPE"ISORs OF MMU COSTA o nuy IHSTRDCT 00 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, 19671 must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue an or after January 1, 1966, 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 Suprrvisars at its office in Roam 1069 County Administration Building, 651 Pine Street, MLrtinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the and of this form. • 0 f ! ! • • 6 0 0 a • f • 0 . 0 • i f f 0 • • • a 9 i f • • * f * • f S • 1 s * • 0 RE: Maim By FOR INDEMNITY/ Reserved for Merk's filing Stam CONTRIBUTION ) RECEIVE® YOSHIO TOMIMATSU ) x Against the County of Contra Costa OCT 2 1 1996 or CLERK BOARD OF SUPERVISORS District) CONTRA COSTA CO. - (Fill in name ) 1he undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $indemnity/contrib.. and in support of this claim represents as follows: .1. When did the damage or injury occur? (Give exact date and hour) June 26 , 1996 at 9 : 00 p.m. 2. Where did the damage or injury occur? (Include city and county) Intersection of Carlson and Cutting in Richmond, California. 3. Row did the damage or injury occur? (Give full detailsf use extra paper if required) See attached sheet 4. What particular act or omission cn the part of county or district officers, servants or employees caused the injury or damage? See attached sheet (over) . 5'. What are the names of county or district officers, servants or employees causing the damage or'injurjrl None known at this time. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Castillo allegedly received injuries in the facial area and has incurred medical expenses totalling $5 , 620 . 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Tomimatsu does not yet have Castillo' s medical bills, but believes that Castillo treated at Brookside Hospital and Richmond Health Center. S. Names and addresses of witnesses, doctors and hospitals. See Richmond Police Report, #95-15882 . Plaintiff treated at Brookside Hospital and Richmond Health Center. 9• List the expenditures you made on account of this accident or injury: DATE ITEM 10/17/96 Court Costs approximately $200 10/17/96 Attorneys fees approximately $1 ,000 . a i i i i i i i i i i i i i i f i i i i i i i i i i i i i i i i i i i i i i i i i i Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEED NOTICES T0: (Attorney) or by some versm on his behalf." ame and Address of Attorneyf��, �__ Marc P. Bouret, Esq. Haims , Johnson, MacGowan & Claimant s signature McInerney 490 Grand Avenue Oakland., . CA 94610 (Address) Telephone No. (510) 8 3 5-0 5 0 0 , Telephone No. i i i i i iI V V T i i i i i i i i V a 9 a a 0 W V V I NOTICE Section 72 of the Penal Code provides: nvery person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any oounty, 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 imprisorment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. CLAIM BY YOSHIO TOMIMATSU, page 3 3. A railroad crossing gate was jammed in the down position for northbound traffic on Carlson immediately prior to the subject intersection. A city of richmond police officer on foot was directing northbound traffic around the crossing gate. Yoshio Tomimatsu followed a patrol car around the crossing gate and across the subject intersection. Plaintiff Andrew Castillo approached from the right on westbound Cutting, colliding with the Tomimatsu vehicle. See Richmond Police Report, #95-15882 4. Plaintiff Castillo has sued the County of Contra Costa, among other persons and entities, apparently on a theory that the County was at least partly responsible for the condition of the subject intersection, including the crossing gate, and the conduct (or lack thereof) of emergency personnel. Yoshio Tomimatsu, the County of Contra Costa, and others are named defendants in the Castillo action. Tomimatsu hereby asserts a claim for indemnity and contribution against the County of Contra Costa with respect to all claims arising from the alleged injuries of Castillo. 140770.1 x � a � cr tr • " z O tp rO tJ� 9 fi ➢� lCJ O NCD9' �' �4 O N 70 �p 0 K ! 4; a