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MINUTES - 12021997 - C32
C. 3 a ,1�ie Board of Supervisors Contra. �rk�� and County Administration BuildingCosta C s�yAdminesoo� 651 Pine Street, Room 106 Martinez,California 94553-1293 County Jim Ropers,1 st District SE C Caryl*R.Uliksms,2nd District Donne Gerber,3rd District . Me*DeSsuinisr,4th District Jos Canelemills,5th District �Sr'S COUNT January 2, 1998 Mr. Robert W. Pickens 2178 Pacheco St. , #5 Concord, CA 94520 Dear Mr. Pickens: Per your telephone request on January 2, 1998, find enclosed a second certified and sealed copy of the rejected claim from the Board of Supervisors meeting of December 2, 1997. Cx� Shirley sillas Senior Deputy Clerk cc: BOS Minutes 12/2/97 CLAIM C , BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 C1aIm Aga;,nst 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 Go r me0*11VT de Amount: $1 29.9 8 Section 913 and 9I5.4. Please note all 3) CLAIMANT: Robert W. Pickens 00T 3 9 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 2178 Pacheco St. , #5 BY DELIVERY TO CLERK ON October 31, 1997 Concord, CA 94520 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 31, 1997 gqIL �ep�tyLOR, 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: 1/ 3" 9 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: /2 -a _ /9 ?.7 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: J� ;3 -/9'? -7 BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA 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 which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for.death or for injury to person or to personal property or growing crops and Which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later V= one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its offioe in Room 1069 County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district.governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of,this form. RE: Claim By ; Reserved for Clerk's Ming stamp I NP Against the County of Contra Costa ) or. 3 1197 ) District) CLERK BOARORS 11 in name a CONTRA COSTA The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ �( Ici . 94� _ and in support of this claim represents-as follows: 1. When did the damage or injury occur? (Give exact date and hour) rwiii�arti.�r..i��z �i�rwb r��•r� r. i mow.- -rr_ ___ rr 2. Where did the damage or injury occur? (Include city and county) .•h .. [� -r.ri�r�����rii..r/r'� r 1 � 1•._ � !^ Ca�_D ,If��FwrM� 3. How did the damage or injury occur? (Give full details; use extra paper if required) u. � •� __..rte__........... 4. What particular act or omission on the part of county or district officers, servants or.employees caused. the injury or.damage? er__s s o U Y, r �, 1 v� c � v• ) r �1� ® r 1 A-\, e r w e r e n a S C_ \r lz 1< L N-J X_ m Y g 5 N C V— o Vr- G 'N 1 G Yt e 5. wnaL are the names of county or district-officers, servants or employees causing" , the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. • 7. How was the amount claimed above computed? (InciuAe the estimated amount of any prospective injury or 1damage.) e- r s C_r 0.t 101 L 1\ 6 \*( V 1 ,C_ . V1 vi 9 1 Ccw, � v. o r � c c� e Q_ C Y ar v C $. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures.you made on account of this accident or injury: DATE • TTI AMOUNT Ai Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES t0f:�` or some person on his..behalf." Name and Address of Attorney =_/.. o (Claimant's Signature Address OL C-V • w Telephone No. Telephone No. C 'W o eeeeeI T 9 V TV V 9 V I Veeeeeeee eee 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 finei-or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,0009 or by both such imprisonment and fine. Attachment_ The lobby referred to in the incident report is a annex: apporximately 127' feet_' square that you enter through a outer set of doors, then you turn to the right to enter the functional part of the library through a second doorway. I parked my bike along the left wall of the lobby with only the rubber hand grip of the handle bars touching the wall and the front wheel of the bike touching the back wall so that it was in the far corner of the room from both doorways where it would NOT be in anyone' s way. I also locked my bike with one of those coiled security cables with a built-in combination lock which I keep locked to a crass-member under the rear of my seat. Since I felt reasonably sure that trey bike was safe in the lobby I didn' t take the cable off the cross-member and thread it through both wheels and the frame, but simply looped the cable under the top side of the rear wheel and back: to the cross-member so that someone couldn' t ,just roll the bike out of the lobby and ride off on it. When Chris Takata made her announcement on the library PA System I was in the magazine reading room which has no speakers ! I am Hard of hearing and the volume is set very low so the announcement was ,just_ a murmur to my ears. When Chris Takata took: it upon herself to move my bike she forced it backwards uncoiling the security cable while pulling it around the wheel and forcing it between its (Nexus) hub and drum brake, this is a new system with the gearing IT) the hub and a outboard drum break: on the same ax-::le. The wheel could only rotate about 240 degress before it ,jammed, the progress of which could be seen and felt but that didn' t deter Chris Takata as she continued to force the bike backwards until she reached a cement garbage can ,just outside the lobby doors where she proped it up by bracing the handle bar support_ arm againts the cement garbage can and in doing so she put deep scratches on the left side of my handle bar support arm and some lighter ones on my front fork: on that side. Ironically, the sole reason that I parked my bike in the lobby was so that it would NOT get scratched ! CONTRA COSTA COUN'T'Y LIBRARY INCIDENT REPORT Please complete within twenty-four hours of the incident and forward to the appropriate Deputy County Librarian. Type or print legibly. I. Date of Incident:10b, `1 7 2. Time of Day: C;2_ 7 3. Branch: ('rlYlCbtc.� Z1. Specific location of incident: C h h c 5. If you do not have direct knowledge of the incident, please list the name(s) of the staff who reported the incident to you: C. Type of Incident: ❑ Building Maintenance Emergency ❑ Break-in/Theft Vandalism ❑ Robbery/Personal Attack ❑ Disturbed or problem patron property Damage �`s��—/ ❑ Fire ❑ Medical Emergency ❑ Other 7. Please describe incident as thoroughly as possible; include names, physical description, times, actions taken by other department staff, etc. Note, in case of criminal activity or disturbed patron, if identity of person is known and/or if it is a repeat problem. 'At tz l—&— ��L, 7 7 - t .j 7 1_4 69-111uCf i /[:di-Z_ / u.m/ aw Q c� �L Form 1.45 (1/94) i 27 'AiCKt',l �COSTA:`CYCLERYI S,-SAFE NOT I 2178 PACHECO ST. #5 CONCORD CA 8C16 68 94520 TERMINAL NO. ,02 T.RANSACTION: 52,', 10/23/97 DON H COD | ' 1 EA 30 FORK GIANT FARRAGO | 59.99 59.99T1 1 EA 555332 STEM ZOOM ADJUSTABLE 1" | 29.99 29.99T1 1 EA 20 INSTALL FORK | 40. 00 40.00 ______ 3 SUBTOTAL 129.98 SALES TAX 1 7. 42 ______ ESTIMATE TOTAL 137. 40 21�1 ed 0 A copy or explanation of state and local laws pertaining to'bicycle helmet us6,and bic'yc'le':`higfiway-safety, Purchaser's Si-nature Date Purchaser's Name (nri/teo) . FORM PAnr#|NyCC911'G'CONTRA TO RE-ORDER CALL WALKING BIRD PUBLICATIONS:(800)525-8247 OR FAX(804)285-8247. COPYRIGHT 1996ALL RIGHTS RESERVED. _ CLAIM & Amended Claim B:=SO 0r Cr CON'Rt COS'A CG:'NTy, CALIFORNIA December 2, 1997 Claim A_a�rst the CCurty, or District governed by) BOARD ACTION the Beard of Supervisors, Rowting Endorsements, ) NOTICE TO CLAI1114hT and Board Acticr. All Section references are to ) The copy of this document mailed to you is your notice of Ca'ifcrria Gcvern�e^t Coces ) the action taker on your claim by the Board of Supervisors (Paragraph Iv below), given pursuant to Gove 1t%?T Amount: Exceeds $10,000 Section 913 and 915.4. Please note all "Wa os". CLAIMANT: See Attacr. exit et al. OCT 2 3 9997 ATTv"RNE'f; Ron Bochner, Esq. MARTINEZ CALIF. Attorney at Law Date received ADDRESS: P.O. Box 70655 BY DELIVERY TO CLERK ON October 22, 19()7 137 Park Place Pt. Richmond, CA 94807 BY MAIL POSTMARKED: October 21 , 1 Aq7 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. October 23 IV�{IL BATCHELOR, Clerk DATED: 1997 9Y: Deputy 11. FROM: County Counsel 10: Clerk of the Board of Supervisors WThis claim complies substantially with Sections 410 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 nct timely filed, The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 1(0 12 By: LCJ Dep,,ty County Counsel 1I1, FRDN.. Clerk of the Board TO: County Counsel (1) County Acn:inistrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOAR, ORDER: By unanimous vote of the Supervisors present ( ✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: HIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have Only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. you may seek the advice of an attorney of your choice in connection with this matter. If you want to consult An attorney, you should do so immediately, *For additional warnina see reverse side of this notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein menyioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_ _/,29 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Ron Bochner,Esq. RECEIVED Attorney-At-Law P.O. Box 70655 'Off 2 2 � 137 Park Place Pt.Richmond, California 94807 CLERK BOARD OF SUPERV6Siv ;: 510-835-9406 CONTRA COSTA co. October 21, 1997 Clerk of the Board of Supervisors SENT VIA CERTIFIED MAIL Contra Costa County RETURN RECEIPT REQUESTED 651 Pine Street, Room 106 Martinez, CA 94553 Re: Amended Claim for Damages by Residents, Visitors, Berth Holders and Lessees at the Pittsburg, California Marina Dear Board: Please take notice that pursuant to Government Code Sections 910, et seq., the claimants whose identities are shown in attachment A hereby claim damages against Contra Costa County, the Contra Costa Occupational Health - Hazardous Materials Department and the Contra Costa Health Services Department as follows: 1. Claimant's address and address where notice is to be sent: Claimant's addresses: See Attachment A Notices to be sent to: Ron Bochner, Esq. P.O. Box 70655 Pt. Richmond, CA 94807 2. Date, place and circumstances of occurrences: On April 21, 1997, the Pacific Gas & Electric power plant suffered a boiler explosion. The boiler was insulated with asbestos containing materials, which were expelled beyond the plant's premises on the persons and property of persons located in Contra Costa County. The County maintains a Hazardous Materials Department which claimants believe are part of the Contra Costa Health Services Department. The Department was called to the scene and, although the Department determined asbestos laden materials had contaminated boats in the northwestern-most portion of the Marina, they did no further testing, nor did they evacuate the area. They agreed with PG&E, the Pittsburg Police and the Pittsburg Harbormaster that the boats should be washed down. They informed individual boat Clerk of the Board of Supervisors October 21, 1997 Page Two owners that any asbestos materials found within their boats should be wiped down by the owners and/or occupants of the boats. The Department expressly refused to test or otherwise regulate or enforce the testing and decontamination of the area, despite requests they do so. Nor did they, nor have they, appropriately determined what the scope of the contamination was and is. Nor did they adequately inform Contra Costa residents that the area had been contaminated. 3. Nature of loss: The net result of Health Services Department's acts and omissions has been the continued exposure and contamination of people and property in areas around the PG&E plant with asbestos for a period of nearly six months now. Berth rents, loss of value of property, medical monitoring and general damages, including annoyance, pain and suffering. Claimants also will seek an order mandating the County to test and decontaminate the area. Each of County's acts was negligent. Further, each of the acts was also substantially certain to cause damage and was done with a willful and conscious disregard for the rights and safety of residents near Pacific Gas & Electric's plant. 4. Name of public employees: Jerri Rosner, Betty Colucci, Steve Morioka, Lew Pascalli, Jim Hattum, Dena Hutchin, Randy Sawyer others. 5. Amount of damages: Exceeds $10,000.00 and is within the jurisdiction of the Superior Court. Y r very truly, Ron Bochner RB encl. ATTACHMENT A THE FOLLOWING CLASS CLAIMANTS: JON PETERSON, AS REPRESENTATIVE OF A CLASS OF BERTH RENTERS IN BASIN 3 OF THE PITTSBURG, CALIFORNIA MARINA; ROBERT BONNET, AS REPRESENTATIVE OF A CLASS OF BERTH RENTERS IN BASIN 1 OF THE PITTSBURG, CALIFORNIA MARINA; LORENA KING, AS A REPRESENTATIVE OF A CLASS OF BERTH AND BUILDING RENTERS IN BASIN 2 OF THE PITTSBURG, CALIFORNIA MARINA; DORTHEA HOLLAND,AS A REPRESENTATIVE FOR HOME OWNERS AND RENTERS IN THE AREA IMMEDIATELY SOUTH AND EAST OF THE PITTSBURG PG&E POWER PLANT; AND ROBERT CLUNE, AS A REPRESENTATIVE FOR HOME OWNERS AND RENTERS IN THE NEW YORK LANDING DEVELOPMENT EAST OF THE PITTSBURG PG&E POWER PLANT. THE FOLLOWING INDIVIDUAL CLAIMANTS: SEE ATTACHED. Jan Ashley Jim Baker Chuck Baldwin P. O. Box 1'702 c/o Lynne Baker 421 Boulder Dr. Pittsburg, CA 94565 710 Foxglove St. Antioch, CA 94509 Encinatas, CA 92024 Dick Baldwin & Sandy Rose Marie Bennett Paul Billeci Perkins Bob Bennett 262 Shoreline Dr. 144 Heron Dr. P.O. Box 429 Pittsburg, CA 94565 Pittsburg, CA 94565 Martinez, CA 94553 Eugene Boggiatto Robert Bonnet Elizabeth & Ray Capella P.O. Box 1216 2523 44th Ave. Child: Matthew Castroville, CA 95012 San Francisco, CA 94116 6490 Marsh Creek Road Clayton, CA 94517 Henry Capurro Renee & Ronald Capurro David Carroll 2606 Belmonte Lane 3740 Roundhill Dr. 2425 42nd St. Pittsburg, CA 94565 Pittsburg, CA 94565 Sacramento, CA 95817 Frank Cayuela David Clark Bob & Jean Marsh Clune 1817 Daniel Maloney Dr. P.O. Box 855 252 Heron Drive San Jose, CA 95121 Pittsburg, CA 94565 Pittsburg, CA 94565 Joseph Cole Tom Collins Frank Craffey Carolyn Cole 2725 E. Vassar Ave. 600 Railroad Ave. P.O. Box 1494 Merced, CA 95340 Pittsburg, CA 94565 Pittsburg, CA 94565 Andy Crivello Jim Crosby & Barbara Smith Cecil, Melissa & Crystal 2309 Dogwood Way 310 3rd St . Davis Antioch, CA 94509 Clovis, CA 93612 215 Creed Ave. Antioch, CA 94509 Michael J. Davis Roy Deplazes Audrey & Steve Dinger P.O. Box 9143 Son: Bradley 1667 Shenandoah Ave. Pittsburg, CA 94565 4319 Pembroke Drive Milpitas, CA 95035 Concord, CA 94521 Ruth Druar Mike Duffey Gayle Elliott P.O. Box 1798 176 Roseann Ave. 1321 W. Leland Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 Robert Enea Stan Eschwig Edythe & William Fairclough 6679 Amador P.O. Box 983 P.O. Box 270 Dublin, CA 945668 Pittsburg, CA 94565 Martinez, CA 94553 Neil Feola, Nancy Fone Pauline Frisse 25 Mossy Oak Ct . 204 Heron St . 1216 Minaker Drive Danville, CA 94506 Pittsburg, CA 94565 Antioch, CA 94509 Dean & Paula Gassoumis Ronald J. Gibbert Linda Grant Children: Maria & Zachary P.O. Box 935 2 Marina Blvd. , 11 A4 21 Lost Valley Road Pittsburg, CA 94565 Pittsburg, CA 94565 Orinda, CA 94563 Daniel & Laura Grey Laura Grimshaw Mildred Gonzalez 1936 Palos Verdes Drive 57 Cleaveland Rd. , #12 David Brown Concord, CA 94519 Pleasant Hill, CA 94523 P. O. Box 103 Pittsburg, CA 9456 Roldano Guerra George Guevara Bob Hall 701 Laurel St . P.O. Box 1276 4884 E. Butte Rd. Menlo Park, CA Pittsburg, CA 94565 Live Oak, CA 95953 Eddie Harris Priscilla & William Heekin Warren Heinback 33 Viking Way P.O. Box 1555 P.O. Box 454 Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 Richard Hicks Paul Higgins Larry Hill 246 Heron Dr. P.O. Box 5132 P.O. Box 1682 Pittsburg, CA 94565 Concord, CA 94524 Pittsburg, CA 94565 Francis Hofineyer Dorthea Holland David Hudspeth Sieglinde Hofineyer 1046 Delta View Lane 1144 Brown Ave. P.O. Box 294 Bay Point, CA 94565 Lafayette, CA 94549 Pittsburg, CA 94565 Rich Irwin Lee Kaplan Donald & Lorena King P. O. Box 691 118 Pelican Loop 51 E. Marina Blvd. Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 John LeGaspi Clyde Leitold Bonita Landry P. O. Box 9102 Rural Route #l, Box 505, P.O. Box 64 Pittsburg, CA 94565 Apartment 104 Pittsburg, CA 94565 Pequot Lake, MN 56472 John, Kathy & John Jr. Mark Leonard Robert & Katherine Lind Lecas Leonard & Associates P.O. Box 1691 3522 Lime Tree Court 105 E. 5th St . , Suite 9 Pittsburg, CA 94565 Walnut Creek, CA 94598 Pittsburg, CA 94565 Claudia & Roger Martin Carlo & Ruth Martinelli Ken McCauley 270 Heron 'Drive 110 Old Oak Ct . 4310 Del Favero Drive Pittsburg, CA 94565 Oakley, CA 94561 Antioch, CA 94509 Bill Miller Kathryn & William Emilio Negron 10 Sea Point Way Montgomery P.O. Box 1963 Pittsburg, CA 94565 Daughter: Melissa Pittsburg, CA 94565 111 Muir Station Road Martinez, CA 94553 Katherine, Angela, David, Rick O' Shia George Olmos Raymond & Brian Norman 51 E. Marina Blvd. P.O. Box 1085 176 Roseann Ave. Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 Lisa and Jon Peterson Rick Prevatt Ralph Renna Children: Joshua, Andrew & 96 E. 5th St . 651 West Sargent Rd. Kristianna Pittsburg, CA 94565 Lodi, CA 95240 P.O. Box 9236 Pittsburg, CA 94565 Ron Ridley Loretta Rodgers Pam Satloff P.O. Box 1451 2400 North Sixth St . P.O. Box 344 Pittsburg, CA 94565 Concord, CA 94519 Pittsburg, CA 94565 Rolph Schmidt Phillip Schwenck Pat Shue 2561 Gillport Lane P.O. Box 203 2120 Arzate Walnut Creek, CA 94598 Pittsburg, CA 94565 Antioch, CA 94509 Ivan & Maria Silva David Silvey Richard and Judy Silvey Children: Annette, Arlene, 1630 North Main St . , #188 6449 Jackson Valley Road Ivan, Jr. Walnut Creek, CA 94596 Ione, CA 95640 104 Linda Vista Ave. Pittsburg, CA 94565 Fayette Smith Robert J. Smith Donald Storey 52 Edgewater Pl . P. O. Box 464 51 E. Marina Blvd. Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 John Templar Jim Thomas Bette Tolnai 1765 Woodcrest Drive 515 River Road, No. 32 640 Bailey Road, #210 Concord, CA 94521-1204 Rio Vista, CA 94571 Pittsburg, CA 94565 Kim Webb Eddie & Ryna West Gordon Williamson 15100 N. Clements Rd. 104 Linda Vista Ave. P.O. Box 1153 Lodi, CA 95240 Pittsburg, CA 94565 Antioch, CA 94509 David, Withely Gene Yee Linda & Steve Zumbrunnen 52 Edgewater PI . P.O. Box 9182 51 E. Marina Blvd. Pittsburg, CA 94565 Pittsburg, CA 94565 Pittsburg, CA 94565 1 PROOF OF SERVICE BY MAIL CCP SECTION 1013 (a) 2 3 I , Ron Bochner declare as follows : 4 I am a citizen of the United States over the age of 18 years and not a party to this action. I have an office at 137 Park Place, 5 Pt. Richmond, California. I am readily familiar with the practice for collection and procession of correspondence for mailing with the 6 United States Postal Service . 7 The document (s) and name and address of the person served as shown on the envelope (s) are set forth below., 8 On October 21 , 1997 the envelope (s) were sealed and placed for 9 Certified Mail, Return Receipt Requested, with the United States Postal Service located in Oakland, California on said date following 10 ordinary business practice . 11 DOCUMENTS MAILED: AMENDED GOVERNMENT TORT CLAIM 12 13 ADDRESSED TO: Clerk, Board of Supervisors Contra Costa County 14 651 Pine St. , Room 106 Martinez , CA 94553 15 16 I declare under penalty of perjury under the laws of the State 17 of California that the foregoing is true and correct and that this declaration was executed on October 21 , 1997 . 18 19 20 Ron Bochner 21 22 23 24 25 26 27 Ron Bochner, Attorney-At-Law, P.O. Box 70655, 137 Park Place Pt. Richmond, California 94807 1 Tel (510) 835- 9406 a k Qhs r ICD H.` 4 .4 i rm s lot -J ru J til � N •it r a ul c - h :... y _ C� ul Ulb ._ Wo gx C:2 D J C m S �J( h N N W C . Cc: cn 0 N RECEIVED k( - V Ron Bochner,Esq. Attorney-At-Law Iff 24 2 097 P.O. Box 70655 137 Park Place CLERK BOARD OF SUPERVISOR Pt.Richmond, California 94807 r_ CONTRA COSTA Co . 510-835-9406 October 20, 1997 Clerk of the Board of Supervisors SENT VIA CERTIFIED MAIL Contra Costa County RETURN RECEIPT REQUESTED 6,51. Pine Street, Room 106 Martinez, CA 94553 Re: Claim for Damages by Residents, Visitors, Berth Holders and Lessees at the Pittsburg, California Marina Dear Board: Please take notice that pursuant to Government Code Sections 910, et seq., the claimants whose identities are shown in attachment A hereby claim damages against Contra Costa County, the Contra Costa Occupational Health - Hazardous Materials Department and the Contra Costa Health Services Department as follows: 1. Claimant's address and address where notice is to be sent: Claimant's addresses: See Attachment A Notices to be sent to: Ron Bochner, Esq. P.O. Box 70655 Pt. Richmond, CA 94307 2. Date, place and circumstances of occurrences: On April 21, 1997, the Pacific Gas & Electric power plant suffered a boiler explosion. The boiler was insulated with asbestos containing materials, which were expelled beyond the plant's premises on the persons and property of persons located in Contra Costa County. The County maintains a Hazardous Materials Department which claimants believe are part of the Contra Costa Health Services Department. The Department was called to the scene and, although the Department determined asbestos laden materials had contaminated boats in the northwestern-most portion of the Marina, they did no further testing, nor did they evacuate the area. They agreed with PG&E, the Pittsburg Police and the Pittsburg Harbormaster that the boats should be washed down. They informed individual boat Clerk of the Board of Supervisors October 20, 1997 Page Two owners that any asbestos materials found within their boats should be wiped down by the owners and/or occupants of the boats. The Department expressly refused to test or otherwise regulate or enforce the testing and decontamination of the area, despite requests they do so. Nor did they, nor have they, appropriately determined what the scope of the contamination was and is. Nor did they adequately inform Contra Costa residents that the area had been contaminated. 3. Nature of loss: The net result of Health Services Department's acts and omissions has been the continued exposure and contamination of people and property in areas around the PG&E plant with asbestos for a period of nearly six months now. Berth rents, loss of value of property, medical monitoring and general damages, including annoyance, pain and suffering. Claimants also will seek an order mandating the County to test and decontaminate the area. Each of County's acts was negligent. Further, each of the acts was also substantially certain to cause damage and was done with a willful and conscious disregard for the rights and safety of residents near Pacific Gas & Electric's plant. 4. Name of public employees: Jerri Rosner, Betty Colucci, Steve Morioka, Lew Pascalli, Jim Hattum, Dena Hutchin, Randy Sawyer others. 5. Amount of damages: Exceeds $10,000.00 and is within the jurisdiction of the Superior Court. You, ery truly, on Bochner RB encl. ATTACHMENT A THE FOLLOWING CLASS CLAIMANTS: JON PETERSON, AS REPRESENTATIVE OF A CLASS OF BERTH RENTERS IN BASIN 3 OF THE PITTSBURG, CALIFORNIA MARINA; ROBERT BONNET, AS REPRESENTATIVE OF A CLASS OF BERTH RENTERS IN BASIN 1 OF THE PITTSBURG, CALIFORNIA MARINA; LORENA KING, AS A REPRESENTATIVE OF A CLASS OF BERTH AND BUILDING RENTERS IN BASIN 2 OF THE PITTSBURG, CALIFORNIA MARINA; DORTHEA HOLLAND,AS A REPRESENTATIVE FOR HOME OWNERS AND RENTERS IN THE AREA IMMEDIATELY SOUTH AND EAST OF THE PITTSBURG PG&E POWER PLANT; AND ROBERT CLUNE, AS A REPRESENTATIVE FOR HOME OWNERS AND RENTERS IN THE NEW YORK LANDING DEVELOPMENT EAST OF THE PITTSBURG PG&E POWER PLANT. THE FOLLOWING INDIVIDUAL CLAIMANTS: SEE ATTACHED. Jan Ashley , Jim Baker Chuck Baldwin P.O. Box i702 ' c/o Lynne Baker 421 Boulder Dr. Pittsburg, CA 94565 "710 Foxglove St . Antioch, CA 94509 Encinatas, CA 92024 Dick Baldwin & Sandy Rose Marie Bennett Paul Billeci Perkins Bob Bennett 262 Shoreline Dr. 144 Heron Dr. P.O. Box 429 Pittsburg, CA 94565 Pittsburg, CA 94565 Martinez, CA 94553 Eugene Boggiatto Robert Bonnet Henry Capurro P.O. Box 1216 2523 44th Ave. 2606 Belmonte Lane Castroville, CA 95012 San Francisco, CA 94116 Pittsburg, CA 94565 Renee & Ronald Capurro David Carroll Frank Cayuela 3740 Roundhill Dr. 2425 42nd St . 1817 Daniel Maloney Dr. Pittsburg, CA 94565 Sacramento, CA 95817 San Jose, CA 95121 David Clark Bob & Jean Marsh Clune Joseph Cole P.O. Box 855 252 Heron Drive Carolyn Cole Pittsburg, CA 94565 Pittsburg, CA 94565 P.O. Box 1494 Pittsburg, CA 94565 Tom Collins Frank Craffey Andy Crivello 2725 E. Vassar Ave. 600 Railroad Ave. 2309 Dogwood Way Merced, CA 95340 Pittsburg, CA 94565 Antioch, CA 94509 Jim Crosby & Barbara Smith Cecil, Melissa & Crystal Michael J. Davis 310 3rd St . Davis P.O. Box 9143 Clovis, CA 93612 2.15 Creed Ave . Pittsburg, CA 94565 Antioch, CA 94509 Roy Deplazes Ruth Druar Mike Duffey Son: Bradley P.O. Box 1798 176 Roseann Ave. 4319 Pembroke Drive Pittsburg, CA 94565 Pittsburg, CA 94565 Concord, CA 94521 Gayle Elliott Robert Enea Stan Eschwig 1321 W. Leland 6679 Amador P.O. Box 983 Pittsburg, CA 94565 Dublin, CA 945668 Pittsburg, CA 94565 Edythe & William Fairclough Neil Feola Nancy Fone P.O. Box 270 25 Mossy Oak Ct . 204 Heron St. Martinez, CA 94553 Danville, CA 94506 Pittsburg, CA 94565 Pauline Frisse Dean & Paula Gassoumis Ronald J. Gibbert 1216 Minaker Drive Children: Maria & Zachary P.O. Box 935 Antioch, CA 94509 21 Lost Valley Road Pittsburg, CA 94565 Orinda, CA 94563 Linda Grant Daniel & Laura Grey Mildred Gonzalez 2 Marina Blvd. , 11 A4 1936 Palos Verdes Drive David Brown Pittsburg, CA 94565 Concord, CA 94519 P.O. Box 103 Pittsburg, CA 9456 George Guevara Bob Hall Priscilla & William Heekin P.O. Box 1276 4884 E. Butte Rd. P.O. Box 1555 Pittsburg, CA 94565 Live Oak, CA 95953 Pittsburg, CA 94565 Warren Heinback Richard Hicks Paul Higgins P.O. Box 454 246 Heron Dr. P.O. Box 5132 Pittsburg, CA 94565 Pittsburg, CA 94565 Concord, CA 94524 Larry Hill Francis Hofineyer Dorthea Holland P.O. Box 1682 Sieglinde Hofineyer 1046 Delta View Lane Pittsburg, CA 94565 P.O. Box 294 Bay Point, CA 94565 Pittsburg, CA 94565 David Hudspeth Rich Irwin Lee Kaplan 1144 Brown Ave . P.O. Box 691 118 Pelican Loop Lafayette, CA 94549 Pittsburg, CA 94565 Pittsburg, CA 94565 Donald & Lorena King John LeGaspi Clyde Leitold 51 E. Marina Blvd. P.O. Box 9102 Rural Route #1, Box 50.-D, Pittsburg, CA 94565 Pittsburg, CA 94565 Apartment 104 Pequot Lake, MN 56472 Bonita Landry John, Kathy & John Jr. Mark Leonard P.O. Box 64 Lecas Leonard & Associates Pittsburg, CA 94565 3522 Lime Tree Court 105 E. 5th St. , Suite 9 Walnut Creek, CA 94598 Pittsburg, CA 94565 Robert & Katherine Lind Claudia & Roger Martin Carlo & Ruth Martinelli P.O. Box 1691 270 Heron Drive 110 Old Oak Ct . Pittsburg, CA 94565 Pittsburg, CA 94565 Oakley, CA 94561 Ken McCauley Bill Miller Kathryn & William 4310 Del Favero Drive 10 Sea Point Way Montgomery Antioch, CA 94509 Pittsburg, CA 94565 Daughter: Melissa 111 Muir Station Road Martinez, CA 94553 Emilio Negron Katherine, Angela, David, Rick O' Shia P.O. Box 1963 Raymond & Brian Norman 51 E. Marina Blvd. Pittsburg, CA 94565 176 Roseann Ave. Pittsburg, CA 94565 Pittsburg, CA 94565 George Olmos Lisa and Jon Peterson Rick Prevatt P.O. Box 1085 Children: Joshua, Andrew & 96 E. 5th St . Pittsburg, CA 94565 Kristianna Pittsburg, CA 94565 P.O. Box 9236 Pittsburg, CA 94565 Ralph Renna Ron Ridley Loretta Rodgers 651 West Sargent Rd. P.O. Box 1451 2400 North Sixth St. Lodi, CA 95240 Pittsburg, CA 94565 Concord, CA 94519 Pam Satloff Rolph Schmidt Phillip Schwenck P.O. Box 344 2561 Gillport Lane P.O. Box 203 Pittsburg, CA 94565 Walnut Creek, CA 94598 Pittsburg, CA 94565 Pat Shue Ivan & Maria Silva David Silvey 2120 Arzate Children: Annette, Arlene, 1630 North Main St . , #183 Antioch, CA 94509 Ivan, Jr. Walnut Creek, CA 94596 104 Linda Vista Ave. Pittsburg, CA 94565 Richard and Judy Silvey Fayette Smith Robert J. Smith 6449 Jackson Valley Road 52 Edgewater Pl . P.O. Box 464 Ione, CA 95640 Pittsburg, CA 94565 Pittsburg, CA 94565 Donald Storey John Templar Jim Thomas 51 E. Marina Blvd. 1765 Woodcrest Drive 515 River Road, No. 32 Pittsburg, CA 94565 Concord, CA 94521-1.204 Rio Vista, CA 94571 Bette Tolnai Kim Webb Eddie & Ryna West 640 Bailey Road, #210 15100 N. Clements Rd. 104 Linda Vista Ave . Pittsburg, CA 94565 Lodi, CA 95240 Pittsburg, CA 94565 Gordon Williamson David Witherly Gene Yee P. O. Box 1153 52 Edgewater Pl . P.O. Box 9182 Antioch, CA 94509 Pittsburg, CA 94565 Pittsburg, CA 94565 Linda & Steve Zumbrunnen 51 E. Marina Blvd. Pittsburg, CA 94565 1 PROOF OF SERVICE BY MAIL CCP SECTION 1013 (a) 2 3 I , Ron Bochner declare as follows : 4 I am a citizen of the United States over the age of 18 years and not a party to this action. I have an office at 137 Park Place, 5 Pt. Richmond, California. I am readily familiar with the practice for collection and procession of correspondence for mailing with the 6 United States Postal Service. 7 The document (s) and name and address of the person served as shown on the envelope (s) are set forth below. 8 On October 21 , 1997 the envelopes) were sealed and placed for 9 Certified Mail, Return Receipt Requested, with the United States Postal Service located in Oakland, California on said date following 10 ordinary business practice . 11 DOCUMENTS MAILED: GOVERNMENT TORT CLAIM 12 13 ADDRESSED TO: Clerk, Board of Supervisors Contra Costa County 14 651 Pine St. , Room 106 Martinez , CA 94553 15 16 I declare under penalty of perjury under the laws of the State 17 of California that the foregoing is true and correct and that this declaration was executed on October 21 , 1997 . 18 19 20 Ron Bochner 21 22 23 24 25 26 27 Ron Bochner, Attorney-At-Law, P.O. Box 70655, 137 Park Place Pt. Richmond, California 94807 1 Tel (510) 835- 9406 - �> & } 3 � CM? Wiz/ & : / \ \ CDs . p . ` \\ \) +_ —E < o o ± _ ƒ Ll U 0 & � • � 2 �_ ƒ / LO a o . � M . rti � ' ' • � ( | C3 ( � ! ( . � \ . : g � \ � } . ~ f . \ $ � \ / \ 2 CLAIM ` BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 C1'aim Aga-nst 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 G vernment Code Amount: $200,000.00 Section 913 and 915.4. Please note all 'Jim JE3D CLAIMANT: Elisabeth Wagner 0 C T 3 1 1997 ATTORNEY: Hilary J. Runnion OOUNTYOOUN TFL 2200 Powell St. , Ste. 120 Date received MARTINEZ ADDRESS: Emeryville, CA 94608-1809 BY DELIVERY TO CLERK ON October 31, 1997 BY MAIL POSTMARKED: October 29, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 31, 1997 JaIl Bep�tyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (� This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �7 BY: r--- 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: /,2 —a — / q,�^/ PHIL BATCHELOR, Clerk, 8y Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ��`3 —/99 '�' BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator VICTOR J. WESTMAN OFFIC&OFCOUNTY,,;COUNSEL DEPUTIES: jI :t� ' :�. PHILLIP S.ALTHOFF COUNTY COUNSEL '' SHARON L.ANDERSON CONTRA-COSTA�CO,U NTY ANDREA W.CASSIDY y "- �- i' 1} VICKIE L.DAWES ARTHUR W.WALENTA,JR. COUNTYADMINISTRATIOWBUILOING: MARKES.ESTIS ASSISTANT COUNTY COUNSEL MICHAEL D.FARR 651•,;PINE=STREET;9tIY;FLQOR LILLIAN T FUJII MARTINEZ:CALIFORNIA-9.4563-1288 CAROLS.GORDON SILVANO B. MARCHESI DENNIS C.GRAVES ASSISTANT COUNTY COUNSEL GREGORY C.HARVEY a3. aaKEVIN T.KERR EDWARD V.LANE,JR. GAYLE MUGGLI VIVIAN LILY OFFICE MANAGER NOTICE OF INSUFFICIENCY MARY ANN MASON ADAM D.MILLER PHONE(510)335-1800 PAUL R.MUNIZ VALERIE J.RANCHE FAX(510)646-1078 AND/OR DAVID F.SCHMIDT NON-ACCEPTANCE OF CLAIM DIANA J.M SILVER WILLIAM E.SIMMONS JACQUELINE Y.WOODS MARY E.WRIGHTSON TO: Hilary J. Runnion 2200 Powell St., Ste. 120 Emeryville, CA 94608-1809 RE: CLAIM OF: Elisabeth Wagner Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ ] 1. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address_ to which the person presenting the claim desires notices to be sent. [ x ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state.the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his behalf. Page 1 j X 1'7. Other: The claim fails to describe any duty or obligation of the public entity and any action giving rise to the claim. Claim needs to be more specific as to circumstances giving rise to claim. Current claim fails to state facts sufficient to show that claim is timely. The County reserves the issue of timeliness as to this claim until further information. VICTOR J. WESTMAN, County Counsel By: 34 � X eputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I amover 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: November 5, 1997,at Martinez,California. n*j cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 1 HILARY J. RUNNION ATTORNEY AT LAW (SBN 178762) 2 JACK C. RUNNION LAW CORPORATION 2200 POWELL STREET, SUITE 125 3 EMERYVILLE, CALIFORNIA 94608-1809 y RECEIVE® (510) 420-1122 FAX (510) 420-1373 4 Attorney for Claimant ' 3 I � i 5 CLECO�RA�OSTA CO.PERVISORS 6 7 8 CLAIM FOR PERSONAL INJURIES 9 (Section 910 of the Government Code) 10 ELISABETH WAGNER, Claimant, 11 VS. 12 CONTRA COSTA COUNTY 13 DEPARTMENT OF HEALTH, DR. NEAL H JACOBI, MD, 14 DR. JOSE GARCIA, MD, and DOES ONE THROUGH TEN, 15 Respondents. 1 16 17 TO CONTRA COSTA COUNTY DEPARTMENT OF HEALTH, DR. NEAL H. 18 JACOBI, MD, DR. JOSE GARCIA, MD, and DOES ONE THROUGH TEN,: 19 You are hereby notified that Elisabeth Wagner, whose address is 243 MacArthur 20 Ave, Pittsburg, California, claims damages from the Contra Costa County Department 21 22 of Health, Dr. Neal H. Jacobi, MD, Dr. Jose Garcia, MD, and does one through ten. 23 This claim is based on negligent failure to properly diagnose and treat Elisabeth 24 Wagner resulting in emotional distress, and physical pain and suffering. 25 The claimant will allege and provide the following losses and injuries as a proximate_ result of the aforementioned professional negligence: 26 27 Since 4/29/1997 through 6/6/97, Elisabeth Wagner was a patient at Merrithew 28 Memorial Hospital, in the city of Martinez, in Contra Costa County. At said time and 1 1 place, various employees and agents of the Merrithew Memorial Hospital, including Dr. 2 Neal H. Jacobi, MD, Dr. Jose Garcia, MD, independent physicians and other medical 3 practitioners whose names are presently unknown to claimants, so negligently and 4 carelessly and otherwise conducted themselves as to cause Elisabeth Wagner, a 70 5 year old woman, to suffer severe emotional distress and physical pain. 6 The parties causing Elisabeth Wagner's injuries are Contra Costa County 7 Deparmtent of Health, Merrithew Memorial Hospital and its staff, including 8 independent physicians, including but not limited to Dr. Neal H. Jacobi, MD, Dr. Jose 9 Garcia, MD; and acting within the scope and course of their employment and agency, 10 with the permission and consent of their employer, intentionally and unlawfully 11 touched Claimant in an offensive and harmful manner, gave Claimant medication she 12 was allergic to and antipsychotic medication that was unnessary; and intentionally and 13 unlawfully exercised force to restrain, detain and confine Claimant, to which Claimant 14 did not consent to such touching, medications, restraint, detention, nor confinement. 15 Claimant Elisabeth Wagner will further presents a claim based on Elder Abuse as 16 prohibited by California Statutory law. 17 As a result of the foregoing, Elisabeth Wagner was injured in her physical and 18 mental health, the exact nature and costs of Elisabeth Wagner's injuries and damages 19 are as yet unascertained and claimant is therefore unable to compute the exact amount 20 of her claim at this time and claim general damages in the sum of $200,000.00. 21 Jurisdiction of this claim would rest in the Contra Costa Superior Court. 22 All notices or other communications with regard to this claim should be sent to 23 Hilary J. Runnion, 2200 Powell Street Site 120, Em ryville, Cali 'a 94608-1809. 24 Dated: October 29, 1997 HILA Y J. RUNNION, 25 Attorney for Clai ant 26 27 28 JACK RUNNION 2 Attorney at Law PROOF OF SERVICE 1 1 am over the age of eighteen years and not a party to the within action. My 2 business address is 2200 Powell Street Suite 125, Emeryville, California 94608, 3 located in Alameda County, California. On the date listed below, I served the following 4 documents: 5 CLAIM FOR PERSONAL INJURIES (Government Code §910) 6 by serving a true copy thereof in the following manner: 7 United States Mail, deposited in a sealed envelope with first class postage 8 thereon fully prepaid, in the U.S. Mail at Emeryville, California. 9 ❑ Facsimile Transmission. 10 ❑ Personal Delivery, delivered by hand. 11 to the following parties herein and locations as stated below: 12 CLERK OF BOARD OF SUPERVISORS 651 PINE ST RM 106 13 MARTINEZ, CA 94553 14 1 declare under penalty of perjury, under the laws of the State of California, that 15 the foregoing is true and correct. Executed on October 29, 1997, at Emeryville, 16 California. 17 (X 18 -T 19 20 21 22 23 24 25 26 JACK RUNNION Attorney at Law 3 \ �\ \ m0 \ ® o �- �p -P 2 y 6 � �y� 7l�E 0 G � . ) � � t � . � 00 Ln a /1. \ 3 APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Goverment Code.) given pursuant to Government Code Se �1�+and 915.4. Please note the "WARNING" be ' q) Claimant: Bobbietter lackland 0 C T 2 8 1997 Attorney: COUNTY COUNSEL MARTINEZ CALIF. Address: 1743 Hanion Way Pittsburg, CA 94565 Amount: $3,000.00 By delivery to Clerk on October 28, 1997 Date Received: October 28, 1997 By mail, postmarked on Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: October 28, 1997 PHIL BATCHELOR, Clerk, By I Deputy II. FROM: County Counsel 70: C erk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). 01, The Board should deny this Application to File Late Claim (Section 911.6). DATED:. �© .2q VICTOR WESTMAN, County Counsel, By eL6 Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). (�) This Application to Fjle Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE:_ /,2 -I- -/9?Z PHIL BATCHELOR, Clerk, By,�.,, D r Deputy WARNING (Gov. Code 1911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, u should do so immediately. IV. FROM: Clerk of the Board TO: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: 1 3 —/9 97 PHIL. BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrator 70: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM Bobbietter Lackland 1743 Hanlon Way Pittsburg, California 94565 510-427-7317 RECEIVED OGT 2�8199Z_ CLERK BO . D OF SUPERVISORS CON A COSTA CO. Bobbietter Lackland ) APPLICATION TO FILE Claimant ) LATE CLAIM AGAINST PUBLIC ENTITY VS. ) Contra Costa County Mental Health ) In the Matter of the Application for Permission To File Late Claim: I, Bobbietter Lackland hereby applies to the Contra Costa County Board of supervisors for leave to present a claim against Contra Costa County on behalf of Contra Costa County Mental Health pursuant to Section 911 .4 of the California Government Code. The cause of action of Bobbietter Lackland as set forth in this claim attached hereto. I, Bobbietter Lackland, claimant' s reason for the delay in presenting this claim against the Contra Costa County board of Supervisors is as follows; the claim was presented the Contra Costa County Mental Health department in a timely manner and did go through the chain of command from John Allen, Dr. Moody, Donna Wiget and Dr. Walker to you this complaint was filed in a timely manner with the individuals mention above who took the complaint drawn it out and held it from July to October 10, 1997 without reaching an amicable decision and each time I would try to contact them to find out when they would be reaching a decision they never responded and then I became ill with a dislocated leg and back and couldn' t file the complaint but the complaint had time to make it to both places in a timely manner had it not been for the chain of command holding it up so long after Ms. Candice Fox had given me the run around and after I became ill, I apologize for this delay and ask for permission to please present this late claim which is interest bearing because I have been put in a collection agency by the Bank of America and each time that this case go over a certain amount of days the collection agency adds extra interest to the unpaid amount that is owed , in this claim I am asking for $3, 000 dollars for damages but if this amount is not satisfied perhaps before the end of the month then the claim will have to be amended to include the extra interest because the interest is being added daily by Surpas Collection Agency not to mention that my name is in everyone' s computer and I cannot cash my checks because I am listed as having taken a county check. WHEREFORE, it is respectfully requested that this application be granted and that the attached claim be received and acted on immediately. October 28, 1997 Bobbietter Lackland d,iaim• to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the .100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud.. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Bobbietter Lackland ) EC ND Against the County of Contra Costa) OCT 171997 ) Pittsburg ) _ #? District) CLERK BOARD OF SUPERVISORS I (Fill in name) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 31000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) (see attached brief) 2. Where did the damage or injury occur? (Include city and county) Pittsburg, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) (Please see attached) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What are the names of county or district officers, servants or ,. employees causing the damage or injury? Candice Fox, Mental Health on School St Pittsburg, Ca R 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) Financial ruin, my name and my credit. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Amount lost and damages, pain and suffering. 8. Names and addresses of witnesses, doctors and hospitals. P. Lackland 817 Sunset Suisun, California 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT 12/25/96 - 4/27/97 @ $450.00per mo Bd an care $1 , 800.00 (Please see attached) Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person o 'Es SEND NOTICES TO: (Attorney) ehalf. " Name and Address of Attorney ) ) (Claimant's Signature) (Address) S Telephone No. ) Telephone No 4;5� 9 --7 I NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. -Mrs. B. Lackland 1743 Hanlon Way Pittsburg, California 94565 510-427-7317 October 16, 1997 Contra Costa County Board of Supervisors Mr. Mark Defaulnier 651 Pine Street Martinez, California 94553 Dear Mr. Mark Defaulnier, This claim is being file with the county in reference to a string of problems I have had caused by one of the Contra Costa County Mental Health counselors Ms. Candice Fox, I would like to tell you how Ms. Fox has ruined me an another individual ' s life with her counseling an incompetence. I have a daughter that have been in the Merrihew Mental Health Hospital and Ms. Fox was assigned to her to follow up on her treatment check on her to make sure that she was adjusting and taking her medication once she was discharged from the hospital and I was told by Ms. Fox later that she was going to be a payee for my daughter ' s Social Security check and to send her the bills that I had incurred for making for expense and purchases for my daughter while she was in the hospital, clothes etc. because the county didn' t pay for her incidental expense while she was in the hospital I was told by Ms.Candice Fox to save all the bills and give them to her and to keep her informed as to what was going on which I did. and as a result of me doing what this County Mental Health Counselor told me to do it has messed me up financially, ran up my accounts and ruined my name. as well as cause me considerable financial loss, as well as another witness as well. Ms. Fox pretended that she didn' t remember, but then she changed her mind and wrote this note that is enclosed after recalling she had told the same thing to another witness. and has caused . continue 2 them considerable problems a well . Plus Ms. Fox had an excuse for every incompetent act from she was too busy to get in contact with the court about the ticket to someone at Social Security wouldn' t call her back. This is an example of those problems. Last year when my daughter went into Merrihew Mental Health Hospital she left no provisions for her five year old child or anything to pay for her storage bill, I told her counselor Miss. Candice Fox of this dilemma and told her about the storage company threatening to sell my daughters furniture I told her that while she was in the hospital she had received a welfare check and Miss. Fox. told me to cash the check and pay her bills and to purchase food and clothing for her five year old child and when my daughter got out of the hospital she went down to the Welfare office and she told them that she had been with her child all that time iiRg she never told them that she had been in a mental hospital and that I had guardianship of her younger child and had been keeping her while she was in the hospital I had applied for aid for the child but I couldn' t get it when I applied for it because my daughter had accused her eligibility worker of having stole her welfare check and her file was at the appeals office and they could do nothing with the case until the file came back but in the meantime I would have to wait to get assistance for the small child, I told Miss. Fox this and that is the reason that she said go ahead and take my daughters welfare check and cash it and take care of her obligations and her child which I did and I have the receipts for it but when my daughter was released from the mental hospital she went to the Welfare Office and told them her check had been stolen and they wrote her another one. Miss. Fox had said if she asked about her check to tell her to see her but my daughter had the Welfare to write her another check they put a stop on the check that I had cashed of hers to pay her bills, I cashed this check by depositing it into my account and when the County put a stop on the check the Bank I was using entered my name in CheckSystem that I had stolen an forged a check and cashed it from the County this fouled up my name so bad I cannot cash any kind of check using my drivers license My daughter had other trips to the mental hospital and My daughter also went to Villa Fairmont Hospital in San Leandro, California and Ms. Fox was her counselor when she was placed in a board and care home in Oakley,Cd'lifornia for a month and while she was there Ms. Fox called me and told me that my daughters Social Security had been approved and that she would be getting it and to give her a copy of the bills that I had continue 3. incurred and she would pay me, ( during the time that my daughter was in the Board an Care Home in Oakley Ms. Fox never went out an checked on her or took her for meetings with the family and she never followed up on the care of my daughter because she was filthy and in very poor condition when her older sibling went to see her sister and to pick her up for the Holidays she was filthy an the medication had her in a stupor, Ms. Fox never observed this to do anything about recommending that the medication be adjusted or even complained about the patient care, so on Christmas day she was brought to my home by her sister, and Ms. Fox was called and told about the care etc. that my daughter had been receiving and how filthy she was and she wanted to stay at home with us so she came here on Christmas and she never left , Ms. Fox was told about this immediately an when Social Security got in contact with me to ask how much my daughter was going to be charged for being here Ms. Fox told me to tell them that she would be paying $450.00 per month, and Ms. Fox told me that the Social Security check would be coming to her so she would pay me for my daughters room and board from December 25, 1976 but then she later told me and my daughter older that she was not able to get the Social Security check to pay us, she had also told me that she was going to take care of a ticket that my daughter had received by getting in contact with the authorities an telling them that my daughter was a mental patient. Ms. Fox had asked for a copy of the ticket but she did nothing about it ( my daughter was so deranged at times she thought that Walt Disney was paying her rent an expenses and she didn't know that they were not being paid and that the apartment where she had been residing had locked her out and she was not suppose to re-enter the apartment so when she broke in through the window so she and her small child would have some place to live the manager called the police and they issued her a ticket and brought her to my house) that ticket turned into a warrant when my daughter didn' t appear in Court because she was actually in the hospital when this came up before the Judge, it was this ticket that turned into a warrent, when I asked Ms. Fox if she had got the ticket taken care of she said no she hadn' t had time, (it has been over a year that she had the ticket and did nothing about it) when I confronted her about it and told her that she told me that she was going to take care of it by getting in contact with the proper authorities but she never did) I told Ms. Fox I depended on her to take care of that matter since my daughter was patient at the time she was suppose to be in Court at the Merrihew Hospital, I told her I didn' t want her to go to jail and she said well jail is not so bad now as a matter of fact it is quite good it is better than what it use to be I told her I didn't care what it was I really didn' t want her to go to jail I asked her if she could do something I told her that she had got me messed up financially by telling me that she would be paying room an board for her staying at my home instead of at the Board and Care Facility in Oakley, as well as the problem with the Welfare check, I told her that my name had been registered all over continue 4 . - the country as having stolen a Welfare Check and forged it and that I couldn't cash my Social Security Check or any other check I have been listed as a criminal and my credit is messed up all because of her and her counseling (I told Ms. Candice Fox about the havoc that she had created in me and my family' s lives she admitted it and she said I know and I ask her what can she do about it and she expressed that she didn' t know what to do about it and told me to call my Congressman and see what he could do about it which I did and I was told about getting in contact with the Mental Health Department as a matter of fact a copy of this complaint has gone through the chain of command from Donna Wiget in Mental Health to Dr.Charles Walker with no satisfactory results . My daughter to date has had no contact with her Mental Health Counselor worker all the information that Ms. Fox obtained regarding my daughter from the time that she was assigned to her to date has been obtained through her family, she has made no effort to contact my daughter to see if she has food or shelter or if she was is adjusting or taking her medication or if the medication is agreeing with her, and at this point I can truefully say that the medication is causing her problems because she is swollen up to over twice her normal size and grown long facial and body hair which is quite unusual for her since she never had it before. The lack of care that my daughter received all the bad counseling that Ms. Fox gave to me the financial dilemma that she put me in by telling me that I would be paid for my daughter room and board as well as the clothing and incidental expense that I incurred as a result of her telling me that she would be getting the Social Security check and then re-imbursting me has been horrible. Ms. Fox' s attitude regarding this matter has been one of don' t care, I have been told by her to call my congressman maybe I should take this matter to Court and she shouldn' t be speaking with me, and I don' t have time to speak with you I will talk to you, I will talk to you next week, etc.she has acted don' t careish from the beginning and I have done absolutely everything I possibly could do to try and get this matter straighten out so I could be able to cash my Social SecurityChecks( to get my name cleared before taking this matter to the Board of Supervisors. I am further reminded how bad her advice messed me up each month I receive my Social Security Check. My charge account is ran up,I had over $1 ,400 .00 owed to me in room and board, I have had to borrow money to take up the slack not to include my name has been messed up as well as my credit the Bank has thrown me into a Collection agency out of Texas called Surpas and the interest on that $490 .00 welfare check that I cased has gone up well over $560. 00 and it is added on each month, the money I had in my account when I deposited that check was confiscated and kept by the Bank, I am asking continue 5. damages in the amount of $3, 000 . 00 so that I can pay this collection that the bank put me in and to get my name out of the CheckSystems, and damages as well as pain and suffering, since this matter has taken 10 months already tired up with Ms. Fox and Mental health Administration, I am asking you to please take care of this matter immediately so that I may be able to clear my name an be able to use the Bank to cash my Social Security Check. Yours truly, 't Bobbietter Lackland County conservatorship papers are on file on my daughter at the County Court House should you need to see them, The name of the collection agency I have been placed in is: Surpas 10000 Richmond Ave Suite 500 Houston, Texas 77042-4212 Reference No. 69795105561 Telephone No. 1 -888-1253 National Network for Consumer Relations Account Verification and 12005 Ford Road Suite 600 Collection Agency Services Dallas, Texas 75234 1-800-428-9623 972-280-8585 September 29, 1997 BOBBIETTER J LACKLAND 1743 HANLON WY PITTSBURG CA 94565 Dear BOBBIETTER J LACKLAND: Inquiries Made: Name: BOBBIETTER J LACKLAND SSN/ID# : 412-68-3778 Financial Institution: BANK OF AMERICA-CALIFORNIA PITTSBURG, CA Date: 09/03/1997 Name: BOBBIETTER J LACKLAND .SSN/I.D#:`::412-68-3778 Financial Institution: BANK OF AMERICA-CALIFORNIA PITTSBURG, CA Date: 07/07/1997 Reported Information: Name: BABBIETTER J LACKLAND Address : 1743 HANLON WY PITTSBURG, CA 94565 SSN/ID# : 412-68-3778 Submitted By: BANK OF AMERICA-CALIFORNIA PITTSBURG, CA RTN # : 121000358 Account # : 0140005168 Date Reported: 7/19/96 Reported For: TRANSACTIONS INVOLVING POSSIBLY FORGED ITEMS OR CHECKS In any future contact with us, please include the following consumer ID: 4847983 for BOBBIETTER J LACKLAND. Sincerely, ChexSysteMs -- Letter ID: 133496 Agent ID: 8372 1 s r Health Services Department • f � ' MENTAL HEALTH DIVISION srq_cou rc September 22, 1997 To Whom It May Concern, Bobbie Lackland had asked my advice regarding obtaining Funds to care for her Granddaughter when her daughter was not taking care of the child. She asked if she could use a check that was made out to her daughter for the child's benefit. I told her that I worked for Mental Health and not Social Services and so I did not know the regulations but it seemed reasonable to me. I am sorry for the inconvenience that this misunderstanding has caused . Sincerely, 1 Candace Fox, M.F.C.C. Pittsburg Mental Health CF/dm A303C (2,92) Contra Costa County This was her previous place of residence Rent Paid By Me For 2076 Shoreview June and July 1995 $144 . 00 Feminine Spray 3. 15 Tsaushu Lackland owes a check to my Bank of America account Tn the amount of $490. 00 , at the time my account had $80 .00 in it and the Bank took that amount to cover the check, if there is any question to the amount of any of these charges $490.00 Clothing For Tsaushu Lackland an incidentials K-Mart Red Sweater 1 /6/97 $10.00 MW Clothing 12/27/96 $114 . 23 McCaulos Multi Color Robe 7/26/96 $25.76 J.C. Penny Coats & Clothing 8/28/96 $52.92 Mervyn' s Clothing 5/25/96 $36 .97 J.C. Penny Black Pants Etc. 1 /25/97 $15 . 13 Clothing 1 /18/97 $12 . 98 Mervyn' s Yellow Sweater 1 /12/97 $12 .97 J.C. Penny Gold and Black Top 1 /25/97 $8. 00 Wal Mart Hair Dye 8/28/96 $4.97 Rene ' s Pants 2/5/97 $3 .57 Wal Mart Pink Robe Gown and Slippers 8/5/96 $25 . 00 Nair Hair Remover 3 . 69 Sanitary Pads 2.49 Storage on Furniture $200 .00 paid by check January 1997 storage payment $100 .00 Total $1 , 255 .83 , : y ;.: - T — ,,a - rr='ti-t t ;T k 90 DAYS 0, 04, .. . . .. . .. v I .,_ ,.,... ...ere ...-.....-....,..-. .._._.•,.. ....-_. ..,...c........... ....:.s...,.,,, ........_... - _ - bili .St. .r.. -.w•=• ..,. •.._t ,,,_.,_.. ... ._,_.._................. ....„ ..,.,».... —.r.....-...........� .,_._...:-` REI (i�_'t�.�i;, - n..,.................... ... . _ ..,. _.;�:: :.:,.: :__; IMI E Til Y N :. RECEIPT REQUIRED FOR CASWREFUND OR -. .. .:. ,. . . . ',_....':.:.: .,. _ ..,.. ... . .. .. .. BANKCRRD Cf,EDIT 305 0011/4b 0583 ,,. .. 452650007098 WMN EXERCISEWR 3.18 496137001940 WOMENS SHIRTS 7.99 495604200770 WOMENS KNITS 14.99 496137003142 WOMENS SHIRTS 7.99 SUBTOTAL 34.15 8.25% SALES TAX 2.82 • 77907529358/ 00000000 MERVYN'S CHARGE 36.97 03 TOTAL 36.97 :- 5/'15/96 3 49PM .. ... ....... ..... T,aA i i FOP �. ,Pc,'?Jr .E ql,ty�;I� • .: 4 t 40 ey t,. SWISS _. _ - _. _ EA .. ._ _ .:_ I, �_ - PRIOR! r,Tv� } 3409 i,} s f'4Ev r NC r' 15M.i :1 4 VAN 21- f ,TY '1 D YOGR MICE .99T 12 /1 CASUAL HOSE OTY 1 3.1_ra _ CLRRAVIE .. - `r(i:l l'l i r�^•{'L'rhr, .99T ., .. �, _ a.✓_ , . , _ ` .may- e-r..ad i vy YOUR PRICE ........::........ t 1 2.01 YOUR PR I CE GFt 3.i_:.} p 2,,�, i 4=} CHO CLEAWANCE "ClUIR PRICE .90 Ml ._. YOUR PRICE ,:. _ �gra. AM I Q TY .... . gnITTJ YOUR PRI CE .99T SUBTOTAL . 48.89 ,, SALES r. 772120041311 1 JC:Fa C: »YiGr_ 52j2 S - l•HC1 LLDER4 -Y-J-410,��. _ ,., lf' GOODS/SERVICES rel H t•y,,, ::i,AT r+ivJ6j. t- - .. _ _ t GCGT iPAY FOR Tl•:'-"' C't�`LtT-�L7 .T.. u ' � CREDIT CONTRACT ., 1;Z CYr'.0 t, 711 RETURN/EXCHANGE WITHIN 30 DAYS PLEASE SAVE THIS RECEIF' 14Tj�'WE OF EXCHANGE/RETURN/ Y THANKS FOR LETTIN U ERV Yrs! �N�FORZ MAN !? ., .. _ 894 c.. 3 kL E 3245075042 PKG FLNL PJ :;.. I SPECIAL ITEM. 11.99 SUBTOTAL 11.99 ............ .........__..:._,.,x,. .........__. -,; TAX 0.99 -------------------------------- MW—CREDIT 12.98 TOTAL 12.98 988415448......_ _....._. MW—CREDIT APPROVAL 61072000 011f9 1 8 7 10:31 SAVE RECEIPT FOR BILLING s AND ADJUSTMENT PURPOSES _.... .' 0F, Y n SAVE RECEIPT FOR ADJUSTMENT OR REFUND. 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VIOLATION(S) SECTION-- - CODE - DESCRIPTION INFRACTION BOOKING D REQUIRED C j Dismiss on proof of Correction If ")checked Here(40610 8 CVC) RADAR APPROX SPEED P/F MAX SPO I VEH SPD IMT SAFE SPD CITY OF OCCUR LJ LOCATIONOF VIOLATION(S) COMMENTS:(WEATHER,ROAD,S.TRAFFIC CONDITIONS) - OFFICER'S DAYS OFF- • 3 M T -W- TIF �OFFENSEIS)NOT COMMITTED IN MY PRESENCE CERTIAF60N INFORMATION AND BELIEF 1 CERTIFY UNDER PEN' ALTY OF PERJURY THAT THE FOREGOING is TRUE AND CORRECT EXECUTED ON THE DATE SHOWWABOVE AT SERIAL NO ISSUING O£FICFP f, f/`?Z : � ; n X -/-. ./�rr r-/ _ �IPLA-CE CALIF z , 1 •Ci NAME OF ARRESTINQOFFICER IF DIFFER&NT FROM ABOVE RlµNO VACATION DATES TO Z' WITHOUT ADMITTING GUI I PROMISE PEAR•AT THE TIME AND PLACE CHECKEC BELOW. �! ' X SIGN ATUEIE ir,�' „Li. •�• Jt� Ty+i.'u/ �_ -. - BEFORE A JUDGE OR A f,URK OF THE MLINICIPAI CRT JUVENILE COURT TRAFFIC.DIVYS10N y DATE TIME _ WITHIN 717�7fy'14 `s,!,i.� x-11 M 15 DAYS FORM APPRC•JED 3Y THE IUDICAI COUNCIL OF CALIFORNIA Rei I:_I In V C.40500(5)40513(aI P C a50.9 FORM V-56 3/85 SEE REVERSE SIDE O► 1. APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" CMU 1E Claimant: Manuel Uresti ����,,77 N O V 14 1997 Attorney: Michael B. Bassi COUNTYCOUNSEL Donna L. Quan MARTINEZ CALIF. Address: A Law Corporation One Montogomery St. , 15th Floor Amount: San Francisco, CA 94104 By delivery to Clerk on NnvPmhPr 17. 1997 $250,000.00 + Date Reeeived: 11/12/1997 By mail, postmarked on NnvPmhPr 170 1997 FFTIFY I. FROM: Clerk of the Board of Supervisors 70: County Counsel Attached is a copy of the above noted Application to File Late Claim. DATED: 11/14/1997 PHIL BATCHELOR, Clerk, By Deputy II, FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). (X) The Board should deny this Application to File Late Claim (Section 911.6). DATED: � �7 �y2 VICTOR WESTMAN, County Counsel, By, :�.;. r_ Deputy III. BOARD ORDER By unanimous vote of Supervisors present _ (Check one only) ( ) This Application is granted (Section 911.6). ( f) This Application to Fjle Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Orden entered in its ininutes for this date. DATE: /97 PHIL BATCHELOR, Clerk, By Deputy WARNING (Gov. Code S911.8) If you wish to file a court action on this utter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application few leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, YOU should do so immediately. IV. FROM: Clerk of the Board T0: 1 County Counsel 2 County Administrator Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: /2 f 9 9T PHIL BATCHELOR, Clerk, By Deputy V. FROM: 1 County Counsel 2 County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM I MICHAEL B. BASSI (SBN 75782) DONNA L. QUAN (SBN 127795) a RECEIVED 2 MICHAEL B. BASSI A Law Corporation � 3 One Montgomery 'St. , 15th Flr. San Francisco, CA 94104 NOV X97., ' _ 4 (415) 986-8122 5 Attorneys for CLAIMANT BOARD OF�ERVISORS y CONTRA CO MANUEL URESTI 6 7 In the Matter of the Claim of ) APPLICATION FOR LEAVE 8 ) TO PRESENT LATE CLAIM MANUEL URESTI ) 9 ) Against CONTRA COSTA COUNTY FIRE ) 10 PROTECTION DISTRICT AND CONTRA ) COSTA COUNTY. ) 11 ) 12 1 . Application is hereby made for leave to present a late claim 13 under Section 911 . 4 of the Government Code. The claim is 14 founded on a cause of action for personal injuries, which 15 accrued on December 5, 1996, and for which a claim was not 16 timely presented. For additional circumstances relating to the 17 cause of action, reference is* made to the proposed claim 18 attached hereto as Exhibit "A" and made a part hereof. 19 2 . The reason for the delay in presenting this claim is the 20 excusable neglect of the Claimant, as is more particularly shown 21 in the Declaration of Manuel Uresti attached hereto as Exhibit 22 "B" and made a part hereof. The Contra Costa County Fire 23 Protection District and Contra Costa are not prejudiced in the 24 defense of the claim by the failure to file the claim in .a 25 timely mariner, as shown by 'the Declaration of Michael B. Bassi 26 attached hereto as Exhibit "C" and made a part hereof. 27 28 APPLICATION FOR LEAVE TO PRESENT LATE CLAIM 1 1 3 . This application is presented within a reasonable time after the 2 accrual of the cause of action, as shown by the Declaration of 3 Michael B. Bassi attached hereto as Exhibit "C. " 4 WHEREFORE, it is respectfully requested that this application be 5 granted and that the attached claim be received and acted on in 6 accordance with Sections 912 .4-912 . 8 of the Government Code. 7 DATED: November 11, 1997 MICHAEL B. BASSI A Law Corporation 8 9 By 10 M B. 11 Att rney fo Claimant 12 13 14 15 16 17 18 19 20 21 22 23 24 u 25 26 C:\URESTI\LATECLAIM.APP 27 28 APPLICATION FOR LEAVE TO PRESENT LATE CLAIM 2 EXHIBIT A A. claims relating Lo causes or action zor aeaLn or ror injury -co person or to personal property or growing crops and which accrue on or before December 31, 190must be presented noter than the 100th day after the accrua of the cause of action. Cwims 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. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553 . C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Manuel Uresti ) Against the County of Contra Costa) or ) Contra Costa County ) Fire Protection District) (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ not less than and in support of this claim represents as follows: $250, 000 . 00 1. When did the damage or injury occur? (Give exact date and hour) December 5; 1996 2 . Where did the damage or injury occur? (Include city and county) Station 81, 315 Tenth St. , Antioch, County of Contra Costa, California 3 . How did the damage or injury occur? (Give full details; use extra paper if required) See Attached. 4 . What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attached. (over) E HUT A - ! See Attached. 6 . What damage o7vinjuries do you claim res ted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) See Attached. 7 . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See Attached. 8. Names and addresses of witnesses, doctors and hospitals. See Attached. 9 . List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT See Attached. Gov. Code Sec. 910.2 provides "The claim must be signed by the cl imant or by some person on his SEND NOTICES TO: (Attorney)--- beh 1 f-11 Ir Name and Address of Attorney ) MICHAEL B. BASSI ) (Claimant's Signature) A Law Corporation ) One Montgomery St. , 15th Flr. ) One Montgomery St. , 15th Flr. San Francisco, CA 94104 ) (Address) San Francisco, CA 94104 Telephone No. (415) 986-8122 ) Telephone No. ( 415) 986-8122 NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1, 000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10, 000, or by both such imprisonment and fine. ATTACHMENT 3. Claimant was at a training site known as Station 81 and located at 315 Tenth Street, Antioch, California. The site is owned and operated by the Contra Costa Fire Protection District and the County of Contra Costa. Claimant was a member of the Volunteer Fire Brigade for his employer, Dow Chemical Company. He was present at the training site for a joint training exercise with the Consolidated Fire Department . 4 . Claimant fell into an open pit of water which could not be visually detected. The manhole cover was open exposing the pit . There were no barricades or warning signs concerning this open pit of water. 5. Unknown at this time. 6. Herniated disk at L4-5; bulging disk at L3-4 . 7 . The amount claimed as of the date of presentation of this claim consists of general damages and special damages relative to Claimant' s injuries, lost income, and loss of use of same in amounts unknown at this time but in an aggregate amount of not less than $250, 000 . 8 . Frederick J. Von Stieff, M. D. , 2481 Pacheco St. , Concord, California 94520 . Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, California. Witnesses include Dow .Chemical Co. employees including: Dale Schell, Sandy Galganski, Jeff Cast, Mark Ayers, Skip Davidson, Kevin Costa, Grace Vasquera. 9 . The expenditures have not been compiled at this time. C:\URESTI\CLAIM A. Claims relating to causes or action for aeatn or tor injury to person or to personal property or growing crops and which accrue on or before December 31, 1 , must be presented not 01terthan the 100th day after the accrua of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property orIgrowing 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. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553 . C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Manuel Uresti ) Against the County of Contra Costa) or ) District) (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ not less than and in support of this claim represents as follows: $250, 000 . 00 1. When did the damage or injury occur? (Give exact date and hour) December 5, 1996 2 . Where did the damage or injury occur? (Include city and county) Station 81, 315 Tenth St. , Antioch, County of Contra Costa, California . 3 . How did the damage or injury occur? (Give full details; use extra paper if required) See Attached. 4 . What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attached. (over) EXH OT See Attached. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) See Attached. 7 . How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See Attached. 8. Names and addresses of witnesses, doctors and hospitals. See Attached. 9 . List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT See Attached. Gov. Code Sec. 910.2 provides j "The claim must be signed by the 1 i nt or by some person on his SEND NOTICES TO: (Attorney) b Name and Address of Attorney ) MICHAEL B. BASSI ) (Cla 's Signature) A Law Corporation ) One Montgomery St. , 15th Flr. ) One Montgomery St. , 15th Flr. San Francisco, CA 94104 ) (Address) San Francisco, CA 94104 Telephone No. (415) 986-8122 ) Telephone No. (415 ) 986-8122 NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1, 000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10, 000, or by both such imprisonment and fine. 0 ATTACHMENT 3 . Claimant was at a training site known as Station 81 and located at 315 Tenth Street, Antioch, California. The site is owned and operated by the Contra Costa Fire Protection District and the County of Contra Costa. Claimant was a member of the Volunteer Fire Brigade for his employer, Dow Chemical Company. He was present at the training site for a joint training exercise with the Consolidated Fire Department . 4 . Claimant fell• into an open pit of water which could not be visually detected. The manhole cover was open exposing the pit . There were no barricades or warning signs concerning this open pit of water. 5. Unknown at this time . 6. Herniated disk at L4-5; bulging disk at L3-4 . 7. The amount claimed as of the date of presentation of this claim consists of general damages and special damages relative to Claimant' s injuries, lost income, and loss of use of same in amounts unknown at this time but in an aggregate amount of not less than $250, 000. 8 . Frederick J. Von Stieff, M. D. , 2481 Pacheco St. , Concord, California 94520 . Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, California. Witnesses include Dow Chemical Co. employees including: Dale Schell, Sandy Galganski, Jeff Cast, Mark Ayers, Skip Davidson, Kevin Costa, Grace Vasquera. 9 . The expenditures have not been compiled at this time. C:\URESTI\CLAIM EXHIBIT B 1 MICHAEL B. BASSI (SBN 75782) DONNA L. QUAN (SBN 127795) 2 MICHAEL B. BASSI A Law Corporation 3 One Montgomery Street, 15th Floor San Francisco, CA 94104-4505 4 (415) 986-8122 5 Attorneys for CLAIMANT MANUEL URESTI 6 7 8 In the Matter of the Claim of DECLARATION OF MANUEL URESTI MANUEL URESTI IN SUPPORT OF APPLICATION 9 FOR LEAVE TO PRESENT LATE Against CONTRA COSTA COUNTY FIRE CLAIM 10 PROTECTION DISTRICT AND CONTRA COSTA COUNTY. 11 12 I, MANUEL URESTI, declare: 13 1. I am the Claimant in the above-entitled matter. I make 14 this Declaration in support of my application for leave to present 15 a late claim pursuant to Government Code §911.4 . I have personal 16 knowledge of the facts set forth herein and if called to testify, 17 can testify thereof of my own personal knowledge and belief. 18 2 . On December 5, 1996, I was employed by Dow Chemical. I 19 was also a member of the Volunteer Fire Brigade for Dow Chemical 20 Company. On December 5, 1997, Dow Chemical Company Volunteer Fire 21 Brigade was to have a training exercise with the Consolidated Fire 22 Department. I was at a training site known .as Station 81 located 23 at 315 Tenth Street, Antioch, California. I suffered personal 24 injuries when I fell into manhole filled and covered with water. 25 The manhole could not be visually detected because it was covered 26 with water. The manhole cover was open exposing the pit, and there 27 were no barricades or warning signs concerning this open pit of 28 water. E HI IT B_ 1 . 3 . My understanding was that a worker injured on the job was 2 entitled to medical treatment through workers' compensation 3 provided by my employer. Since my personal injuries occurred while 4 I was on the job for Dow Chemical Company, .I applied for, and was 5 granted, workers' compensation benefits. 6 4 . In December, 1996, sought medical treatment from a 7 doctors provided by my employer. The company doctor assured me 8 that I had no serious injuries and he released me to return to 9 work. Later that month, December 1996, I sought a second opinion 10 from my personal physician, and he also assured me that I was able 11 to return to work. I was off work for approximately nine days 12 after the injury. See, Exhibit A, a copy of my medical record, 13 attached hereto. 14 5. On July 26, 1997, I had an MRI for my low back. I 15 learned of the results of the MRI on approximately August 6, 1997 . 16 I have small herniated disk at L4-5. I have a bulging disk at L3- 17 4. See, Exhibit B; MRI Report, attached hereto. 18 6. I went off work on approximately August 3 , 1997, when I 19 again was unable to work. After the MRI results, I received an 20 epidural steroid injection, and some physical therapy. The 21 medical treatment was not successful in curing me. 22 7 . I returned to work on or about September 18, 1997 and was 23 only able to work approximately three days. I have been off work 24 since then. 25 8. After I was off work for the third time, I then called 26 the Contra Costa County Bar Association Lawyer Referral Service and 27 28 DECLARATION OF MANUEL URESTI IN SUPPORT OF APPLICATION FOR LEAVE TO PRESENT LATE CLAIM -2- I asked to be referred to a workers' compensation attorney. They 2 referred me to Timothy Timmons, a workers ' compensation attorney in 3 Contra Costa County about my rights under workers' compensation 4 benefits. I consulted with Mr. Timmons approximately October 3, 5 1997. It was only at that time that I learned that I had a claim 6 against the Consolidated Fire District of the City of Antioch, 7 County of Contra Costa, California. Mr. Timmons referred me to 8 Michael B. Bassi to determine whether or not I had a claim that was 9 not exclusively limited to workers' compensation. I met with' Mr. 10 Bassi the week of October 13 , 1997. 11 8. I did not consult with an attorney until approximately 12 October 3, 1997, because I was receiving payment of my medical 13 bills through my workers' compensation benefits from the date of my 14 injury to the present. These benefits were paid to me without my 15 having to file a formal claim. Until I consulted with Mr. Timmons, 16 I believed that these benefits were my exclusive remedy. 17 9. I decided to consult with an attorney after I learned 18 that my injuries might be quite serious, and I wanted to know what 19 my rights were as an injured worker under workers ' compensation. 20 That is why I asked the Contra Costa Bar Association Lawyer 21 Referral Service to refer me to a workers ' compensation attorney. . 22 I declare under penalty of perjury under the laws of the State 23 of California that the foregoing is true and correct, and that this 24 Declaration is executed on November 8, 1997, in San Francisco, 25 California. 26 MANUEL URESTI C: \URESTI\URESTI.DEC 27 28 DECLARATION OF MANUEL URESTI IN SUPPORT OF APPLICATION FOR LEAVE TO PRESENT LATE CLAIM -3- ANTI OCI� . 3450 Hillcrest Avenue AMIMAGINGAntioch, MEDICAL (at Wildflower Drive) y CA 9450 (510) 757-2100 Fax (510) 757-2101 PATIENT NAME: URES'fI, MANUEL DATE:•07/29/97 DATE OF BIRTH: 11/26/53 PATIENT ID: 11849 REFERRED BY: S. JORGENSON, M.D. MAGNETIC RESONANCE IMAGING OF THE LUMBOSACRAL SPINE HISTORY: Lack pain. TECHNIOUE. An MRl examination of the lumbosacral shine was performed in the sagittal and axial planes using the following imaging sequences: Sagitt<d spin echo TR550 TE11, 4 mm; Sagittal fast spin echo TR3000 TE96, 4 mm; Sagittal FMPIR TR3000 TE32, 4 mm; Axial spin ecl o ,rR716 TE12, 4 mm; Axial fast spin echo TR5533 TE102, 4 mm. FINDINGS: Vertebral body stature and alignment are normal. No abnormal signa't is seen within the vertebral body bone marrow. There is desiccation of the intervertebral disk at L4-5. A small disk herniation is also present at L4-5. This is located in the midline and results in mild encroachment on the thecal sac. Mild disk bulging is present at 1,3-4. Neural foramina appear intact. The conu:, medullaris is norrhal in position .and configuration. IMPRESSION: 1. Small disk herniation at L4-5. 2. Mild disk bulging at L3-4. Thank you for referring your patient to AMI. ERIC P. SALDIN • ER, M.D./psr D: 07/30/97 T: 07/30/97 SUTTER DELTA MEDICAL CENTER 3901 LONE TREE WAY . ANTIOCH, CA 94509 . (510) 779-7200 EMERGENCY ROOM REPORT PATIENT: URESTI, MANUEL 145262 DATE OF ER VISIT: 12/05/96 TIME OF EVALUATION: 1050 hours . PHYSICIAN: MARY A. FITZSIMONS, M.D. CHIEF COMPLAINT: Mechanical fall injury to legs, hips and back. HISTORY OF PRESENT ILLNESS: This is a 43-Year-old male who injured_ himself at work when he fell into a hole. He fell down as deep as to the level of his hips , hitting the right hip and low back against the lip of the hole. He was able to climb out of the hole. He sustained a laceration to the anterior aspect of the left lower leg. He is complaining of pain in both lower legs, his left knee and right hip as well as his low back, as well as the laceration. He denies striking his head. He denies other injuries . I PAST MEDItAL HISTORY: The patient states he has a history of hepatitis C. He is otherwise healthy. MEDICATIONS : A nasal spray for seasonal allergies . ALLERGIES : No medical allergies . REVIEW OF SYSTEMS : CENTRAL NERVOUS SYSTEM: No syncope, no headaches . No limb paresthesias . MUSCULOSKELETAL: Neck, hip and lower extremity pain. INTEGUMENT: Laceration to the left leg. The remainder of the review of systems is unremarkable . PHYSICAL EXAMINATION: GENERAL: An alert male. VITAL SIGNS : Blood pressure is 142/86, pulse 97 , respiratory rate 16, and temperature 98 . 8 orally. HEENT: Sclerae are anicteric, conjunctivae are clear . Oral mucosa is pink and moist. NECK: Supple . LUNGS : Clear to auscultation throughout. CARDIAC: Regular rate and rhythm, no murmur. . . . CONTINUED. . . EX [ 9 SDMC EMERGENCY ROOM REPORT PATIENT: URESTI, MANUEL 145262 PAGE 2 ABDOMEN: Rounded, bowel sounds present, normoactive, soft to palpation, nontender, no masses or guarding. SKIN: There is an open abrasion/laceration on the pretibial surface of the left lower leg that is approximately 1 cm in length and extends into the subcutaneous layer only. The right hip has no bruising. There is no pain with range of motion and no localized tenderness . BACK: Point tenderness at the midline lumbosacral area with some mild paralumbar muscle spasm. There is no tenderness at the sacroiliac joints . EXTREMITIES : The lower extremities are tender over the pretibial surfaces bilaterally. NEUROLOGIC: _ Cranial nerves are intact. Deep tendon reflexes are 2+ and equal over the brachial radialis and patellar tendons . Sensation is intact to light touch throughout . Mental status is alert and oriented times four. EMERGENCY DEPARTMENT COURSE : X-rays of the lumbar spine, the right and left tibia and fibula and the left knee are obtained, and per radiologist all are negative for fracture. The laceration was repaired. PROCEDURE NOTE - LACERATION REPAIR: The skin is anesthetized with 1% lidocaine, the wound scrubbed with, a dilute solution of Betadine and sterile saline and rinsed with sterile saline, and then closed with #4-0 nylon X two simple interrupted sutures . The patient tolerated the proceaure well . IMPRESSION: Multiple contusions and strains , laceration to the leg which has been repaired; no evidence of fracture or neurologic deficit . PLAN: The patient will be discharged home today and off work tomorrow due to the numerous contusions and strains . He is to return to the emergency department for a wound check in two days , Saturday. An Op-Site dressing has been placed today which should be changed on Saturday. Starting on Monday, which is the patient ' s next scheduled work day following the Friday work day which will be cancelled, the patient is to arrange for all follow up care at Dow Chemical Plant. I have discussed this with Dr. Carson, the plant physician, and he concurs . He will see the patient on Monday morning at 8 : 30 a .m. . The patient will be discharged home on Vicodin and Motrin for pain, and Keflex 500 mg q. i .d. X ten days . . . .CONTINUED. . . SDMC EMERGENCY ROOM REPORT PATIENT: URE STI, MANUEL 145262 PAGE 3 DISCHARGE DIAGNOSES : 1 . Acute lumbar strain and contusion. 2 . Contusion to hip and lower legs . 3 . Laceration repair of the left leg, a 1 cm simple repair. MARY A. FITZSIMONS, M. MF x75sb 12/05/96 : 12/05/95 72 cc: ER Physici n ' s Billing Billing Office 7 EXHIBIT C I MICHAEL B. BASSI (SBN 75782) DONNA L. QUAN (SBN 127795) 2 MICHAEL B. BASSI A Law Corporation 3 One Montgomery St. , 15th Flr. San Francisco, CA 94104 4 (415) 986-8122 5 Attorneys for CLAIMANT MANUEL URESTI 6 7 In the Matter of the Claim of ) DECLARATION OF MICHAEL B. 8 ) BASSI IN SUPPORT OF APPLICA- MANUEL .URESTI ) TION FOR LEAVE TO PRESENT 9 ) LATE CLAIM Against CONTRA COSTA COUNTY FIRE ) 10 PROTECTION DISTRICT AND CONTRA ) COSTA COUNTY. ) 1-1 ) 12 I, MICHAEL B. BASSI, declare: 13 1 . I am an attorney at law duly licensed to practice before all 14 courts of the State of .California and the attorney of record herein 15 for Claimant. 16 2 . The Contra Costa County Fire Protection District and Contra 17 Costa County are not prejudiced in the defense of the claim by 18 Claimant' s failure to file the claim in a timely manner. Witnesses 19 and physical evidence still exist. The incident occurred less than 20' a year ago so the recollections of witnesses will still be fresh in 21 their minds . No depositions or discovery have been propounded. No 22 trial date has yet been set. 23 3. This application is presented within one year of the date of 24 the injury on December 5, 1996. As evidenced by the Declaration of 25 Manuel Uresti, Claimant' s failure to file a timely claim is excusable. 26 He relied on. the theory that since he was injured while he was on the 27 28 DECLARATION OF MICHAEL B. BASSI 1 EXH OT _� I job, workers' compensation was his sole remedy. He promptly sought 2 and was granted workers' compensation benefits . He had no reason to 3 seek the advice of counsel and was, in fact, acting in the manner 4 designed by the workers' compensation laws . 5 For the foregoing reasons, this application is presented within 6 a reasonable time after the accrual of the cause of action. 7 I declare under penalty of perjury that the foregoing is true and 8 correct, and that this Declaration is executed on November 11, 1997, 9 in San Francisco, California. 10 11 M . 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 C:\URESTI\DECLARATION.MBB 27 28 DECLARATION OF MICHAEL B. BASSI 2 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY - INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be. presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved ,for Clerk's filing stamp Manuel Uresti ) ) ) ) Against the County of Contra Costa) ��� or ) Contra Costa County ) Fire . Protecti.on District) (Fill ini"name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ not less than and in support of this claim represents as follows: $250, 000 . 00 1. When did the-"' damage or injury occur? (Give exact date and hour) December 5; 1996 2. Where did the damage or injury occur? (Include city and county) Station 81, 315 Tenth St. , Antioch, County of Contra Costa, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attached. 4. What particular act or omission on the part of county or district officers, --servants or employees caused the injury or damage? See Attached. (over) 5. What are the names of county or district officers, servants or. employees causing the damage or injury? See Attached. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) See Attached. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See Attached. 8. Names and addresses of witnesses, doctors and hospitals. See Attached. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT See Attached. Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOThCES ITO;:'11 (Attorney) bei&l Name and Address'of Attorney ) MICHAEL B. BASSI ) (Claimant's Signature) A Law Corporation ) ` One Montgomery St. , 15th Flr. ) One Montgomery St. , 15th Flrr: San Francisco, CA 94104 ) (Address) San Francisco, CA 94104 Telephone No. (415) 986-8122 ) Telephone No._( 415) 986-8122 NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10, 000, or by both such imprisonment and fine. ATTACHMENT 3. Claimant was at a training site known as Station 81 and located at 315 Tenth Street, Antioch, California. The site is owned and operated by the Contra Costa Fire Protection District and the County of Contra Costa. Claimant was a member of the Volunteer Fire Brigade for his employer, Dow Chemical Company. He was present at the training site for a joint training exercise with the Consolidated Fire Department. 4 . Claimant fell into an open pit of water which could not be visually detected. The manhole cover was open exposing the pit. There were no barricades or warning signs concerning this open pit of water. 5. Unknown at this time. 6. Herniated disk at L4-5; bulging disk at L3-4 . 7 . The amount claimed as of the date of presentation of this claim consists of general damages and special damages relative to Claimant' s injuries, lost income, and loss of use of same in amounts unknown at this time but in an aggregate amount of not less than $250, 000 . 8 . Frederick J. Von Stieff, M. D. , 2481 Pacheco St . , Concord, California 94520 . Delta Memorial Hospital, 3901 Lone Tree, Way, Antioch, California. Witnesses include Dow .Chemical Co. employees including: Dale Schell, Sandy Galganski, Jeff Cast, Mark Ayers, Skip Davidson, Kevin Costa, Grace Vasquera. 9. The expenditures have not been compiled at this time. C:\URESTI\CLAIM INSTRUCTIONS TO CLAIMANT A. 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 before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause ,of action. (Gov't 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. raud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Manuel Uresti ) Against the County of Contra Costa) or ) District) (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ not less than and in support of this claim represents as follows: $250, 000. 00 1. When did the damage or injury occur? (Give exact date and hour) December 5, 1996 2. Where did the damage or injury occur? (Include city and county) Station 81, 315 Tenth St. , Antioch, County of Contra Costa, California 3. How did the damage or injury occur? (Give full details; use extra paper if required) See Attached. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? See Attached. (over) 5. what are the names of county or district officers, servants or employees causing the damage or injury? See Attached. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) See Attached. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See Attached. S. Names and addresses of witnesses, doctors and hospitals. See Attached. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT See Attached. Gov. Code Sec. 910.2 provides "The claim must be signed by the 1 im nt or by some person on his SEND NOZICE�S �, ,0: (Attorney) b Name and*Addres's of Attorney ) MICHAEL B. 'BASSI ) (Cla 's Signature) A Law Corporation ) One Montgomery St. , 15th Flr. ) One Montgomery St. , 15th Flr. San Francisco, CA 94104 ) (Address) San Francisco, CA 94104 Telephone No. (415) 986-8122 ) Telephone No. (415 ) 986-8122 �*�**��*���,�***�*�*�***�*��***rt*****��r***�r******�*mow** NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. ATTACHMENT 3. Claimant was at a training site known as Station 81 and located at 315 Tenth Street, Antioch, California. The site is owned and operated by the Contra Costa Fire Protection District and the County of Contra Costa. Claimant was a member of .the Volunteer Fire Brigade for his employer, Dow Chemical Company. He was present at the training site for a joint training exercise with the Consolidated Fire Department. 4 . Claimant fell- into an open pit of water which could not be visually detected. The manhole cover was open exposing the pit. There were no barricades or warning signs concerning this open pit of water. 5. Unknown at this time. 6. Herniated disk at L4-5; bulging disk at L3-4 . 7 . The amount claimed as of the date of presentation of this claim consists of general damages and special damages relative to Claimant' s injuries, lost income, and loss of use of same in amounts unknown at this time but in an aggregate amount of not less than $250, 000 . 8 . Frederick J. Von Stieff, M. D. , 2481 Pacheco St. , Concord, California 94520 . Delta Memorial Hospital, 3901 Lone Tree Way, Antioch, California. Witnesses include Dow Chemical Co. employees including: Dale Schell, Sandy Galganski, Jeff Cast, Mark Ayers, Skip Davidson, Kevin Costa, Grace Vasquera. 9. The expenditures have not been compiled at this time. C:\URESTI\CLAIM FedEx FOCEliE4MAirbill tN�mbe 801499731378 0200 LUNo RecipiCopy From M Express Package Service Pakvw under l5oas. Da'he sooimnsomeereas �] dEx Priority Overnight FedEx Standard Overnight FedEx 2Day` late 11-11-9• WNeahusmesamommg) �(Naxtbut—ssaftemoon) ❑(Second business day) FedEx Express Saver' (Third business day) tamer 5 Donna L L. Quan, Bag• Phone(415 ►9 8 6-8112 2 O FedEx First 1,6.ss fight (Earliest next busmess marring delneryto select locations) •ydEx(seer safe not evadable (Higher fares apply) Minimum charge One pound rete. ;ompany Michael B. Bassi, A Law Corporation ' Express Freight Service Packomoverimitns. Deinn"e II,.. �sp-a.m �FedExOvernighlFTeight [:]Fad!x ay Freight E]FedEx Express Saver Freight (Next business day) (Second busmess dayl (Up to 3 business days) address One Montgomery S t. , 15th Fl r• )Call for delivery schedule.See back for detailed descriptions of freight services.) DeptlRootlSu' om San Francisco CA 94104 Packaging FedEx FedEx FedEx FedEx Other M State ZIP LE]Letter ak ❑Box ❑Tube,y ❑Pkg. J� --D" la" va a ©Your Internal Billing Reference Information Uresti Special Handling v w amaned snppe a Does this shipment corrtain dangerous goods? Yes�l Yes nansussJ) D Ice x []Cargo Aircraft Only To Dry Ice,9,UN 1815111 kg.9D/ CA BCI Ierlt�5 (Dangerous Goods Shipper's Declaration net re cared) lame Clerk Of the Board Of Phone(510 ►335-1900 ° supervisors U PaymentObtain Recipient ❑FedEx Account No. ompany Bill Sender [ Cash/ Bi Sencleno.in Recipient Third Parry Credit Card Check Check here noon I will be Whad) i_IEmer FedEx account no or Credit no.aglow) 6 51 Pine S t._, Fun. 106 —J County Administration Bldg. ffresidence ddress iorE""Fa'dE;ef9e'S51�aa Expre saver) D'HOLD'at FedEx location,print FedEx address here) i Dept/Roor/SUlte/ROom k M Martinez StateCA ZIP 94553 Toml cliages Total igoF d Taal DeclaredVahre Total Charges For HOLD at FedEx Location check here For Saturday Delivery check here $ .00 $ ❑Hold Weekday HOId$ (Nnt availehle et all locations) (Extra Charge.Not available W all locations) (Nmaveilablewth II E111,adaaleMrFed Pnmdy Ovemighf O(Available for FedEx priority Overnight `When Glaring avalue higher then OO per ip errt,you pay an additional charge.See SF]lY1CF FedEx Fim Ovemightl-.--- .and Fed&2Day only) and FedEx 2Dey only) CON ONS,DECUREO YALUE 11Ym 1UBIlflY section further information. Credit Cala Aud1, I - - U Release Signat ,e Your signature authorizes Federal Express to deliver this ship. i ment without obtaining a signature and agrees to mdemgity ...t and hold harmless Federal Express from any resulting claims. 1 Questpio/nyYg�Y'? C JCY 2 8 7 pe Date 5/97 {Ail I-SOO-Glo+edlEx(8001463-3339Pan 1150365 I , 99497 FedEx FWNTED IN U1 A ' GBFE gM7 ) 1 ® PRIORITY OVERNIGHT WED Fecl& AA eV# 59862 11NOV97 18:24 Trk# 8014 9973 1378 FDre 6M PAK Deliver B OAK 120'47 94553-OA-UB WA CCR i MICHAEL B. BASSI A LAW CORPORATION ONE MONTGOMERY STREET FIFTEENTH FLOOR TELEPHONE MICHAEL B.BASSI SAN FRANCISCO,CALIFORNIA 94104 415-986-8122 CHRISTY J.STYER DONNA L.QUAN FACSIMILE 415433-3883 VIA FEDERAL EXPRESS RECEIVED November 11, 1997 F WV1181997 Clerk of the Board of Supervisors CLERK6 OB:;;FONTRA�OS7ACO.OSORS? County Administration Building 651 Pine St. , Rm. 106 Martinez, CA 94553 Re: CLAIM BY MANUEL URESTI Dear,'Sir/Madam: Enclosed are the original and one copy of each of the following documents: ' a. Claim against Contra Costa County Fire Protection District; b. Claim against County of Contra Costa; and c. Application for Leave to Present Late Claim with Exhibits "A" through "C. " Please file the Claims and Application for Leave to Present Late Claims and conform the copies. A self-addressed, stamped envelope is enclosed for the return of the conformed copies . Please contact the undersigned if there are any questions . Very truly yours, MICHAEL B. BASSI A Law Corporation DONNA L. QUAN Attorney at Law Enclosures C:\URESTI\SUPERVISORS.LTR CLAIM l., 3 aZ� BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 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 u erv• P-r�� (Paragraph IV below), given pursuant to Gove LLL Amount: $69.89 Section 913 and 915.4. Please note all "Warnings" N 4 V 14 1997 CLAIMANT: Gina Villavicencio COUNTY COUNSEL ATTORNEY: MARTINEZ CALIF. Date received ADDRESS: 1219 Stirling Drive BY DELIVERY TO CLERK ON November 12, 1997 Rodeo, CA 94572 BY MAIL POSTMARKED: November 10, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: November 14, 1997 JqIl �ep�tyLOR, Clerk 67 II. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: A ��� �� BY: Deputy County Counsel 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: /,,2 _-2 _ 122 Z_PHIL BATCHELOR, Clerk, By .A Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 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: I o? 2 - 19 9 7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT' A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its .office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp T° RECEIVE® Against the County of Contra Costa ) ► I 'L 1997 or ) District) CLERK BOARD OF SUPERVISORS n Fill in name ) CONTRA COSTA Co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ (, q, and in support of this claim represents as follows: ___-_____ -_- 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3• How did the damage or injury occur? (Give full details; use ext paper if required) _'sed G�t �ltie� de��zu Ls', 4. What particular act or omission on the part of county or district officers, servants or .employees caused- the injury or.damage? (over) 5. what are the names of county or district officers, servants or employees causing the damage or injury? --------- -j`------------------------------------------------------------------- 5. What damage or injuries do you claim `resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Lk(IQ Ote 7. ow was the amount cla med above computed? (Include the estimated amount of any prospective injury or damage.) Names 5: : addi� sSe: if vitlE3SCS, dCCterr ...-e.F'_S= � -------------------------w- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT - Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person onhis. behalf." Name and Address of Attorney _.�-- (Claimant's Signature Address Telephone No. Telephone N6-70)c;r-) * * I V V 9 W V * * * +t NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by'a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, -or 'by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. .. 4 7 November 3, 1997 Board of Supervisors of Contra Costa County 651 Pine Street, Room 106 County Administration Building Martinez, California 94553 This is in reference to my claim against the County of Contra Costa for damages in the sum of$69.89. Statement of damages: On Sunday, October 26, 1997 at 2:00 P.M. I was entering the Viewpointe Homes Development in Rodeo, California when I came upon a large and deep pot hole located at the entrance of Viewpointe Blvd. and Coral. My van directly hit the water filled pot hole causing alignment damage to the vehicle which was just purchased on Saturday, October 25, 1997 . lam seeking reimbursement for the sum of$69.89. 1 have all ready•serviced my vehicle on Wednesday, October 29, 1997 at Wheel Works in Walnut Creek, California I have attached a copy of the invoice for your convenience. Yours truly, � �, Gina Villavicencio 1219 Stirling Drive Rodeo, California 94572 (510)294-7079 .. _y •a :'tom¢.T. .,_Y_a.. .. - : _... .._._ ....__ ." �.... ....,w.�..:....�......,.- .. ^ _.. DN 3 -. 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(�,g, qtr - Y "� , 111 - $� � kTi .•!!•a;P .s#:';N R_` �0. # - i$ - ��- .�� x`s'I.... 2 }... 'a,f 7; v�td', ; =e'P,`>::*:•G•- = a # g `si }f _ I � .j mo K' l '�yf,. ''_ - (_ *�:3 m # z3 'd ;.sk im" •r[T -ice.+^ WKS a a •� �,�' � THE itch P� -..,. # m a 7 m� # n � _ •� a .nrr �m Qo . I^r.- . a # 'S .. ':{ ��' O _ 4 - d' _ # - * is o •= _ 'N r'� '3�1. Act - +%.' r'd as N m*xcn -% n - oil711 �g _❑ ag r l �yw 1 ON( cn jr {1 O SS t �iz O �♦ l o N S t N O�. tp 7 � 40 CLAIM BOARS 0; OF CONTRA COSTA COJNTY, CALIFORNIA December 2, 1997 Claim Ayairst 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 y5,� �f California Gcvernnent Codes. ) the action taker, on your claim by the Board o `r` sscrss q) (Paragraph IV below), given pursuant to Government�Cod � 7 9997 Amount: $396,000.00 Section 913 and 915.4. please note all "Wzrnin T CLAIMANT: Charles J. Flynn MARTINEZCALIFL ATTORNEY: Spencer P. Scheer Polk, Scheer & Prober Date received ADDRESS: 145 No. Redwood Drive, Suite 200 BY DELIVERY TO CLERK ON ob 24, 1997 San Rafael, CA 94903 BY MAIL POSTMARKED: October 239 1997 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppHH gg v DATED: 0 qq� B1 IL DeputyLOR, Clerk �e1r tib r 27 1 , J PP 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (v) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send .warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) other: Dated: eputy County Counsel 11I. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( v/ ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /02 a -1,7 9,7 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six• (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney. you should do so immediately. *For additional warnino see reverse side of this notice. AFFIDAVIT OF MAILING 1 declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:_1,2 q%7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF PERVISORS OF CONTRA COST�*OUNTY s STRUCTIONS TO CLAIMANT ; A. 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 before December 31, 1987, must be presented not later than the .100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't 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. : Y; end of this form. RE: Claim By Reserved for Clerk's filing stamp CHARLES J. FLYNN ) RECEI�E� ) Against the County of Contra Costa) - �'�''�' 2 4 07 or ) District) CLERK BOARD OF SUPERVISORS (Fill in name) ) CONTRA COSTA CO. ) The undersigned claimant hereby ,makes claim against the County of Contra Costa or the above-named District in the sum of $ 396,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Indemnification claim arises from Complaint filed against Charles Flynn on November 12, 1996 and is based on County's negligent acts and/or omissions on dates as vet unknown. 2. Where did the damage or injury occur? (Include city and county) 528 Moraga Way, Orinda, Califonria 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attached sheet 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Negligent act and/or omission in maintenance of the culverts and drainage easements located at or near the real property commonly known as 528 Moraga Way, Orinda, CA (over) 5. What are the na*s of county or district coicers, servants or employees caus-, . -.j the damage or injury? Unknown. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) Plaintiff's claims, out of which the claim for indemnification arises, include: excavation and temporary repair of drain pipe ($35,000) ; damage to carpet & flooring ($4,000) ; damage to driveway & landsca ing ($45,000) ; repair of swimming pool ($12,000) : replacement of culvert ($200.000-$30.000_ 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Repairs: $96,000; Culvert replacement: $300,000 S. Names and addresses of witnesses, doctors and hospitals. Charles Flynn: 145 No. Redwood Dr. 4200, San Rafael, CA (415) 491-8900 Sheryl Hayworth: 1676 No. California Blvd. , 44200, Walnut Creek, CA (510) 937-2960 J. Andrew Paulson: 265 Miller Ave. , Mill Valley, CA (415) 381-6399 9. List -the expenditures you made on account of this accident or inj ury.. SATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) ) behalf. " Name and Address of Attorney ) POLK, SCHEER & PROBER ) SPENCER P. SCHEER ) (Claims s ignature) 145 No. Redwood Drive, Suite 200 � San Rafael, CA 94903 ) r (Address) %�� y� Telephone No. (415) 491-8900 ) Telephone No. Sia 0 Aj L NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. Attachment to Claim Form Indemnification claim arises from Complaint against Charles J. Flynn and others filed on November 12, 1996, in Contra Costa Superior Court, Action No. C96-04987 entitled "Hayworth v. Paulson, et al . " (copy attached) , which seeks compensatory and punitive damages from defendants for, inter alia, fraud. The basis for claim of indemnity against the County of Contra Costa is said entity' s negligent acts and/or omissions in maintenance of the culvert and drainage easements located at or near the real property commonly known as 528 Moraga Way, Orinda, California, and legally described as Lot 3 , Map of Moraga Del Rey, Unit No. 1, filed May 24, 1996, Map Book 29, Page 27, Contra Costa County Records. POLK, SCHEER AND PROBER A LAW CORPORATION MICHAEL S.POLK 145 NORTH REDWOOD DRIVE,SUITE 200 SPENCER P.SCHEER SAN RAFAEL,CALIFORNIA 94903 WOODLAND LS DEAN PROBER TEL: (415)491-8900 6400 CAAVENUE 50 OWEN H.PRAGUE FAX:(415)491-8910 SUUITEITE WOODLAND HILLS, CA 91367 DAVID E.PINCH EMAIL:PSPN @ AOL.COM (818)227-0100 DONALD H.CRAM, III 818: MICHAEL IMFELI) FAX ( )227-0101 VICTOR CAPONPON REPRESENTING SECURED MARK DOMEYER CREDITORS NATIONALLY LEE S.RAPHAEL NANCY WECHSLER JARED KLIPFEL DAVID E.RUSSO DATE: October 22, 1997 TO: Clerk of the Board of Supervisors 651 Pine Street County Administration Building Martinez, CA 94553 RE: Claimant: Charles Flynn PSP File No. : F-65-6 Dear Clerk: Enclosed herewith are the following documents: NOTICE OF CLAIM AGAINST THE COUNTY OF CONTRA COSTA for the purpose designated below: Signature on the enclosed document and return in the envelope provided. X Filing and return of the endorsed/filed copies to the undersigned in the envelope provided. Signature by the Judge, filing of the original (s) and return of the endorsed/filed copy(ies) to the party(ies) the enclosed envelope(s) are addressed to. Enclosed is a check in the sum of $ to cover costs involved. Please issue a hearing date. Thank you for your assistance and cooperation in this matter. Sincerely, 3SPOLK, S ER & P SPE ER . SCHEER SP /cls clos r-s k T! / � `- }�< &° - � / \ 9 . ■ i �` � , ■ . . +! $ « -r4 \ k � . . 44 0 \ 41 4 � - - o » # \ 43" % ! 4 0: / -r-4 ~ m _ p r ) q % \ / ® . , w . \ � e c � w # f . ; � � } z � c a ) § � � £ , CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 Claim j�gain5t,,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 Gov1A . t� II��� Amount: $70.00 Section 913 and 915.4. Please note all Wa CLAIMANT: Sharon N. Dohemann OCT 2 9 1997 ATl ORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 411 Rolling Lane BY DELIVERY TO CLERK ON October 29, 1997 Alamo, CA 94507 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 29, 1997 JyIL �eputyLOR, Clerk v II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( 1 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: Z2 , 1157 BY: Z � eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (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. t` Dated: / _ _ /!�q Z HIL BATCHELOR, Clerk, By Deputy Clerk T WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at-all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez. California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: IA- 5 —)`�9� BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of .action for-death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its .office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this form. RE: Claim By ) Reserved for Clerk's filing stamp a RECEIVE® Against the County of Contra Costa ) WT 2 91997 or ) CLERK BOARD OF UPERVISORS District) CONTRA COSTA CO. Fill in name ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 70.00 _ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) l�-Ll nod, ev�t1T,QA �asrA Co. 3. How did the damage or injury occur? (Give full details; use extra paper if required) DRov� oti /(JEU)4y PA ✓ED 2dAo 1-1/1.Z-S Com, ) Tp R65-AC / 1-141ME , 6cJET 71,1,` 3S,01qHYED ON IYIY eA^0 Fle6m TJR E.S_ 4. What particular act or omission on the part of county or district officers, servants or .employees caused. theinjury or- damage? R6PAVilkJ6- WA S 5'C1P/d6.EO TO 5TAk_" qT -7.106 01.07 • 0A)-/D/l�-!. 7HE --VO6 Wq-5 -5'7-AR7-E,O /iUSTEliD,, LATE /f1 MA11A)6- 6A)Z) %H,Ri''�DRE, lUaT ENo0614 71ME W q5 �qL�o �,1JEiJ F k P4 ViAf C- To SET 1_�Fc,a -KJ D 0,1L,Dr9 Y. 7WflAq, /v or/,f4- HEY -6WI 15 (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? , 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Dn) 13o—l# 5/DFS 0IC (�ifP 6CIWAID Ti/SES F6k PA. a,3 r- i 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) (,dEN i o ,_Uel 7ft -rltc Y5/6,Cc7-f-,D 44 Nt A&C-_ ----------- ---------- ----------- 8. Names and addresses of witnesses, doctors and hospitals. -M----------------------N_N___-_ ____-M_-M-- -------_________-_____M_�___ 9• List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT � T�� /��Nt�yA� 36,c�v V* * 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 Claimant's Signature � (Addres Telephone No. Telephone No. J�'DI I F' -iF N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine,-,or -by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. .� Wires 192 2061 Camino Ramon•San Ramon, CA 94583 510/901-1400•FAX 510/901-1401 NAME: DATE: sff ,,fv ADDRESS: CITY: Z/li ail/.J C- A I U DAY PHONE: EVENING PHONE: LICENSE PLATE#: YEAR: MAKE13: MODEL: COLOR: AtJ CONDITION OF VEHICLE: 4 ESTIMATE AMOUNT: 7M7 DELIVER? TIME RECEIVED: TIME PROMISED: PHONE WHEN READY? Sponges Professional Interior $ Sponges Super Shine $ Sponges Professional Shine $ Sponges Professional Complete Detail Special $ ALA CARTE SERVICES Shampoo Carpets Front_ Middle_ Back All ................ $ Shampoo Seats Front_ Middle_ Back All ................. �$ Shampoo Floor Mats Rubber?_ Carpet?— Quantity ............... $ Dress Interior Leather Seats_ Doors Dash_ All .............. $ Carpet&Fabric Protector Carpets Fabric Both_ ................ $ ry o Road Tar Removal ..................................................... $ G7 Overspray Removal .................................................... $ Engine Cleaning Top— Bottom_ Both_.......................... $ Authorized By ...........................................TOTAL AMOUNT $ -70 Special Instructions&Disclaimers: Dash Dressing ❑Bright ❑Matte REF BY WRITTEN BY CUSTOWAER COPY ' C_ •3 2� CLAIM . B:A;: 0r S c:ci'.S:=.S CC CCNTkA C:STA CO'_"QTY, CALIFOR.,A December 2, 1997 Clair„ Acairst the Ccunty, or C,strict governed by) BOAR: ACTION the Bcard of Supervisors, Ro„ ting Endorsements, ) N.^TICE TO CLAIMANT and Board Actic^. All Section references are to ) The copy of this document mailed to you is your notice of Cal�fc-ria Gcverr-%e^t Codes. ) the action taken on your claim by the Board of Superviscrs (Paragraph IV below), give^ pursuant to Government Code Amount: Unknown Section 913 and 915.4. Please note all "Wq071gVIED CLAIMANT: Miriam Cobiseno (Davis) OCT 2 3 1997 ATTORNEY: Gregory H. McCormick, Esq. Caudle, Welch, Politeo & Bovee Date received MARTINEZCALIF. ADDRESS: 1390 Willow Pass Road, Suite 200 BY DELIVERY TO CLERK ON October 23, 199 Concord, CA 94520 8Y MAIL POSTMARKED: October 21, 1997 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: October 23, 1997 �aIl DepuiyLOR, Clerk II.” FROM/: County Counsel 70: 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 warring of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 0%�} / BY: Dep.•ty County Counsel 111. FROw.: ClerK of the Board TO: County Counsel (1) County Ac-iristrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOA;,: ORDER: By unanimous vote of the Superviscrs 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: /A - a -/9 9 7 PHIL BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you Should do so immediately. *For additional warnino 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: IA - ,3 - BY: PHIL BATCHELOR by� ' Deputy Clerk CC: County Counsel County Administrator 1 JOHN P. CAUDLE, ESQ. State Bar No. 42741 2 GREGORY H. McCORMICK, ESQ. State Bar No. 164461 CAUDLE, WELCH, POLITEO & BOVEE 3 1390 Willow Pass Road, Suite 200 Concord, CA 94520 RECEIVE 4 Telephone: 510/688-8800 Facsimile: 510/688-8801 5 OCT 2 31997 Attorneys for Claimant 6 MIRIAM L. DAVIS CONTRA COSTA CLE RK BOARD OF SUPERVISORS 7 8 CLAIM AGAINST COUNTY OF CONTRA COSTA 9 TO: COUNTY OF CONTRA COSTA 10 Clerk of the Board of Supervisors 651 Pine Street, Room 106 11 Martinez, California 94553-1293 12 CLAIMANT'S NAME: MIRIAM COBISENO (DAVIS) 13 c/o CAUDLE, WELCH, POLITEO & BOVEE 1390 Willow Pass Road, Suite 200 14 Concord, California 94520 15 CLAIMANT'S TELEPHONE: c/o'510/688-8800` 16 AMOUNT OF CLAIM: Indemnification and contribution. 17 18 ADDRESS TO WHICH NOTICES 19 ARE-TO BE SENT: Gregory H. McCormick, Esq. 20 CAUDLE, WELCH, POLITEO & BOVEE 1390 Willow-Pass Road, Suite 200 21 Concord, California 94520 22 DATE OF OCCURRENCE: May 10, 1996 23 ORIGINAL COMPLAINT: Contra Costa Municipal Court 24 Delta Judicial District Action No. DC 054408 25 SERVED ON CLAIMANT: July 15, 1997 Claimant MIRIAM COBISENO (DAVIS) 26 herewith files this claim for indemnification and 27 = contribution against the County of Contra Costa within the six months of being served the original complaint, as 28 required by 'Government Code Section 911.2. CAUDLE,WELCH POLITEO&BOVEE A P-f—i—I taw Coryo` — I PLACE OF OCCURRENCE: At the intersection of Wilbur Street and a private road 2 (name of which-is currently unknown) in City of Antioch, County of Contra Costa, State of California. 3 HOW DID CLAIM ARISE: MIRIAM COBISENO (DAVIS) was traveling on Wilbur 4 Street in Antioch, California on May 10, 1996 at approximately 8:30 p.m. when she was involved in an 5 auto accident because a stop sign at the intersection of 6 Wilbur Street and a private road (name of which is currently unknown) had been knocked down prior to MS. 7 COBISENO'S (DAVIS) arrival at the area. 8 MS. COBISENO (DAVIS) was unaware of the dangerous condition presented by the 9 lack of a stop sign which is believed to have been placed, maintained, and controlled by the 10 City of Antioch, and, because of the dangerous condition MS. COBISENO (DAVIS) was 11 involved in a motor vehicle accident. 12 13 The names of the public employees causing plaintiffs injures are presently unknown. 14 My claim is in the form of indemnity and contribution for damage sustained by other parties 15 involved in the accident according to proof. 16 DATE: October , 1997 CAUDLE, WELCH, POLITEO & BOVEE 17 18 19 GREGO Y H. McCORMICK, ESQ. 20 Attorneys for Defendant MIRIAM COBISENO (DAVIS) 21 22 23 .24 25 26 27 28 CAUDLE,WELCH POLITEO&BOVEE A P-f—.,W Law Ca'poca— —2— 1 PROOF OF SERVICE BY MAIL (C.C.P. Sections 1013a(3). 2015.51 2 I, the undersigned, declare: 3 That I am employed in the City of Concord, County of Contra Costa, State of 4 -California; that I am over the age of eighteen years and not a parry to the within cause; that _ny business address is 1390 Willow Pass Road, Suite 200, Concord, California 94520. 5 That on OctoberW , 19971 served the within CLAIM AGAINST THE 6 COUNTY OF CONTRA COSTA on the interested parties, by placing a true copy thereof 7 inclosed in a sealed envelope with postage thereon fully prepaid, in the outgoing mail box -ocated in my office addressed as set forth below in accordance with ordinary business 8 oractices for deposit with the United States Postal Service in Concord, California. I am =eadily familiar with my office business practice for collection and processing of 9 correspondence for mailing and the within correspondence will be deposited with the United 10 States Postal Service this date in the ordinary course of-business. 11 Steven H. Henderson Jill Stem-Henderson 12 JAW OFFICES OF STEVEN H. HENDERSON 3024 Railroad Avenue 13 ?ittsburg, CA 94565 14 15 I declare under penalty of perjury under the laws of the State of California that the 16 -oregoing is true and correct. 17 Executed on October02/, 1997at Concord, California. 18 Sally 14,61vorosa, Declarant 19 20 21 22 23 24 25 26 27 28 CAUDLE,WELCH POLUEO&BOVEE A 14dwi W La Catpm tim o y, r Y Ju- Lo t! N jo . ►0 03 tr O• rp W o i t 1 3 i 6 titin � , o � - CLAIM BOARO OF SI-EPV!SORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 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 Gcvernnent Codes. ) the action taken on your claim by the Board of Supervisors� y (Paragraph IV below), given pursuant to Gove T Amount: $50,000.00 Section 913 and 915.4. Please note all "Warnins" 6 C T 2 1 1997 CLAIMANT: Gary B. Moore COUNTY COUNSEL ATTORNEY: MARTINEZ CALIF. Date received ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON October 24,J997 Martinez, CA 94553 BY MAIL POSTMARKED: October 23, 1997 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. October 27 1997 PpHHIL ATCHELOR, Clerk DATED Bl: Deputy a J v 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 910.2, 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: ZD—zs' `J BY: ZV" _ AJ eputy County Counsel III. FROM.: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /02 - - /9 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six- (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For additional warnino 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: 12 -\3 —/721Z BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator t " Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT R. 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 before December 31, 1987, must be presented not later than the .100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after- the accrual of the cause of _ action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. if claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp C RECEIVED ' Against the County of Contra Costa) or ) _ !(�i, 2 41997 District) CLERK BOARD OF SUPERVISORS- (Fill in name) ) CONTRA COSTA CO. ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ O an� oa and in support of this claim represents as follows: 1. When did the damage or injury occur'? (Give exact date and hour) G V5 V' 1 � 1 19 � 1 BMJ Cts-4L O.V46,-J _611S _�I L C..,Lt J Ae 2. Where did the damage or injury occur? (Include city and county) V%- C4. C 0 %/ Vt 3. How did the damagenjury�, occur? (Give full �etails; use extra paper if required)< `w� o �ttvAv \,, �0 © y 0 GVH/ l 4., at pakticular act or omission on the pari of county or district officers, servants or employees caused the injury or damage? 0 �s (a� '� (over) 5. What are the names of county or district officers, servants or i employees causing .the damage or injury? ZJo�50 �J r`^ �r-1 lwcz C..o...��_y 7J S 6. What damage or injuries do you claim resulted? (Give full ext nt of injuries or damages claimed. Attach two estimates for auto damage. ) 1 f 7. How was the amount claimed above computed? (Include the estimated amount of an� prospective injury or damage. ) ''Ov C, Cw w P V cri �!'�C �. 4�.� ya,�Y :� Fr GtS .�.�.. 8. Names and addresses of witnesses, doctors and hospitals. MNe.J, Q.OQ 7 0# ,` '°� �`�a �tic� ��►.fir �� S � � 9. List the expenditures you made on account of this a cident or injury. DATE TIME AMOUNT Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) ) behalf. " Name and Address of -Attorney ) ( aimant's ignature) (Address) _ t 'AJ ) Telephone No. ) Telephone No. �7ii i VV*//�t��1��1 XCE 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 bey imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. r G_wA - BSc.._ A-Wo �-2§4 � w.0 O��IC e.,S �I A V� C!� �2.Y S�1��•t J D�'O V��+,v-� 7Y- �N 0.5 V lo.`a1 'p-CA., Vl-% (i S (—O N5l ti�V� �OhJG' kaQv�� � e c�tN e r `V� � be Te.ayse. e42 ` ..Z VAV- �5 ire. %.c- -A � �„e � �r¢� �6�,� 1 l �c� Cov - - Are, C4 sO v�_CAVIIN. _ea V- �ArJiS01- - 1-Chcf^ .. a_C�.�I �. _—o�+Nt.� � Gt.�-� 0. ._oN� O - etl,-- . 5'-°- 1t� V'oe�w�1 l r o v 1 O _. O L c t� .r✓ q 1^ C1 �1 _lam �a� J �CA.vt. ct c�a �°J e.a c1't_¢S�•l�_q c ►�.t u e�n�a ---- ---- -----• - �—•-----'�l `-`\�� --t N. .����' _s�� `c-ti„Cam-���- -�e, _ ��S_ \/ to,c��eo'�- - - -- - - ._ - - - Y�y ��►.�S11lvl-�vwcx�. �rl�. �_�.�� � .. � � �r_e.�e_�.�ea�- : - - - --- --- - - 0 �-- - ct UN.e�"v4W�� - _ w-CVl - a1 c� �,_ w CA r Ab - - �` �S 0.�^. � '{c Z Y3v� �@a41p � L1S@+r§�3yct �b S C- A w o 60 G'Tl�e F—q+a S e1 t��.a 1!�C vJ ' �t Y G o G3 CLQ, cvu a � . ` Ve r-ov(A • Me , O a �1 sow Olv �{ ) V^ a�J Sc l ` g y �S _l�.! CcnSr. lvvr.' ° 0 eaV Cl1NU2 �XCCSSIv��'�Ow�� V�.�eW C �j�o1r O� t ilak=ioaklait",kl= lie lie CL 41F cc 4n VA 0% CD ko" LA -Z cr 157- 71"7,77777 CLAIM C 3 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA December 2, 1997 C1aim'Ag6i-ns't 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 Govtt Amount: Exceeds Jurisdictional Limits Section 913 and 9i5.4. Please note all " rnd Ws 1EM) of the Municipal Court CLAIMANT: Sarah Peck, et al. NOV 14 1997 ATTORNEY: Robert B. Galler, Esq. COUNTY COUNSEL Bennett, Johnson & Galler Date received MARTINEZ CALIF. ADDRESS: 1901 Harrison Street, Suite 1650 BY DELIVERY TO CLERK ON November 7, 1997 Oakland, CA 94612 BY MAIL POSTMARKED: November 6, 1997 Certified Mail I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. BATCHELOR, DATED: November 14, 1997 ��IL Clerk II. FROM: 'County Counsel TO: Clerk of the Board of Supervisors (li/) 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). 1 Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: /!' /r / / BY: -,71 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( v ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /-;?-�? —/172Z PHIL BATCHELOR, Clerk, By Deputy Clerk CL WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /�Z _,3_l9q 7 BY: PHIL BATCHELOR by putt' Clerk CC: County Counsel County Administrator GOVERNMENT CLAIM FOR DAMAGES TO CLAIMEE: COUNTY OF CONTRA COSTA and its agents, employees and representatives c/o Clerk of the Board of Supervisors RECEIVED �} 651 Pine Street, Room 106 Martinez, CA 94553 1�V - 7199f i j CONTRA COSTA COUNTY DEPARTMENT OF CLERK BOARD OF SUPE r" '"`g MENTAL HEALTH and its CONTRA_CO�°" -, agents, employees and representatives Adult Services No. 40 Douglas Drive, Suite 140 Martinez, CA 94553 FROM CLAIMANTS : SARAH PECK and the heirs and representatives of the Estate of SUSAN PATRICIA STEELE, deceased 1617 B Street Napa, CA 94559 ADDRESS TO WHICH NOTICES Robert B. Galler, Esq. ARE TO BE SENT: Bennett, Johnson & Galler 1901 Harrison Street, Suite 1650 Oakland, CA 94612 DATE CLAIM ACCRUED: On or about May 9, 1997 PLACE CLAIM ACCRUED: 3137 Sheffield Place Concord, California CIRCUMSTANCES : Claimees, and their employees, agents and representatives were negligent in the care and treatment provided to Decedent and failed to follow proper procedure for the care, treatment and monitoring of an individual such as Decedent . Further, said Claimees, and their employees, agents and representatives, negligently placed the Decedent in an unlicensed board and care facility and knew, or should have known, that as a result improper services, including improper medical care, would be provided to her. Additionally, said Claimees and their employees, agents and representatives negligently allowed the Decedent' s conservatorship to lapse and, as a result, necessary medical care was not provided to her as well as other appropriate services . As a direct and legal cause of the negligence of Claimees and their employees, agents and representatives, SUSAN PATRICIA STEELE died. DAMAGES : As a result of the negligence of Claimees and their employees, agents and representatives, as referenced herein, the Claimants have suffered the loss of said Decedent' s care, comfort, society, affection, companionship, love, support, guidance and instruction. The total damages claimed exceed the jurisdictional limits of the Municipal Court . AMOUNT OF CLAIM: In excess of the jurisdictional limits of the Municipal Court, subject to proof . DATED: November 3 , 1997 . ;BERT ET JOHNSON & GALL R B. GALLER Attorneys for Claimants 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 November 4 , 1997, 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 COUNTY OF CONTRA COSTA 10 c/o Clerk of the Board of Supervisors 651 Pine Street, Room 106 11 Martinez, CA 94553 12 CONTRA COSTA COUNTY DEPARTMENT OF MENTAL HEALTH - ADULT SERVICES 13 No. 40 Douglas Drive, Suite 140 Martinez, CA 94553 14 Sent Certified Mail - Return Receipt Requested 15 / X / (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 corre`' t . 25 Executed at Oakland, California, on November 4, 1997 . 26 27 CINDY R N (!! 28 bd td W 1 coo 3 0 e,, _ x o O ew C3a g It-Itgs � ` neo .4 co C(0 p ,p y va *' (3)zo oCD $ r N Amo n oo n r co n � ao (D (-Ta Ln Lawn w O O O t-' cs O m ri, to tR N ca ti LAVP OFFICES BENNETT, JOHNSON & GALLER AN ASSOCIATION INCLUDING A PROFESSIONAL CORPORATION MAIN OFFICE 1901 Harrison Street 16th Floor ,a..� Oakland,CA 94612 (510)444-5020 November 4, 1997alw � RECENED 1 FAx(510)835-4260 � 5 County of Contra Costa ARK CO. BOAR pF SUPERvoSOF'S c/o Clerk of the Board of Supervisors C C04r COs rA 651 Pine Street, Room 106 Martinez, CA 94553 RE: Claim of Sarah Peck Dear Clerk: Enclosed please find an original and copy of a Claim presented on behalf of our above- captioned client. Please "receipt stamp"the copy and return it to this office in the envelope provided at your earliest convenience. Very truly yours, 7BT, JOHNSON& GA LER Robert B. Galler RBG:clh Encls. NAPA COUNTY RIVERSIDE COUNTY SANTA BARBARA 1001 Second Street 82500 Hwy. 111 COUNTY Suite 275 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