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HomeMy WebLinkAboutMINUTES - 09091997 - C22 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Gocm VT, Amount: $3,000,000.00 Section 913 and 915.4. Please note all "WVs.. 3) . CLAIMANT: Lois Desch AUG 0 T 1997 COUNTY COUNSEL ATTORNEY: Stan Casper MARTINEZGAUF. Casper, Meadows & Schwartz Date received ADDRESS: 2121 North California Blvd.. BY DELIVERY TO CLERK ON August 6, 1997 Suite 1020 Walnut Creek, CA 94596 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. August 7 1997 QQHHIL BATCHELOR, Clerk ' GATED: g BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2,,and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ! , BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: "9 - q- q 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:—')- SID-9 1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator RECEIVED STAN CASPER, State Bar 56705 AUG 6 199 CASPER, MEADOWS & SCHWARTZ =s 3 �'�. A Professional Corporation CLERK BOARD OF SUPS_--`%� sORS 2121 North California Boulevard, Suite 1020 1 CONTRA Cos-1s'__c.�X_j Walnut Creek, California 94596 Telephone: (510) 947-1147 Attorneys for Claimant CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: County of Contra Costa Board of Supervisors 651 Pine Street Martinez, California 94553 CLAIMANT'S NAME Lois Desch ADDRESS AND 96 Elder Drive,Apt. E TELEPHONE NUMBER Pacheco, CA 94553 510/686-6711 AMOUNT OF CLAIM $3,000,000.00 ADDRESS TO WHICH _ NOTICES ARE TO BE SENT: STAN CASPER CASPER, MEADOWS & SCHWARTZ A Professional Corporation 2121 North California Boulevard Suite 1020 Walnut Creek, California 94596 DATE OF OCCURRENCE : March 5, 1997 PLACE OF OCCURRENCE : Martinez, California HOW DID CLAIM ARISE . This claim is based upon the medical negligence of Dr. William P. Sweezer, Jr., and other staff members including physicians of Merrithew Memorial Hospital in failing to properly diagnose and treat Claimant's decedent (Craig Desch) during his post-operative recovery period. Claimant's decedent Craig Desch was admitted for a surgical procedure (craniotomy with laminectomy) on February 28, 1997. While recovering from the operation Claimant's decedent aspirated a pill which lodged in the right main stem bronchus. Hospital staff had. permitted decedent to be given medication by mouth (pill) notwithstanding their knowledge and appreciation for decedent's respiratory and eating(swallowing)problems. Claimant's decedent was required to be intubated by staff physicians. Notwithstanding staff physicians' knowledge and appreciation that decedent's condition was unstable and that his breathing tube should not be removed, staff physicians permitted Dr. William P. Sweezer, Jr. to remove decedent's breathing tube in an effort to remove the aspirated pill. Decedent immediately went into respiratory failure and died. The injuries sustained by Claimant as far as known as of the date of the presentation of this claim consists of loss of future earnings and the loss of love, society, and companionship. Jurisdiction over the claim would rest in the Superior Court. ITEMIZATION OF CLAIM Loss of Earning Capacity $2,750,000.00 General Damages Including Loss of Love, Comfort and Society $ 250,000.00 Dated: August 1, 1997 CASPER,MEADOWS & SCHWARTZ A Professi al Corporation TAN CA; Attorneys for C imant LOIS DESCH RE: CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: Board of Supervisors, County Of Contra Costa PROOF OF SERVICE BY HAND DELIVERY I declare that: I am employed in the County of Contra Costa, State of California. I am over the age of eighteen (18) years and not a party to the within entitled cause. My business address is 2121 North California Boulevard, Suite 1020,Walnut Creek, California 94596. On August 6, 1997, I served the CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL by hand delivering a true copy thereof to the following: Board of Supervisors County of Contra Costa 651 Pine Street, Suite 106 Martinez, California 94553 I declare under penalty of perjury of the laws of the State of California that the foregoing is true and correct and that this declaration was executed on August 6, 1997, at Walnut Creek, California. JSJTEIDWICK RE: CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: Board of Supervisors, County Of Contra Costa PROOF OF SERVICE BY HAND DELIVERY I declare that: I am employed in the County of Contra Costa, State of California. I am over the age of eighteen (18) years and not a party to the within entitled cause. My business address is 2121 North California Boulevard, Suite 1020, Walnut Creek, California 94596. On August 6, 1997, I served the CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL by hand delivering a true copy thereof to the following: Board of Supervisors County of Contra Costa 651 Pine Street, Suite 106 Martinez, California 94553 I declare under penalty of perjury of the laws of the State of California that the foregoing is true and correct and that this declaration was executed on August 6, 1997, at Walnut Creek, California. f i*AIDC WICK CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $3,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Tina Desch ATTORNEY: Stan Casper Casper, Meadows & Schwartz Date received August 6 1997 ADDRESS: 2121 North California Blvd. BY DELIVERY TO CLERK ON g Suite 1020 Hand Delivered Walnut Creek, CA 94596 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. Au ust 7 1997 PpHHIL BATCHELOR, Clerk DATED: g BY: Deputy 41 1 a II. FROM: County Counsel TO: Clerk of the Board of Supervisors ' This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY; Deputy County Counsel 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 ( /) 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. i Dated: �1 - q q 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: 10- 9-79 BY: PHIL BATCHELOR by h 61AQ, _Deputy Clerk CC: County Counsel County Administrator RECEIVE STAN CASPER, State Bar 56705 M 61997 CASPER, MEADOWS & SCHWARTZ a:5� 3 A Professional Corporation CLERK BOARD OF SUPERVISORS 2121 North California Boulevard, Suite 1020 CONTRA COSTA CO. Walnut Creek, California 94596 Telephone: (510) 947-1147 Attorneys for Claimant CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: County of Contra Costa Board of Supervisors 651 Pine Street Martinez, California 94553 CLAIMANT'S NAME Tina Desch ADDRESS AND 96 Elder Drive, Apt. E TELEPHONE NUMBER Pacheco, CA 94553 510/686-6711 AMOUNT OF CLAIM $3,000,000.00 ADDRESS TO WHICH NOTICES ARE TO BE SENT: STAN CASPER CASPER, MEADOWS & SCHWARTZ A Professional Corporation 2121 North California Boulevard Suite 1020 Walnut Creek, California 94596 DATE OF OCCURRENCE : March 5, 1997 PLACE OF OCCURRENCE : Martinez, California HOW DID CLAIM ARISE . This claim is based upon the medical negligence of Dr. William P. Sweezer, Jr., and other staff members including physicians of Merrithew Memorial Hospital in failing to properly diagnose and treat Claimant's decedent (Craig Desch) during his post-operative recovery period. i Claimant's decedent Craig Desch was admitted for a surgical procedure (craniotomy with laminectomy) on February 28, 1997. While recovering from the operation Claimant's decedent aspirated a pill which lodged in the right main stem bronchus. Hospital staff had permitted decedent to be given medication by mouth (pill) notwithstanding their knowledge and appreciation for decedent's respiratory and eating(swallowing)problems. Claimant's decedent was required to be intubated by staff physicians. Notwithstanding staff physicians' knowledge and appreciation that decedent's condition was unstable and that his breathing tube should not be removed, staff physicians permitted Dr. William P. Sweezer, Jr. to remove decedent's breathing tube in an effort to remove the aspirated pill. Decedent immediately went into respiratory failure and died. The injuries sustained by Claimant as far as known as of the date of the presentation of this claim consists of loss of future earnings and the loss of love, society, and companionship. Jurisdiction over the claim would rest in the Superior Court. ITEMIZATION OF CLAIM Loss of Earning Capacity $2,750,000.00 General Damages Including Loss of Love, Comfort, Society and Consortium $ 250,000.00 Dated: August 1, 1997 CASPER, MEADOWS & SCHWARTZ A Professi al Corporation Y: STAN CA Attorneys for �aimant TINA DESCH RE: CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: Board of Supervisors, County Of Contra Costa PROOF OF SERVICE BY HAND DELIVERY I declare that: I am employed in the County of Contra Costa, State of California. I am over the age of eighteen (18) years and not a party to the within entitled cause. My business address is 2121 North California Boulevard, Suite 1020,Walnut Creek, California 94596. On August 6, 1997, I served the CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL by hand delivering a true copy thereof to the following: Board of Supervisors County of Contra Costa 651 Pine Street, Suite 106 Martinez, California 94553 I declare under penalty of perjury of the laws of the State of California that the foregoing is true and correct and that this declaration was executed on August 6, 1997, at Walnut Creek, California. 6VSA TEDWICK 4 Y CLAIM (1 ,2a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $750.00 + Section 913 and 1 "Warnings". CLAIMANT: Ann H. Devor JUL 2 8 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 2916 Eccleston Avenue BY DELIVERY TO CLERK ON July 22, 1997 Walnut Creek, CA 94596 BY MAIL POSTMARKED: July 21, 1997 I. FROM: Clerk of the Board of.Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 28, 1997 PpHHIL BATCHELOR, Clerk Bl�: Deputy II. FROM: my Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( Y) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: - 9 HIL BATCHELOR, Clerk, BY-11211A hJy 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: BY: PHIL BATCHELOR by kJJA A V1 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 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 l agai tom' more i han 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 ANN H. DEVOR ) 30 R ECEI�Y ED Against the County of Contra Costa) ;. ,� 2 2 19g-1 or CONTRA COSTA FLOOD CONTROL District) I CL�RKBOARDOFSUPER�lISOR5 (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 $ 750.00 + and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) January 22, 1997 and January 25, 1997 - exact hours unknown 2. Where did the damage or injury occur? (Include city and county) 2916 Eccleston Avenue, Walnut Creek, California 94596 3. How did the damage or injury occur? (Give full details; use extra paper if required) Flooding from storm drain. Sewage overflow. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to prov de..adequa,te storm drainage in Walnut Creek and Pleasant Hill and failure to maintain .st.orm drainage easement. (over) 5. What are the names of county or district officers, servants or i • employees causing the damage or injury? Unknown. The damages were jointly caused by the City of Walnut Creek and 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) Debris and hazardous waste from flooding and •and sewage overflow had to be cleaned up. Side gate to back yard undermined and knocked over by flooding. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) Receipt for debris clean-up is attached. Unknown amount for gate repair. 8. Names and addresses of witnesses, doctors and hospitals. Neighbors on Eccleston Avenue are aware of flooding on these dates. Neighbors also helped me deal with flooding as it happened. 9. List t::2 expanditures you uicic a un account of this accident or inj ury.. DATE TIME AMOUNT Not an accident or personal injury. $750.00 has been expended for clean-up to date. Gate. repair needs to be done. 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 ) _ /Z//y No attorney- at this time., ) (Claimant's Signature) Ann H. Devor 2916 Eccleston Avenue Walnut Creek CA (Address) 94596 Telephone No. ) Telephone No. 510-943-1173 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. SQ I» 1� ABA LANDSCAPING Concrete Tree Trimming Fences Hauling Stonewall, Brick Concrete Repairs Retaining ails q/Stump Removal Dovegs�G . s+ 4 , t ViI Ito r %- �� �G►� c:� _ � Dom, ..� � . �� Sir ;.'' �; "`�L psi .S ;Q,© \ �,.• •.. �Y CLAIM C a BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: in Excess of $101000 Section 913 and 915.4. Please note all "WaffP(r1R11 tUf 1E10 CLAIMANT: Jerry and Donna Fellows AUG 0 7 1997 ATTORNEY: Glendon W. Miskel, Esq. COUNTY COUNSEL Johnson & Miskel Date received MARTINEZ CALIF. ADDRESS: 2330 Marinship Way, Ste. 230 BY DELIVERY TO CLERK ON Thy 31, 1997 Sausalito, Ca -945fr5=2800 9�tq(oS BY MAIL POSTMARKED: July 30, 1997 gX110r o n ZIP Co DN 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ppaII D eputOR, Clerk DATED: At�ust 7, 1Aq7 y II. FROM: County Counsel TO: Clerk of the Board of Supervisors ` '� This claim complies substantially with Sections 910 and 910.2. !( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARDD ORDER: By unanimous vote of the Supervisors present ( 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: 9-9 - 91 PHIL BATCHELOR, Clerk, BDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: yl BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF {� JOHNSON ,T,`Cv 1 11 ISK L TELEPHONE (415)332-0222 N1 �>1C Ji �iLue FACSIMILE (415)332-1192 WILLIAM F.JOHNSON 2330 MARINSHIP WAY E-MAIL j_mlaw@pacbell.net GLENDON W.MISKEL SUITE 230,MARINA OFFICE PLAZA SAUSALITO,CALIFORNIA 94965-2800 FROM SF (415) 391-1320 July 30, 1997 VIA FEDERAL EXPRESS RECEIVED Clerk of the Board of Supervisors JUL 3 11997 Contra Costa County CLERK Room 106 BOARD OF SUPERVISORS CONTRA COSTA CO. County Administration Building 651 Pine Street Martinez, CA 94553 Re: Death of Ted Fellows/Claim of Terry and Donna Fellows Dear Sir/Madam: Enclosed please find a claim against Contra Costa County arising out of the death of Ted Fellows. This claim results from events occurring on March 15, 1997 at Merrithew Hospital in Martinez, California. Please forward the Contra Costa County response directly to the undersigned. ery tr s Glendon W. Miskel GWM:sam Enclosure cc: Clients \CCC0730.LTR - JUN-17-'97 14:04 ' ID:'JOHNSON f9ISKEL TEL N0:415-391-7321 #061 P01 Glaim,Lo: :HOARD:OF4UPERVISDRS 0F�aOtiMMST*0OUNTY INSTRUCTIONS TO CUIMAAff A. Claims relating to causes of action for death or for injury to person or to per- sonal property.Qr growing crops-and-which accrue on or berbre DecemW 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 fnr.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 rause of aotion.. Claims relating to any other cause of action must-be presented scot later than one year after the accrual of the cause of action. (Govt. Code §411.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its offioe 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 claiam, Penal. Code Sec. 72 at the end of this fFm—.. rr • aerrre • • +t.�raessseatsaEeraisee • rrRafeaa< • 1r +raa ■ +rs RE: Claim By ) Reserved for Clerk's filing stamp ) JERRY and DONNA PEU04S ---�.-- RECEIVED Aga ns the EMU of EM costa ) or JUL 3 11957 District)) . CLERK BOARD OF SUPERVISORS ' Fill in name �—�) CONTRA COSTA CO. The undersigned claimant hereby makes slams against the County of Contra Costa or the above-named District in the sumas" ink cess of-s1o.00oand in support of this claim represents as follows: .. wwwwwrrr.�wwwrrwa.wrwwwrr rararrr�a.�3r�sra:.rw..rr+...+..rwr-rrr 1. When. did the damage or injury occur? (Give exact date and hoar) March 15, 1997, 15:06-le:15 Lin r..+Www-+rr..w►wr-r--.+r..r.-rwrrrr�.+rwr-rrr�-w....w+.r.�.r..rrrr..rrrrr-+r-r-�-�.�--rr►.sM...-_ .- 2. Where did the damage or Injury occur? (Include city and county) MERRITHEW MEMORIAL HOSPITAL Emergency Room Martinez, Contra. Costa. County, California rr-rw++..w+.wrw.+++- w+w .r-.�wwwrrrwrrrr-�•wrw�•r:-r-..w..r--rr 3. How did the damage or injury occur7 (Give full details; use extra- paper if required) dee attached statement.;• r�.rM+w.v rwrrrr..—rrrr r,n.�.r. —w----rw�-- ----------- r+.w—.�wwM—r 4. What particular actor omission on 'the part of county or district oMcers, servants or employees caused the injury or damage? Pr. Shiela David misdiagno.aed•Ted Fellows' strep. infection as-- influenza. JUN-17-'97 14:05 ID:JOHNSON MISKEL TEL NO:415-391-1321 #061 P02 5. Wnat are the names of county or district officers, servants or employees causing the damage or injury? Dr. Shiela David, the administrators and staff of Merrithew Memorial Hospital. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Death of our 14-year-old son. -We. have lost his love, companionship, comfort, affection, society, solace, physical assistance and economic --w--Mw�w-+-r.Mr--Tww--wwwNwNwwwwNww-w rwwww-w�I+.www-..MwwwNwY 7. How was the amount claimed above computed? (Include the estimated amount of any Buppox t prospective injury or damage.) Amount exceeds $10,000_. Our claim asof this ,date -is' in an amount that would place it within the jurisdiction of the Superior Court. w-ww--r-----ww-r-r-r--r---rwwwww r..-+..w+-wr...aww..www+-ww.w-w-+rrNwwwwwa-..s..�ww�.. 9.. Names -and addresses of witnesses, doctors and hospitals. Jerry Fellows, Donna Fellows, Stacey Fellows, Dr. Sheila David and the staff at Merrithew Memorial Hospital. _wr_.......,._-..-_...._..-..wr-w.- www-wr..r.....r_-_www...._....-w_w__-.. 9. List the expenditures you made on account of this aooident or injurya DATE -Im AMOUNT _ Presently unknown and uncalculated. • st • w r r st • e .e • e e a x e e e •e s.e e e • e e • e e e w e • s st • • s s • e w e God. Code Sec. 910:2 providest " laim must be signed by the claimant SEND NOTICES TOs (Attorney) bV some-person on his. ." VZWIRT Address of Attorney Glendon W. S , EsEsq. 1mant s Signature)D3MFELLS JOHNSON 1* MISKEL XEL 2330 Marinship Way, Suite 23 711 Carquinez Street Sausalito, CA 94965-2800 (Address) Martinez; CA= .94553 Telephone No. (415) 332-0222 Telephone No.(510) 372-6052 • sitsw • ts • es * esee si • s► 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 oounty fail for a period of not more than one-year, by a fine of not exceeding one thousand ($2,000), 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 AGAINST CONTRA COSTA COUNTY BY TERRY AND DONNA FELLOWS On March 15, 1997, Ted Fellows, a 14 year old male, was brought by his parents to the Emergency Room at Merrithew Memorial Hospital in Martinez with complaints of"sore throat, headache, chills and fever." His temperature at the time of admission was 104.3' and ran as high as 105.1' while he was in the Emergency Room. His parents informed the admitting nurse that his fever had been as high as 105.7° just prior to his arrival and that they suspected he was suffering from spinal meningitis or some other serious infection because of his extremely high fever. Dr. Shiela David, the emergency room physician, examined Ted and made a diagnosis of "influenza." She prescribed and administered Motrin 600 mg. and discharged Ted after reassuring Ted's parents that there was nothing seriously wrong with him. During the following two days Ted's parents called the Emergency Room as Ted's temperature continued to spike as high as 102° plus. They were told not to worry and to double the dosage of the Motrin which would have the effect of lowering the temperature temporarily. On March 19,1997,Ted was returned to the Emergency Room in critical condition. He was then diagnosed with "Viral Encephalitis, Intracranial Abscess, Subdural Hemorrhage, Ethmoidal Sinusitis and Bacterial Infection/Strep Grp D." In short, Ted had a common strep infection that progressed from his sinuses and entered his brain. Ted went into a coma and subsequently died on March 26, 1997. Despite Ted's unusually high fever of 105' plus, Dr. Shiela David and other members of the Merrithew Memorial Hospital staff failed to recognize the obvious signs of a serious infection, failed to properly diagnose Ted's condition and failed to order the routine lab work that would have shown that Ted was suffering from an acute strep infection. Similarly, they failed to administer.antibiotics which could have remedied the strep infection and prevented the progress of the strep infection that caused Ted's death. Additionally, the administration and staff at Merrithew Memorial Hospital- failed to implement reasonable procedures and protocols which would require lab testing as a matter of course in treating a patient with a fever of more than 104 degrees. FELLOWS\ATTACH.CLM -� z -- 3 � -OIC OW 3 til ` r '� �~ } .a Ul 4-A Its ru cil Do cr fu GOOM cnnot, o CRJ am 111 • .p '� s� �.p � �.^ � €s t n° r � S g'. 1 s so33 mm ,Q �� CD dc C30i Jtt �o , CD . a { 301 Vo la AL 'z. i� _ L .I'S� � z�,;ea.;.• �,^ ! R y� i�,.ra�.3r. ... C � :. � a t, t �.��y, ,�_ y • LAW OFFICES OF .- JOHNSON & MIISKEL TELEPHONE (415)332-0222 1111 vY FACSIMILE (415)332-1192 WILLIAM F.JOHNSON 2330 MARINSHIP WAY E-MAIL j_Tniaw@pacbell.net GLENDON W.MISKEL SUITE 230,MARINA OFFICE PLAZA SAUSALITO,CALIFORNIA 94965-2800 FROM SF (415) 391 1320 August 22, 1997 RECEIVED AUG 2 6 1997 Clerk of the Board of Supervisors CLERK BOARD OF SUPERVISORS Contra Costa County CONTRA COSTA CO. Room 106 County Administration Building 651 Pine Street Martinez, CA 94553 Attn.: Shirley Casilas Re: Death of Ted Fellows/Claim of Terry and Donna Fellows Dear Ms. Casilas: This is.in follow-up to our telephone conversation today wherein you confirmed that you received the referenced claim on July 31, 1997. You have advised me that you have placed this claim on the September 9, 1997 Bo of Supervisor's calendar. ery trul ours, Glendon W. Miskel GWM:sam cc: Clients \CCC0822.LTR C , aa_ 4' 1 U CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 1997 Claim Against the County, or District governed by) BO RD ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $3,000,000.00 Section 913 and 915.4. Please note all 1162 MIMMM) CLAIMANT: Lewis Desch AUG 0 7 1997 ATTORNEY: Stan Casper COUNTY COUNSEL Casper, _Meadows & Schwartz Date received MARTINEZ CALIF. ADDRESS: 2121 North California Blvd. BY DELIVERY TO CLERK ON August 6, 1997 .Suite 1020 Walnut Creek, CA 94596 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. August 7 IL BATCHELOR, Clerk DATED: g 1997 �a: eputy 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: L�f�!7 BY: Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( 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: 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 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 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: GJ— [D —qJ BY: PHIL BATCHELOR by , , Q ,.�, Deputy Clerk CC: County Counsel County Administrator RECEIVED STAN CASPER, State Bar 56705 AUG 61997 CASPER, MEADOWS & SCHWARTZ 1 :BOARD A Professional Corporation CLERKCONTRAOCOSTA CO.ISOR5 2121 North California Boulevard, Suite 1020 Walnut Creek, California 94596 Telephone: (510) 947-1147 Attorneys for Claimant CLAIM AGAINST MERRITHEW MEMORIAL HOSPITAL TO: County of Contra Costa Board of Supervisors 651 Pine Street Martinez, California 94553 CLAIMANT'S NAME Lewis Desch ADDRESS AND 34 Oak Island Circle TELEPHONE NUMBER Santa Rosa, CA 95409 707/359-5005 AMOUNT OF CLAIM $3,000,000.00 ADDRESS TO WHICH NOTICES ARE TO BE SENT: STAN CASPER CASPER, MEADOWS & SCHWARTZ A Professional Corporation 2121 North California Boulevard Suite 1020 Walnut Creek, California 94596 DATE OF OCCURRENCE March 5, 1997 PLACE OF OCCURRENCE : Martinez, California HOW DID CLAIM ARISE . This claim is based upon the medical negligence of Dr. William P. Sweezer, Jr., and other staff members including physicians of Merrithew Memorial Hospital in failing to properly diagnose and treat Claimant's decedent (Craig Desch) during his post-operative recovery period. 1 Claimant's decedent Craig Desch was admitted for a surgical procedure (craniotomy with laminectomy) on February 28, 1997. While recovering from the operation Claimant's decedent aspirated a pill which lodged in the right main stem bronchus. Hospital staff had permitted decedent to be given medication by mouth (pill) notwithstanding their knowledge and appreciation for decedent's respiratory and eating(swallowing)problems. Claimant's decedent was required to be intubated by staff physicians. Notwithstanding staff physicians' knowledge and appreciation that decedent's condition was unstable and that his breathing tube should not be removed, staff physicians permitted Dr. William P. Sweezer, Jr. to remove decedent's breathing tube in an effort to remove the aspirated pill. Decedent immediately went into respiratory failure and died. The injuries sustained by Claimant as far as known as of the date of the presentation of this claim consists of loss of future earnings and the loss of love, society, and companionship. Jurisdiction over the claim would rest in the Superior Court. ITEMIZATION OF CLAIM Loss of Earning Capacity $2,750,000.00 General Damages Including Loss of Love, Comfort and Society $ 250,000.00 Dated: August 1, 1997 CASPER, ADOWS & SCHWARTZ ' A Professal Corporation STAN COaimant Attorneys for LEWIS DESCH �. CLAIM C v2a— BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $3,000.00 to $5,000.00 Section 913 and 91 11 "Warnings". CLAIMANT: Efren Lozano 1��1V JUL 29 1997 ATTORNEY: Date received N F`MARTIAU ADDRESS: 3881 Cloverbrook Ave BY DELIVERY TO CLERK ON T„�,_� Tgg7 Oakley, CA 94561 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. ppH�{ gB DATED: July 28, 1997 BAIL DeputyLOR, Clerk II. FROM: C unty Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 9 -9— PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. 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- J 0 - 9:1 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator NN C4 w O Q T > > O o > O � ,10- 0 < 00 QQ D L+J 16 4t t'd �My O 4 O C C O -, CD .., O N (D > O0 � y C'? C/) QN ? CD OU e .gyp r* . 0 O j t»tn � _ ; O <- CA (s) ID cn ED 4V Q b VAI ,p t 9 All , ae�'r**ww*•ar�► . , 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 ) Reser ' amp EFnen Lo��,c) RECEIVE® j JUL 2 51997 Against the County of Contra Costa ) Or ) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 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 $ and in support of this claim represents as .follows: 1. Yhen did the damage or injury occur. (Give exact date and hour) , t aQ 7 t -� ►� ---- ' = ------------------------------ 2. Where did the damagor injury occur?. (Include city and county) -------------- 3• How did the damage or injury cur? (Give full details; use extra paper if required) "",,"" l� "awk and d�----------------- 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? LE�c " Lze� .4, t� tr rdQA 6n cfs -o�t� ~��, � E- iR L d at L ( we-ab-o (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. L� '7 . 0 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) [OC.A4 3. Names- and addresses of witnesses, doctors--and hospitals. -- -- - - ---------------------------- ---- --- ----------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM:may:. AMOUNT - .. ! M 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 1 's S gnat OOye oo V- 4wS (Address) Did,de Telephone No. Telephone No. ( 0 to,-79-to LO l-v 3 moi,/ 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. Date: 07/24/97 03:43 P.M. Estimate ID: 3388 Preliminary Profile ID: BRENTWOOD f01 BRENTWOOD AUTOBODY 4535 O'HARA AVENUE BRENTWOOD CA 94513 (510) 634-6366 °QUALITY IS NO ACCIDENT" FIN: 94-2958593 BAR # AE194601 Damage Assessed By: DARRYL JONES Insured: EFREN LOZANO Address: 3881 CLOVERBROOK AVE OAKLEY CA 94561 Home Phone: (510) 679-1047 Mitchell Service: 915489 Description: 1992 CHEVROLET C1500 XCAB PU X-CAB VIN: 2GCBC19Z4N1265939 License: 5M00572 CA Mileage: 100,917 Color: BURGANDY Line Entry Labor Line Item Part Type/ Dollar Labor CEG Item Number Tyne Operation Descriation Part Number Amount Unit Unit 1 500610 REFIN REFINISH FRT FACEBAR 1.0 1.0 2 500620 BODY REMOVE/INSTALL FRT BUMPER ASSY 0.8 # 0.8 3 510270 RBFIN REFINISH HOOD OUTSIDE C 3.2 3.2 4 512210 REFIN REFINISH R FENDER OUTSIDE C 2.2 2.6 5 512220 RBFIN REFINISH L FENDER OUTSIDE C 2.2 2.6 6 524340 GLASS REMOVE/REPLACE W/SHIELD GLASS 15704276 GM PART 335.00 1.9 # 1.9T 7 527390 RBFIN REFINISH CAB ROOF C 2.8 3.2 8 527410 REFIN REFINISH R CAB SIDE PANEL C 2.0 2.4 9 527420 RBFIN REFINISH L CAB SIDE PANEL C 2.0 2.4 10 527530 RBFIN REFINISH R CAB ROCKER C 1.0 1.4 11 527540 REFIN REFINISH L CAB ROCKER C 1.0 1.4 12 532950 RBFIN REFINISH R FRT DOOR OUTSIDE C 2.3 2.7 13 532960 RBFIN REFINISH L FRT DOOR OUTSIDE C 2.3 2.7 14 538700 RBFIN REFINISH R BED OUTER PANEL C 1.6 1.8 15 538710 RBFIN REFINISH L BBD OUTER PANEL C 1.6 1.8 16 538800 BODY REMOVE/INSTALL BBD ASSEMBLY 2.5 2.5 17 900500 BODY +REMOVE/INSTALL TRIM TO PAINT 5.0' 18 900500 BODY *ADD'L LABOR OPR PREP ALL PANELS FOR ROCK DAMAGE EXISTING 8.0* 19 AUTO RBFIN ADD'L LABOR OPR CLEAR COAT 5.5k 20 933003 RBFIN ADD'L LABOR OPR TINT COLOR 0.5t 21 AUTO ADD'L COST PAINT MATERIALS 350.00* T t Judgement Item # Labor Note Applies C Included in Clear Coat Calc Prior Damage FRT BUMPER/R BEDSIDE SCRATCHES PRIOR TO ROCK DAMAGE ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 3388 Mitchell Data Version: JUN-97_A Copyright (C) 1990-1996, Mitchell International Page 1 of 2 All Rights Reserved Date: 07/24/97 03:43 P.M. Estimate ID: 3388 Preliminary Profile ID: BRENTWOOD (0] Add'1 Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 16.3 50.00 815.00 Taxable Parts 335.00 Refinish 31.2 50.00 1,560.00 Sales Tax @ 8.25 27.64 Glass 1.9 50.00 95.00 Total Replacement Parts Amount: 362.64 Labor Subtotal 2,470.00 Labor Summary Totals 49.4 2,470.00 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 350.00 Customer Responsibility: 0.00 Sales Tax @ 8.250 28.88 Total Additional Costs: 378.88 I. Total Labor: 2,470.00 II. Total Replacement Parts: 362.64 III. Total Additional Costs: 378.88 Gross Total: 3,211.52 IV. Total Adjustments: 1 0.00 Net Total: 3,211.52 This is a preliminary estimate . Additional changes to the estimate may be required for the actual repair. Under California Code of Regulations, Title 10, Chapter 5, Subchapter 8, Section 2695,.8.d2c., you are advised, that you have the right to have any repair facility of your choice to do the repairs to your vehicle. However, your insurance company can reasonably adjust any written estimate prepared by the repair shop of your choice. ...................................................................... Brentwood Autobody Guarantees All Repairs Preformed On Your Vehicle Including Parts, Workmanship And Refinishing For A Period Of Not Less Than One Year From The Time Of Repair Completion. Defects in Craft- manship Or Refinishing Are Warranteed For As Long As You Own Your Vehicle. ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 3388 Mitchell Data Version: JUN-97 A Copyright (C) 1990-1996, Mitchell International Page 2 of 2 All Rights Reserved DAMAGE REPORT LOZANO 07/24/97 at 16 : 30 D.R. 25297-0001761 AF 167121 Est : J. NOVERO VORNHAGEN BODY AND PAINT (510) 516-1969 150 MIDDLEFIELD CT SUITE #A BRENTWOOD, CA 94513- (510) 516-9166-FAX Owner: EFREN LOZANO Day Phone: (510) 679-1047- Address : 3881 CLOVERBROOK AVE Other Ph: ( ) - - OAKLEY CA 94561 Deductible : $ N/A Insurance Co. :STATE FARM INSURANCE COMPANIES Phone: Claim No. . Adj . : 92 CHEV C15 4X2 EXTENDED CAB SPORTSIDE 2D P/U RED MET 6-4 . 3L-FI Vin: 2GCEC19Z4N1265939 License: 5M00572 CA Prod Date: 6/92 Odometer: C Power steering Power brakes Tinted glass Dual mirrors Anti-lock brakes (2) Clear coat paint -------------------------------------------------------------------------------- PART NO . OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 FRONT BUMPER 2 R&I bmpr assy w/o impct strp 1 0 .9- 3* Repr Fc br pntd w/o impct strp 1 1 . 0 1 . 5 4 Add for Clear Coat 1 0 . 6 5* Repr Cntr fllr w/o grll vnt hls w/o 1 0 . 3 0 . 8 6 Overlap Minor Panel 1 -0 .2 7 Add for Clear Coat 1 0 . 1 8* Repr RT Otr fllr w/o grll vnt hls w 1 0 .3 0 . 3 9 Add for Clear Coat 1 0 . 1 10* Repr LT Otr fllr w/o grll vnt hls w 1 0A 0 . 3 11 Add for Clear Coat 1 0 . 1 12 GRILLE 13 R&I grille assy 1 0 .4 14 HOOD 15* Repr Hood 1 2 . 0 3 .2 16 Overlap Major Adjacent Panel 1 -0 .4 17 Add for Clear Coat 1 0 . 6 18 FENDER 19* Repr RT Fender 1 1 .5 2 . 6 20 Overlap Major Adjacent Panel 1 -0 .4 21 Add for Clear Coat 1 0 . 4 22* Repr LT Fender 1 1 .5 2 . 6 23 Overlap Major Adjacent Panel 1 -0 .4 24 Add for Clear Coat 1 0..4 25 CAB / EXTENDED CAB 26* Repr Roof panel 1 3 . 0 3 .2 27 Overlap Major Adjacent Panel 1 -0 .4 Page : 1 DAMAGE REPORT LOZANO 07/24/97 at 16 : 30 D.R. 25297-0001761 AF 167121 Est : J. NOVERO VORNHAGEN BODY AND PAINT (510) 516-1969 150 MIDDLEFIELD CT SUITE #A BRENTWOOD, CA 94513- (510) 516-9166-FAX ------------------------------------------------------------------------------- PART NO. OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC ------------------------------------------------------------------------------- 28* Add for Clear Coat 1 0 . 6 29* R&I Cowl grille center 1 0 . 5 30* Repr RT Side panel outer 1 1 . 0 2 . 0 31 Overlap Major Adjacent Panel 1 -0 . 4 32* Add for Clear Coat 1 0 . 3 33* Repr LT Side panel outer 1 1 . 0 2 . 0 34 Overlap Major Adjacent Panel 1 -0 .4 35* Add for Clear Coat 1 0 . 3 36 FRONT DOOR 37 RT R&I trim panel 1 0 . 4 38 LT R&I trim panel 1 0 .4 39* Repr RT Door shell 1 1 . 5 2 . 8 40 Overlap Major Adjacent Panel 1 -0 .4 41* Add for Clear Coat 1 0 . 5 42* Repr LT Door shell 1 1 . 5 2 . 8 43 Overlap Major Adjacent Panel 1 -0 .4 44* Add for Clear Coat 1 0 .5 45 R&I RT Belt w' strip 1 J . 3 46 R&I LT Belt w' strip 1 0 . 3 47 R&I RT Mirror 1 0 .2 48 R&I LT Mirror 1 0 .2 49 R&I RT Handle, outside 1 0 . 4 50 R&I LT Handle, outside 1 0 .4 51 PICK UP BOX 52* Repr RT Side panel 1 2 . 0 3 . 0 53 Overlap Major Non-Adj . Panel 1 -0 .2 54* Add for Clear Coat 1 0 . 6 55* Repr LT Side panel 1 2 . 0 3 . 0 56 Overlap Major Non-Adj . Panel 1 -0 . 2 57* Add for Clear Coat 1 0 . 6 58* Refin Tail gate BLEND 1 1_5 59 REAR LAMPS 60 R&I RT Combo lamp assy Stepsid 1 0 . 5 61 R&I LT Combo lamp assy Stepsid 1 0 . 5 62 REAR BUMPER 63 R&I bumper assy 1 0 .5 64* Repr R&I GLASS 1 X 300 . 0 65* Repr R&I BEDLINER 1 1 . 0 66* COLOR TINT 1 0 . 5 67* SPOT RUB AS NEEDED 1 6 . 0 Page: 2 i DAVAGE REPORT LOZANO 07/24/.97 at 16 : 30 D.R. 25297-0001761 AF 167121 Est : J. NOVERO VORNHAGEN BODY AND PAINT (510) 516-1969 150 MIDDLEFIELD CT SUITE #A BRENTWOOD, CA 94513- (510) 516-9166-FAX ------------------------------------------------------------------------------- PART NO. OP. DESCRIPTION OF DAMAGE QTY COST . LABOR PAINT MISC ------------------------------------------------------------------------------- ------------------------------------------------------------------------------- Subtotals -__> 0 . 00 32 . 3 33 . 5 300 . 00 Page : 3 DAMndE REPORT LOZANO 07/24/97 at 16 : 30 D.R. 25297-0001761 AF 167121 Est : J. NOVERO VORNHAGEN BODY AND PAINT (510) 516-1969 150 MIDDLEFIELD CT SUITE ##A BRENTWOOD, CA 94513- (510) 516-9166-FAX Parts O . 00 Body Labor 32 .3 units @ $50 . 00 1615 . 00 Paint Labor 33 . 5 units @ $50 . 00 1675 . 00 Paint/Materials 33 . 5 units @ $22 . 00 737 . 00 Sublet/Misc 300 . 00 -------------------------------------------- SUBTOTAL $ 4327 . 0C Tax on $ 737 . 00 at 8 .2500% 60 . 8C -------------------------------------------- GRAND TOTAL $ 4387 . 80 --------------------------------------------- INSURANCE PAYS $ 4387 . 80 THIS IS JUST AN ESTIMATE OF REPAIRS, IF ON FURTHER INSPECTION, ADDITIONAL PARTS OR REPAIRS ARE NEEDED, YOU WILL BE CONTACTED FOR AUT HORIZATION. WE ARE NOT RESPONSIBLE FOR LOSS OR DAMAGE TO YOUR VEHICLE FROM FIRE, THEFT, ACCIDENTS, OR CAUSE BEYOND OUR CONTROL. SIGNED X WE WARRANT OUR WORKMANSHIP, INCLUDING REFINISHING, FOR ONE YEAR. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide DR1GH88. Database Date 4/97 Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer. CAPA items have been certified for fit and finish by the Certified Auto Parts Association. EZEst A product of CCC Information Services Inc. Page : 4 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Go rnment de Amount: $95.00 Section 913 and 915.4. Please note all "P�C�aW)AM) CLAIMANT: Stan Marquis AUG 0 7 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 36 Sherburns Hills Road BY DELIVERY TO CLERK ON August 4, 1997 Daville, CA 94526 BY MAIL POSTMARKED: Hand Delivered via: Risk Mgmt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: August 7, 1997 JVIL BAATTCYELOR, Clerkepu ' II. FROM: County Counsel TO: Clerk of the Board of Supervisors (X) This claim complies substantially with Sections 910 and 910.2. (, `) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: &Z-1:2 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (�) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. r Dated: PHIL BATCHELOR, Clerk, 8 A 0Deputy 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: 9 - p _ 9 7 BY: PHIL BATCHELOR byOn. eputy 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 �& RECEIVE® Against the County of Contra Costa l` ; or ir. AUG -- 41997 � Distric_ t 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 $ 9So0 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) o _7ass; .gd�v//C,_L r � OM��_ T� �. 3• How did the damage or injury occur? (Give full details; use extra paper if required) 4. Wha particular act or omission on the part of county or district officers, servants or .employees caused theinjury or damage? ,S.0,14,/ ag Tl-,/e C'Qi Slc' (over) 5. what are the names of county or district officers, servants or employees causing the damage or injury? ------�-�-A a=W/!- ----------- oa d- q= =�'-= `--- -,- ----------------- 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. �a� /cinod 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ACJ L'� (mss -r-- B. Names and addresses of witnesses, doctors and hospitals. - -------- ---------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT x/30 Wo Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or I?X some person on. his behalf." Name and Address of Attorney (ClP=ts Signature l� _ //Address . Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bili, 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. • CIairn to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY (�/� ►,G� 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 roast 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 ) Against the County of Contra Costa or ) A District) ARD OF SVP RVISORS f Fill in name ) I CLERKCOgpNI�ACOST�CO. The undersigned claimant hereby makes claim against the County. of Contra Costa or the above-named District in the sum of $ 9,57oo and in support of this claim represents as follows: - 1. When did the damage or injury occur? (Give exactdate and hour) -- �_ @M_r0M,YS a in ---------------------------------------- 2. Where did the damage or �injury occur? (Include city and county) 3. How did the damage. or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? A/) S/P/a f/ GS CGi- lha S Pa/ (over) 5. wnat are the names of county or district officers, servants or employees causing the darzge 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? (Include the estimated amount of any prospective injury or damage.) ------------------------------------------------------------------------------------- 8. Names and addresses of witnesses, doctors and hospitals. ------------- i- -------------- ----- --- ---------------------------- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT do u� Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO:'.:-' (Attorne ) orb some 2erson on his behalf." Name and Address of Attorney (Cl, is Signat e Address Telephone No. Telephone No. 7341, N0•TICE 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. r � � . UA ` - p to fy k y t a s . to `s: r eT�G 'k y v, 'C CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA - September 9, 1997 Claim Against the County, or District poverned by) BOARD .ACTION the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of.this document mailed to you is your notice of California Government Codes. ) the action taken on your claim by the Board of Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $700,000,000 Section 913 and 915.4. Please note all CLAIMANT: Dana Lynn Matteri, AUG 0 7 1997 Danielle Nicole Matteri and Family ATTORNEY. Douglas Warrick 1333 Pine St. , Ste. E Date received MARTINEZ COUNTYCALIF. ADDRESS: Martinez, CA 94553-1818 BY DELIVERY TO CLERK ON August 4, 1997 and Pro Per Dana Matteri BY MAIL POSTMARKED: Hand Delivered 5030 San Pablo Dam Rd. , #1 n9:�) t$Fk1:C —i 1152(12 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pH gg DATED: August 7, 1997 Bl'IL DepuLyLOR, Clerk , 1I. 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:\��VGGo C'� GO izo — �g Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( J ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 1 - q - PHIL BATCHELOR, Clerk, By ,J Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six• (6) months from the date this notice was personally served or deposited in the 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 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. l Dated: 9 -97 BY: PHIL BATCHELOR by ,J Deputy Clerk CC: County Counsel County Administrator claim. to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TOCLAIMiANT 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. •****gra*���********�*�*,�*********+t���****����**********��*��a��t��*: .;�:�at�* RE: Claim By �Re erved for Clerk's filing stamp RECEIVE® ICA 149, Against the County of Contra Costa) or0111 , BAUG - 41997 1 CLERKOA OF SUPERVISORS (Fill 131 name) CONTRA COSTA CO. The undersigned claimant hereby makes claire against the County of Contra Costa or the above-named District in the sum of $� N-nd in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Whe�:e did the damage or injury o r. (Include cit and county) q YJ . How id the damay or injury ccu ? (Give full details; use extr paper if required �`� yra 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? trd 0�_s C�u 5S N � tee. �1 oon.a ew 4jp r Woveys bs" eo e'll r V W 4w- L'o l--Pt vl:= 16 t UV e 1,u( t'PW t,J oun cQ SCh C)W S of cn (�I. -� F-. What are the names of county or district officers, servants or () �,employees causing the damage or injury. incl —e5f `+J o1'l aY�-t✓C C�'1 0-!� at damage or injuries do you claim resulted? (GiVd full extent � N k -1of injuries or damages claimed. Attach two estimates for .auto a damage. ) '(Y1t l ��fl� 1 �i Otw��/c`� J DSS n--n- cox ,Cl�(�sQ t,l-f t vt t.cr��5 � ��� ct.r t oc�'-'�c�=1.S-� c�► 6P-oss 05.e_ erns c-2 ss i �S e ( f Sv n c .a How was the amount claimed ab ve computed? (Include, the s ma ed amount of any prospective injury or damage. ) � 4 � �� �ne�a�7 sY� 8. Names and addresses of witnesses, doctors and hospit IS. AWW9 T\ __LJa h Q Mv7 LAG 9. List the expenditures you made on account 16-f this accident or injury. NOV q DATE _ TIME AMOUNT 7,k 1-7 JO Y1 r� 700, 0-6-0 0-0-0, 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. 11 _ Name and Address of Attorney ) 1 ou . /a.S a)0"r1,/cam" ) 3 �/ /�-P s•/ si / ) (Clai ant' Sig ma) rVI L�*nm ) (Ad ess(�Ia7� _ Telephone No. ��6 — Telephone No 9`6-76 ^ �� •����******�*��*���**���****��**�***��*��***���**��*���*�*:+►sew*��* NOTICE Section 72 of the Penal Code provides: mvery 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. G 9 9, 14 yam• C�i7LtZ,C�Gvri Lf/ttt .�![�r�OvL[s+mar s �7tp r/ Gf�J Ale 7 ;ZLYlz 7 fir' 4� Gifu ,vle 44 ?� 3SGY STATE AND CONSUMER SERVICES AGENCY PETE WILSON, Governor MEDICAL BOARD OF CALIFORNIA of CENTRAL COMPLAINT UNIT 9ND 1430 HOWE AVE, SUITE 93 Consumer SACRAMENTO CA 95825-3236 Fairs TELEPHONE: (916) 263-2424 • ' '® , FAX: (916) 263-2435 1-800-633-2322 May 14, 1997 DANA MATTERI 5030 SAN PABLO DAM RD. , #1 EL SOBRANTE, CA 94803, Regarding: DOCTOR BARTON HARRIS RUBIN Control Number: 1F 97074516 Dear DANA MATTERI : This is to acknowledge your recent correspondence regarding the above named subject. We are presently reviewing the information you have provided and will be conducting a thorough analysis. Our review may require procuring medical records, documents, and obtaining an opinion from expert consultants as to any potential violation of law. This process can take up to six months. If we need any additional information during the course of our inquiry, you may be contacted by a Consumer Services Analyst. We appreciate your patience and would like to thank you for bringing your concerns to our attention. If you have additional information or would like to check the status of your complaint, please contact us at 1-800-633-2322. It would be helpful if you would refer to the control number shown above in your correspondence or contacts with us. We will advise you of any action we take in this matter. Sincerely, r CENTRAL COMPLAINT UNIT MEDICAL BOARD OF CALIFORNIA SUPERIOR COURT OF THE STATE OF CALIFORNIA (r f FOR THE COUNTY OF CONTRA COSTA JUVENILE COURfir In the matter of ) tg9h DE% 13 DANIELLE NICOLE CLEVENGER ) Age 9 Birthdate: 08-02-87 ) PETITION Address Confidential ) Court Number J96-02785 G ) I,the undersigned petitioner,say: The person whose name,address and age are shown in the above caption is under eighteen years of age and comes within the provisions of Section 300(a)m)&(a) of the Welfare and Institutions Code of California as follows:, 00 : 1. Said minor was previously adjudged a dependent of this Court and removed from the minor's mother's custody pursuant to findings related to the mother's drug related psychotic behavior. The mother subsequently failed to comply with the court ordered family reunification service plan requirements,and t the court dependency was eventually vacated in concurrence with the granting of sole physical and legal custody of the minor to the minor's father. r OCO: 2. Sometime in 1994,said minor's father was incarcerated pursuant to being convicted of possession of illegal drugs,and he then failed to make appropriate arrangements for the minor's care or take any measures to prevent the minor's mother from regaining physical custody of the minor. Comiuueu on page 2 Therefore,I request that this minor be declared a dependent child of the Juvenile Court. John B.Cullen,Director Contra Costa County By L�Jy ,-��; ilti, Social Worker,(CCN-Q]-BA ) Social Service Department MARTIN GlJ C Date December 13,1996_ This minor is:(JQ Detained,since December 11. 1996 ( )Not detained The names and addresses of parents,guardians,adult relatives and/or attorneys known to me are: NAME RELATIONSHIP ADDRESS 1 Dana Matteri Mother 5030 San Pablo Dam Rd.,El Sobrante,CA 94803 Jack Ray Clevenger Father CDC 012258,San Quentin State Prison San Quentin,CA VERIFICATION I am the Social Worker noted above.: I have read this petition and know its contents. I declare it is true of my own knowledge,except as to any matters therein stated upon my information and belief,and to those matters I believe i::o be tr6e. I decla:-e under pcnalty of perjury that the foregoing is true anti correct. Date December 13. 1996 atHgrcules ,California by:0i" MARTIN GUTHERZ,So orker Hearing is hereby set for Friday December 20 1996 Q 9-00 a.m. West County Juvenile Court, 100 37th Street,Richmond,CA 94805 Stephen L.Weir,County Clerk,by o BAZILE DC 8(Rev.5189)PETITION File: UR MG/bev'misc-18/danielle.pet 1 In the matter of DANIELLE NICOLE CLEVENGER PETITION _Birthdate 08-02-87 Court Number J96-02785 ' 3. On a virtual daily basis,said minor's mother hits,kicks,and shoves the minor. 300(b): 4. Said minor's mother habitually calls the minor,"stupid,"and an"idiot,"and blames the minor for her,i.e., the mother's,delusional mental state and personal problems. f S. During recent family counseling sessions,said minor's mother disclaimed knowing the identity of the / minor,who was sitting next to her,and complained that someone was inserting a pencil in her rectum. J 300(a1: 6. During a recent family counseling session,said minor's mother attempted to hit the minor. When the j counselor thwarted the mother's attempt to do this,the mother threatened to take the minor to a dark place where no one would be able to find them and to then physically harm the minor. / 7. On or about December 10,1996,said minor's mother attempted to hit the minor in the head,thereby causing the minor to use a pillow as a shield to protect herself. / 300(b): 8. As a result of said minor's mother disenrolling her from school several weeks ago,the minor is not attending school. 9. As a result of said minor's mother's threats to kill the minor,the minor is fearful of being murdered by the mother. 10. As a result of said minor's mother's physical and emotional abuse of her,the mother's delusional mental state,and the minor's fear that the mother will murder her,the minor does not want to remain in the mother's custody. I SUPERIOR COURT OF THE STATE OF CALIFORNIA FOR THE COUNTY OF CONTRA COSTA JUVENILE COURT DC 8B(New 5/80)PETITION,Page 2 STATE CF CALIFORNIA STATE ECARC OF CONTROL P. C . Box :035 Sacramento , CA 95&12-3035 (916) 223-2564 ATSS 473-3564 July . 1 # 1997 DANA MATTERI 5030 SAN PABLO CAM RD 41 EL SOBRANTE, C.A 94603 Re: MATTERI , DANA LYNN AND DANIELLE NICOLE Claim Number : G324E21 Code : Your claim was presented to the State Board of Control (Board) on Jure 99 1997 We have reviewed the claim and determined. that the Board has no jurisdiction to accept the claim for consideration for the following reason(s) : The entity that you allece caused the damages or injuries is QgI a State Government Acency . THE STATE OF CALIFCRNIA HAS NO JURISDICTION OVER CONTRA COSTA SHERRIFF 'S DEPARTMENT . The Board will take no further action cn ,your claim . Sincerely, Government Claims Civision State Board of Control ( IS - No jurisdicticn) r/ c-" l ,d r - o n abiC ,14 PF .. , , 7el .c� � �/;�zta� �►Lti`r L�/a-"' '.�.r- ���a�-G�e.�e.�1 ..�1'.`/�`�'�' ,�Qll�w��•Pc. ria. jJ G" — (� Gid o 723 11 co 9 GLCco—rt-��- all 'Ae all( xq f�d'✓.e�''` -,�,��'��,.e.,• .-�-a... ca.. --Rr�G�,`•,�,.{ � -ter G�.tt�ter. (244 �� �'�'`'' .•ems 24 2�7 iKik6 � 5eAlr � 4L �71 a o 74;6r <v► .Ws � Eya It'I_J t1trK ca Q �j' V v�i �m l �u�6c o �tceszlOY � lda�wrt e-e leo \Z_ ajw (F- c �v V/ 75 MJ JPL - dam q � *)-fZI cu��M I - � - ,� - - c���_, al_e �r_n� erg�--= o-►% J a.ss v 14J t4 =ate aw-_e_S__ La i �h wv o�ce s t.�Ov-,�" / d-eW �� d /( v-C/ a. 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Oq 4-o � -0- cc) - _ -no O U b.P ,p 10 . - � elasC)YIS AVt c - P( ao -0- 4p � YYtO-1-ic�Y1 � � Dry _ �� cur (` h4 c , S � t 1 004tW- A rrA_ JH— 6o f o,47- 9 ,c,�e- -- n ck- UJ� �V- au H-5 LAD o0�s v� _ � l�-e < < yes I;� [4'l+ n n� `� YA OJA VIC =,�c�v��-e_ I�e� -ha �sa�_ .740 cif a 1 2 3 4 5 6 7 REPORT AND RECOMMENDATION TO THE JUVENILE 8 COURT OF CONTRA COSTA COUNTY 9 10 Date of Hearing: April 23, 1997 11 Time of Hearing: 1:30 p.m. 12 Location: 100-37th Street, Richmond, CA 94805 13 Date of Report: April 18, 1997 14 CHILD'S NAME COURT# BIRTHDATE/AGE BIRTHPLACE 15 DANIELLE CLEVENGER J96-02785 08-02-87/ 9 San Pablo, CA. 16 FAMILY: NAME BIRTHDATE/AGE ADDRESS 17 18 Mother: Dana Matteri 02-13-60/ 37 5030 San Pablo Dam Rd. Apt. 41 19 El Sobrante, CA 94803 20 Father: Jack Ray Clevenger 21 07-01-51/ 45 Contra Costa County Sheriff's Dept. West County Detention Facility 22 5555 Giant Highway 23 Richmond, CA 94806 24 Siblings: None. 25 ABSENT PARENT SEARCH: 26 27 Does not apply. 28 Danielle Clevenger, J96-02785 Page 2 1 CHILD'S LEGAL RESIDENCE: 2 The minor is a resident of Contra Costa County based upon the residence of the 3 mother, who has joint legal custody of her, in El Sobrante, California. 4 5 WHEREABOUTS OF CHILD: 6 The minor currently resides in the home of her maternal greataunt, Phyllis 7 Wood, 3238 Colusa Street, Pinole, California 94564. 8 COUNSEL AND OTHER PARTIES: 9 10 Attorney Alternate Defender's Office for Mother: 1333 Pine Street, Suite E 11 Martinez, CA 94553 12 (510) 646-1740 13 Guardian Ad Litem Brian Stern, Attorney at Law for Mother: 124 Washington Avenue 14 Richmond, CA 94801 15 (510) 234-2700 16 Attorney Public Defender's Office 17 for Father: 3811 Bissell Avenue Richmond, CA 94805 18 (510) 374-3233 19 Attorney James Fishel 20 for Minor: 110 Blue Ridge Drive, Suite I 21 Martinez, CA 94553 (510) 935-2021 22 Attorney County Counsel 23 for Agency: 651 Pine Street 24 Martinez, CA 94553 (510) 335-1830 25 26 27 28 Danielle Clevenger, J96-02785 Page 3 1 NOTICE OF HEARING: 2 Dana Matteri, mother, noticed in person. 3 Jack Ray Clevenger, father, noticed in person. 4 5 Anticipated participation in hearing by: Both parents, the various attorneys, the 6 mother's Guardian Ad Litem, and social worker. 7 REASON FOR HEARING: 8 9 Disposition. 10 Recommendation: Out-of-home dependency. 11 CURRENT DEPENDENCY ACTION: 12 Contra Costa County Juvenile Court: 13 14 12-13-96 Original W&I 300 (a) (b) and (g) petition filed. 15 12-16-96 Detention Hearing. Detention order issued, W&I 308 order issued authorizing withholding of exact whereabouts of minor from mother, 16 order for appointment of Guardian Ad Litem for mother. 17 02-06-97 Amended Petition I filed under W&I 300 (a) (b) and (g) and reads as 18 follows: 19 300 b 20 1. On May 20, 1988, said minor was adjudged a dependent child of this 21 Court and removed from her mother's custody pursuant to findings that 22 the mother had past substance abuse problems, that she was receiving treatment for her emotional problems, and that she was unable to provide 23 a home or to care for the minor. There was also a fording that the 24 minor's father had a history of excessive use of alcohol and use of crank. The dependency was vacated.on October 18, 1988, and the minor was 25 then returned to the mother's custody. . 26 2. On December 15, 1988, said minor was adjudged a dependent child of 27 this Court and removed from her mother's custody pursuant to a finding pertaining to the prior court dependency and an additional finding that 28 the mother had been inconsistent in the taking of her medication, and Danielle Clevenger, J96-02785 Page 4 1 that she was emotionally distraught and exhibiting erratic behavior which was interfering with her ability to care for the minor. The mother 2 subsequently failed to comply with the court ordered Family 3 Reunification Service Plan requirements, and on December 4, 1990, the dependency was vacated in concurrence with the granting of sole 4 physical and legal custody of the minor to the minor's father. 5 3. On December 6, 1993, the Contra Costa County Family Court awarded 6 sole physical and legal custody of the minor to the minor's mother. On January 12, 1995, the custody order was modified to the awarding of 7 joint legal custody to the minor's parents with the minor's mother 8 continuing to having sole physical custody of her. 9 300 (a): 10 4. Prior to December 11, 1996, the date that said minor was placed in 11 protective custody, the minor's mother was hitting, kicking, and shoving 12 her on a virtual daily basis. 13 300 b 14 5. Prior to December 11, 1996, the date that said minor was placed in 15 protective custody, the minor's mother habitually called the minor "stupid" and an"idiot," and blamed the minor for her, i.e., the mother's 16 delusional mental state and personal problems. 17 6. Prior to December 11, 1996, the date that said minor was placed in 18 protective custody, the minor's mother disclaimed knowing the identity of the minor, who was sitting next to her, while the minor and the mother 19 were engaged in a family counseling session. 20 300 (a): 21 22 7. Prior to December 11, 1996, the date that said minor was placed in protective custody, said minor's mother threatened to hit the minor 23 during a family counseling session. Subsequently, the mother threatened to take the minor to a dark place where no one would be able to find 24 them and to then physically harm the minor. 25 8. On or about December 10, 1996, said minor's mother attempted to hit 26 the minor in the head, thereby causing the minor to use a pillow as a 27 shield to protect herself. 28 Danielle Clevenger, J96-02785 Page 5 1 300 (b): 2 9. Sometime in November/1996, said minor's mother disenrolled her from 3 the school that she was attending. 4 10. As a result of said minor's mother's threats to kill the minor, the minor is 5 fearful of being murdered by the mother. 6 11. As a result of said minor's mother's physical and emotional abuse of her, the mother's delusional mental state, and the minor's fear that the mother will murder her, the minor does not want to remain in the mother's g custody. 9 300 (g)- 10 12. Said minor's father is currently incarcerated. 11 12 Contested jurisdictional hearing was held on April 9, 1997. The mother was 13 present and was represented by Deputy Alternate Defender Doug Warrick. The 14 mother was also assisted by Brian Stern, Attorney at Law, acting as her Guardian Ad 15 Litem. The father was present and was represented by Deputy Public Defender Marita 16 17 Mayer. The minor was present for the purpose of testifying in the proceedings. The 18 minor was represented by court appointed private attorney James Fishel. 19 Counts 1 through 3 of Amended Petition I were dismissed; Count 4 amended to 20 read as follows was sustained: "Prior to December 11, 1996, the date that said minor 21 22 was placed in protective custody, the minor's mother was hitting and kicking the minor 23 often;" Count 5 amended to read as follows was sustained: "Prior to December 11, 24 1996, the date that said minor was placed in protective custody, the mother habitually 25 26 called the minor `stupid' and an `idiot;' Counts 6 and 7 were sustained. Count 8 was 27 dismissed; Count 9 was sustained; Count 10 amended to read as follows was 28 Danielle Clevenger, J96-02785 Page 6 1 sustained: "As a result of said minor's mother's behavior, the minor is fearful of the 2 mother;" Count 11 amended to read as follows was sustained: "As a result of said 3 minor's mother's physical and emotional abuse of her, the mother's delusional mental 4 5 state, and the minor's fear of the mother, the minor does not want to remain in the 6 mother's custody;" Count 12 was sustained. 7 A 300 (a) (b) and (g)jurisdictional finding was made. The prior detention order 8 was then continued pending disposition. 9 10 PRIOR DEPENDENCY ACTION: 11 Contra Costa County Juvenile Court: 12 03-08-88 Original Petition filed. 13 03-09-88 Detention Hearing. Detention order issued. 14 15 04-29-88 Jurisdictional fording made. 16 05-20-88 Jurisdictional fording continued, minor adjudged dependent child, out-of- 17 home placement ordered. 18 10-18-88 Dependency vacated and petition dismissed, sole physical custody of 19 minor awarded to mother, father granted unsupervised visitation rights. 20 11-08-88 Original Petition filed. 21 11-09-88 Detention Hearing. Detention order issued. 22 11-15-88 Amended Petition I filed. 23 24 12-01-88 Jurisdictional finding made. 25 12-15-88 Jurisdictional fording continued, minor adjudged dependent child, out-of- home placement ordered. 26 27 05-15-89 Jurisdictional finding and out-of-home dependency continued. 28 08-28-89 Jurisdictional finding and out-of-home dependency continued. Danielle Clevenger, J96-02785 Page 7 1 12-04-89 Jurisdictional fmding and out-of-home dependency continued. 2 02-15-90 Jurisdictional finding and out-of-home dependency continued. 3 07-06-90 Jurisdictional finding and court dependency continued, order that minor 4 be returned to custody of father under Social Service Department 5 supervision. 6 11-29-90 Dependency vacated and petition dismissed upon Court's signing of JV- 200 custody order, parents referred by Court to Family Court Services 7 for mediation. 8 12-04-90 JV-200 custody order signed granting sole physical and legal custody of 9 minor to father, reasonable visitation rights granted to mother. 10 INDIAN CHILD WELFARE ACT: 11 12 There is no indication in the court reports pertaining to the prior court 13 dependencies that the minor has any significant Indian heritage. The minor's maternal 14 greataunt, Phyllis Wood, was asked on April 14, 1997, about the possible Indian 15 heritage of the minor. She reported that the minor does not have any maternal Indian 16 17 heritage. The father will be questioned about this issue in order to determine if the 18 minor has any paternal Indian heritage. 19 INVESTIGATION: 20 21 On May 20, 1988, the minor was adjudged a dependent child of this Court and 22 removed from the mother's custody. The findings which resulted in the jurisdictional 23 finding and the out-of-home dependency included sustained allegations pertaining to 24 the mother's past substance abuse problems, her receiving treatment for her emotional 25 26 problems, and her inability to provide a home for or to care for the minor. There was 27 28 Danielle Clevenger, J96-02785 Page 8 1 also a finding pertaining to the father's history of excessive use of alcohol and use of 2 crank. 3 The court ordered reunification service plan for the mother included 4 5 requirements that she undergo an evaluation by a drug rehabilitation counselor, that 6 she comply with the counselor's treatment recommendations, that she undergo random 7 urine testing and test clean for drugs and alcohol for at least three consecutive months, 8 9 and that she participate in a mental health counseling program. 10 Pursuant to the social worker's report indicating that the mother had complied 11 with the reunification service plan requirements, and the social worker's evaluation 12 indicating that there was no need for continued court dependency, the dependency was 13 14 vacated on October 18, 1988. The minor, who had been placed with her maternal 15 grandfather and stepgrandmother, Jerry and Chere Matteri, was then returned to the 16 mother's custody. 17 Approximately two weeks subsequent to the vacating of the court dependency, 18 i.e., on November 4, 1988, the minor was placed in protective custody, and a new 19 20 dependency petition was then filed. On December 15, 1988, the minor was adjudged a 21 dependent child of this court for the second time and was again removed from the 22 mother's custody. The findings which resulted in the jurisdictional finding and the 23 24 out-of-home dependency included sustained allegations pertaining to the prior court 25 dependency and an additional finding that the mother had been inconsistent in the 26 taking of her medication, and that she was emotionally distraught and exhibiting erratic 27 behavior which was interfering with her ability to care for the minor. There was also a 28 Danielle Clevenger, J96-02785 Page 9 1 sustained allegation pertaining to the father that he was unable to provide daily care 2 and supervision for the minor due to his employment obligations. 3 The court ordered reunification service plan for the mother included 4 5 requirements that she undergo a psychiatric evaluation and follow the psychiatrist's 6 recommendation, that she complete a drug treatment program, and that she submit to 7 random drug testing. The court ordered reunification service plan for the father 8 included requirements that he comply with the provisions of his probation sentence 9 10 and that he complete an alcohol abuse treatment program if he was arrested for further 11 alcohol related offenses. 12 At the time of the dispositional court hearing, the minor was placed with her 13 maternal greataunt and greatuncle, Phyllis and George Wood. The minor remained in 14 15 this placement until June/1990, when pursuant to a court order, she was placed with 16 her father on a thirty day trial visit basis. The Family Reunification social worker 17 originally recommended at the eighteen month review hearing that a permanency 18 planning fording be made for long-term foster care of the minor. However, 19 20 subsequently the recommendation was revised to returning the minor to her father 21 under Social Service Department supervision. On July 6, 1990, the Court, in 22 accordance with this recommendation, ordered an in-home dependency with the father. 23 24 The court ordered Family Maintenance service plan included requirements for the 25 father to refrain from illegally transporting the minor, to maintain safe and suitable 26 housing for the minor, and to fully cooperate with the Social Service Department's 27 arrangements for the minor's visits with the mother. 28 Danielle Clevenger, J96-02785 Page 10 1 A Family Maintenance social worker submitted a court report for a three month 2 review hearing. The report indicates that the father was complying with the service 3 plan requirements. However, the social worker recommended that the in-home 4 5 dependency be continued and that another three month review hearing be set. 6 However, on November 29, 1990, the Court ordered that the dependency be vacated 7 upon the signing of a JV-200 custody order. This order was issued on December 4, 8 1990, and awarded sole physical and legal custody of the,minor to the father. The 9 10 mother was granted reasonable visitation rights with either the father or another person 11 supervising the visits. In addition, the father was granted authority to allow 12 unsupervised and overnight visitation between the minor and the mother. 13 14 On February 27, 1992, our agency received a referral indicating that the father 15 was selling drugs out of his home, that he was drinking and driving while the minor 16 was in his car with him, that the father had molested the minor, that he was not feeding 17 her properly, and that he was brainwashing her against her mother. This referral was 18 19 not investigated because of the unreliability of the reporting party. 20 On September 20, 1993, our agency received a referral indicating that the father 21 had recently been sentenced to a forty-five day jail term pursuant to a conviction for 22 possession and sale of PCP, that he left the minor in the care of his girlfriend, Rhonda 23 24 Walker, and that Ms. Walker was neglecting the minor's care. This referral was not 25 investigated because of the unreliability of the reporting party. 26 In 1993, the mother initiated proceedings in the Family Court to modify the 27 Juvenile Court custody order. On December 6, 1993, the Family Court awarded sole 28 Danielle Clevenger, J96-02785 Page 11 1 physical and legal custody of the minor to the mother. The father was granted 2 reasonable visitation rights. On January 12, 1995, the Family Court modified this 3 order: joint legal custody was awarded with the mother retaining sole physical 4 5 custody; the father's visitation rights were changed to allow supervised visitation only 6 with a requirement for professional supervision of the visits. 7 On January 17, 1995, and then on August 28, 1995, our agency received 8 referrals indicating that the mother wasn't allowing the father to visit the minor, that 9 10 the minor had observed the mother beating the minor's maternal grandmother, that the 11 mother was schizophrenic and an alcoholic, that she was not feeding the minor 12 properly, and that she was verbally abusing the minor. Neither of these referrals was 13 investigated because of the unreliability of the reporting party. 14 15 On July 24, 1996, our agency received a referral indicating that the mother was 16 mentally ill, that she was not taking her medication, that she had hit the minor in the 17 face and head, that she had kicked the minor, that the only food in the home was 18 19 popsicles and condiments, that the mother was going to bars at night and leaving the 20 minor unsupervised, that the mother was sleeping until 5:30 p.m. and that the minor 21 was therefore not being supervised during the daytime, that the mother was planning to 22 not enroll the minor in school, and that the minor wanted to be removed from the 23 24 mother's custody. This referral was investigated by an Emergency Response social 25 worker. A determination was then made that although there was evidence that the 26 mother had serious psychological problems and was exhibiting behavior which could 27 have a negative influence on the minor, there was insufficient basis to refer the case 28 Danielle Clevenger, J96-02785 Page 12 1 for court action. The case was then closed. 2 The referral to our agency which resulted in the initiation of the current 3 dependency proceedings was received on December 11, 1996. The caller reported that 4 5 the mother, Dana Matteri, was a paranoid schizophrenic, that she was not taking her 6 medication, that she was hallucinating and delusional, that she was blaming the minor 7 for her problems, and that she was being both physically and emotionally abusive to 8 the minor. The caller further alleged that the minor was fearful that the mother would 9 10 murder her. The caller also reported that the minor's father was imprisoned. 11 This referral was immediately investigated by an Emergency Response social 12 worker who interviewed the minor and the minor's counselor, Tamara Hicks. Pursuant 13 14 to the information obtained from these interviews, the social worker determined that 15 the allegations were valid. The social worker then contacted the Sheriff's Department, 16 and a Sheriff's Department patrolman then interviewed the minor who reiterated that 17 she had been subjected to physical and verbal abuse by her mother. The minor also 18 19 reported that she had not attended school for approximately one month because her 20 mother had disenrolled her. 21 The mother was subsequently interviewed by the social worker and the Sheriff's 22 Department patrolman. The mother denied the allegations and said that everyone was 23 24 lying. However, the minor was placed in protective custody. The social worker then 25 placed her with someone whose identity is confidential per the W&I 308 order issued 26 at the detention hearing. A referral was then made for court action. 27 28 Danielle Clevenger, J96-02785 Page 13 1 REASONABLE EFFORTS: 2 Past: 3 Referral of mother to substance abuse treatment resources, provision of drug 4 5 testing service, psychological evaluation and counseling service, both outpatient and 6 hospital psychiatric treatment service, and parenting education service to mother, and 7 authorization of service funds for mother's psychological counseling service; referral 8 9 of father to substance abuse treatment resources, provision of drug testing service to 10 father by Probation Department, and provision of Family Maintenance service to 11 father; arrangement of visitation between both parents and the minor. 12 present: 13 Provision of psychological counseling service and psychiatric treatment service 14 15 to mother, provision of psychological counseling service to minor, emergency shelter 16 care service for minor in confidential placement and then in home of relative, and 17 arrangement of visitation between both parents and the minor. 18 19 FAMILY SITUATION: 20 The following social history regarding the parents is excerpted from a court 2.1 report dated May 17, 1988: 22 "Dana Matteri was born in Richmond and lived there until she 23 was approximately age five or six. The family then moved to El 24 Sobrante and she went to local schools. According to her father, Jerry Matteri, she was a model student and got straight A's until she 25 was fifteen years old. She was then introduced to street drugs, 26 specifically crank. Her behavior immediately changed and she `started throwing fits.' He states she lost interest in school, her art 27 work, and no longer behaved like herself. In 1981, when Ms. Matteri was twenty-one years old, her 28 parents separated and later divorced. They have both remarried. Danielle Clevenger, J96-02785 Page 14 1 Her father is in the wholesale furniture business and her mother has worked part-time as a beautician. Ms. Matteri has one sibling, three 2 years younger. 3 In the 12th grade, Ms. Matteri quit school and went to work as a waitress. Also, she has worked as a secretary/clerk at the VA 4 Hospital and for a larger supermarket as a checker. 5 For the past years, Ms. Matteri has had a stormy relationship with the father of her daughter. According to Ms. Matteri's father, 6 she wanted to get married and this young man did not. He said that since the birth of Dana's daughter, she has become more and more violent, unpredictable, and less able to get along with others. 8 According to the family, Ms. Matteri has been arrested two or three times for assaults upon policemen. It appears that when pulled 9 over to the side of the road, when driving or a passenger in an 10 automobile, Ms. Matteri becomes belligerent and then starts swinging at the officers. She has had her driver's license suspended, 11 but, according to her father, she now has it back. The father is confident that she was on crank or other street drugs and liquor when 12 the above arrests occurred. 13 Ms. Matteri has no known physical health problems. Ms. Matteri has received food stamps; however, there is no 14 record of other income. 15 Jack Clevenger comes from a family of fourteen children and was raised in Contra Costa County. His mother and sisters have 16 expressed concern about his child's welfare and are satisfied that she 17 is receiving good care in the maternal grandparents' home as is Jack. He was employed at Mare Island Naval Shipyard as a carpenter until 18 he was arrested. He appears to be in good health." 19 Ms. Matteri subsequently applied for and was granted SSUSSP disability 20 benefits. She was also receiving AFDC benefits for the minor which were 21 22 discontinued subsequent to the minor's detention. 23 Ms. Matteri resides in an apartment in El Sobrante. I have never visited her at 24 the apartment and I am therefore unable to provide information regarding its condition. 25 26 Ms. Matteri has been receiving outpatient psychological counseling service 27 from Dr. Bart Rubin of the Family Institute of Pinole for several years. He has 28 referred her for psychiatric treatment, and medication has been prescribed for her. Danielle Clevenger, J96-02785 Page 15 1 However, as Ms. Matteri has refused to sign an exchange of information authorization 2 which would enable me to obtain more specific information pertaining to her current 3 treatment status, I do not know if she is taking her medication. 4 5 A psychiatric evaluation of Ms. Matteri dated March 21, 1990, conducted by 6 Dr. Paul Morentz, indicates that although Minnesota Multiphasic Personality Inventory 7 results were "characteristic of a Paranoid Schizophrenic, the subscales were not 8 9 characteristic of the mental disorder. They reflect an isolated person who feels 10 vulnerable and wary of people. The overall profile is that of someone who is 11 emotionally labile and immature. It does not show a great deal of depression." 12 A psychological evaluation of Ms. Matteri dated May 1, 1990, conducted by Dr. 13 14 Arvalea Nelson, indicates that Ms. Matteri's "Minnesota Multiphasic Personality 15 Inventory results showed her two highest scale scores to be on Schizophrenia and 16 Paranoia." The report further indicates that"although the results may not be valid, 17 because they were so extreme, they are consistent with a diagnosis of Paranoid 18 19 Schizophrenia." 20 Mr. Clevenger was convicted on May 25, 1993, of possession of a controlled 21 substance and was sentenced to forty-five days in jail and two years probation. 22 Subsequent to this conviction, Ms. Matteri initiated the Family Court proceedings 23 24 which resulted in the return of the minor to her custody. 25 On January 19, 1994, Mr. Clevenger's probation was revoked, and he was 26 sentenced to a sixteen month prison term. He was apparently paroled prior to the 27 28 expiration of his prison term as he was arrested on January 26, 1995, for suspected Danielle Clevenger, J96-02785 Page 16 1 receipt of stolen property. However, he was not prosecuted for this alleged offense. 2 On February 16, 1996, Mr. Clevenger was arrested for suspected manufacture 3 of methamphetamine. It was also determined that he had changed his residence 4 5 without informing his parole agent. He was then returned to prison for apparent parole 6 violation. 7 Mr. Clevenger was scheduled to be released from San Quentin Prison on 8 February 15, 1997. However, prior to his release, he was charged, pursuant to his 9 10 arrest approximately a year earlier, with one felony count of manufacture of a 11 controlled substance plus two felony counts of possession of components for 12 manufacture of a controlled substance, and he was then transferred to the County Jail. 13 He continues to be detained in the West County Detention Facility pending 14 15 adjudication of these charges. The next court hearing is set for April 22, 1997. 16 THE CHILD: 17 Danielle is an attractive, intelligent, personable, and amiable nine year old girl. 18 She does not have any significant medical problems. 19 20 Danielle is continuing to receive counseling service from Tamara Hicks, 21 psychologist intern, at the Family Institute of Pinole. Due to Ms. Matteri's hostility 22 towards Ms. Hicks, who testified at the contested jurisdictional hearing, I am not 23 24 including a requirement in the mother's reunification service plan that she participate 25 in the minor's counseling program. 26 Danielle is enrolled in the third grade at Ellerhorst Elementary School. She 27 states,that she enjoys attending this school. Her caretaker, Ms. Wood, states that 28 Danielle Clevenger, J96-02785 Page 17 1 Danielle is performing well, both academically and behaviorally, at school. 2 Danielle was initially detained in a placement which was kept confidential per a 3 W&I 308 order. Both Tamara Hicks and I became concerned about Danielle's 4 5 caretaker being overreactive and somewhat rigid in her management of Danielle's 6 behavior, and her accusing Danielle of lying when it did not appear appropriate to do 7 this. However, Danielle stated that she did not want to be moved from this placement. 8 9 Then, on February 25, 1997, the caretaker, who had previously expressed opposition 10 to Danielle having any contact with her mother, did not cooperate with me in the 11 arrangement that I made for Danielle to visit her mother on that day, and then did not 12 respond to both a note and telephone messages that I left for her to call me in order to 13 14 reschedule the visit. A decision was then made to place Danielle in the care of her 15 maternal greataunt, Phyllis Wood. 16 Danielle was previously placed in Ms. Wood's care for a period of 17 approximately one and one half years, and had regular contact with Ms. Wood 18 19 subsequent to this previous placement with her. Ms. Wood also sometimes 20 accompanied Ms. Matteri to her visits with Danielle prior to Danielle's current 21 placement with Ms. Wood. 22 Danielle expressed unhappiness about being removed from her previous 23 24 placement but has made an excellent adjustment to her placement with Ms. Wood. 25 The plan for Danielle is to continue the placement. 26 27 28 Danielle Clevenger, J96-02785 Page 18 1 FAMILY CONTACT: 2 Parents: 3 4 When Danielle was in her previous placement, Ms. Matteri was visiting 5 Danielle at my office, and I was supervising the visits. Although Ms. Matteri generally 6 interacted appropriately with Danielle during these visits, and it was evident that their 7 relationship is a loving one and has positive attributes, Ms. Matteri, on several of these 8 9 occasions, spent an inordinate amount of time questioning me regarding various issues 10 instead of being attentive to Danielle. 11 When Danielle was placed with Ms. Wood, it was not possible to keep the 12 Placement confidential. Initially, Ms. Wood agreed to allow Ms. Matteri to visit 13 14 Danielle at Ms. Wood's home, and to supervise the visits. For awhile, this visitation 15 arrangement was satisfactory but Ms. Wood then reported that Ms. Matteri was 16 exhibiting unprovoked hostility towards the girlfriend of Ms. Wood's adult son, Daniel 17 Osterude, who lives with Ms. Wood, and that Ms. Matteri had threatened to assault the 18 19 girlfriend. Ms. Wood therefore requested that alternative visitation arrangements be 20 made. 21 Ms. Matteri denied exhibiting hostile behavior towards Daniel's girlfriend or 22 threatening to attack her. I advised Ms. Matteri that her visits with Danielle would 23 24 have to occur at my office pending further evaluation. Ms. Matteri became very angry 25 when I informed her of this, and has refused to visit Danielle per this arrangement. 26 Since then, the only face-to-face contact between Danielle and Ms. Matteri was at an 27 Easter Sunday church service. 28 Danielle Clevenger, J96-02785 Page 19 1 A parent aide is transporting Danielle to the West County Detention facility for 2 visits with Mr. Clevenger. Danielle reports that she enjoys her visits with her father. 3 Grandparents: 4 5 Danielle's maternal grandfather, Jerry Matteri, called me on December 27, 6 1996, to inquire about Danielle and about visiting her. I suggested that he could visit 7 her concurrently with her mother's visits with her, and he seemed to be receptive to 8 this suggestion. However, he never accompanied the mother on any of her subsequent 9 10 visits with Danielle. 11 Phyllis Wood recently took Danielle to visit her maternal grandmother, Diane 12 Lopez, who is currently hospitalized. 13 14 During her previous placement, Danielle was visiting her paternal grandmother 15 on a regular basis. However, since her placement with Ms. Wood, Danielle's contact 16 with the paternal grandmother has consisted of telephone conversations only. Ms. 17 Wood is receptive to any requests that the paternal grandmother or other paternal 18 19 relatives make to arrange visits with Danielle. 20 Danielle's paternal grandfather is deceased. 21 Others: 22 Danielle has regular contact with various maternal relatives. As previously 23 24 indicated, Ms. Wood's son, Daniel Osterude, lives with Ms. Wood. He and Danielle 25 have a good relationship. 26 ASSESSMENT/EVALUATION: 27 The previous Juvenile Court dependencies and the Family Court decision to 28 Danielle Clevenger, J96-02785 Page 20 1 return the minor to the mother's custody have not resulted in the establishment of any 2 stability for the minor. It is evident that the mother has severe and chronic 3 psychological problems which impair her ability to provide consistent and adequate 4 5 care of the minor, that the mother's psychological problems intermittently manifest in 6 the form of both physically and verbally abusive behavior towards the minor, and that 7 the minor would therefore be placed at substantial risk of neglect and both physical 8 and emotional harm if she was returned to her mother's custody. 9 10 Due to the chronicity of the mother's psychological problems and the evidence 11 that the psychological counseling and psychiatric treatment services that she has 12 received has not resulted in any long-term stabilization of her behavior, I am 13 pessimistic about the prognosis for safely reunifying the minor with her. However, as 14 15 there does not appear to be any legal basis for not providing reunification services to 16 the mother, a service plan for reunifying the minor with the mother is being submitted. 17 There is no significant evidence of any illegal drug use or alcohol abuse by the 18 19 mother during the past few years. I am therefore not including a requirement for 20 substance abuse counseling or drug testing in her service plan. A current 21 psychological evaluation of her is included in the plan in order to obtain an assessment 22 of her capacity to become an adequate parent to the minor. 23 24 The father has a history of alcohol and drug abuse and substance abuse related 25 involvement with the criminal justice system. It appears that he has a chronic 26 substance abuse problem and is engaged in a lifestyle that is incompatible with 27 childrearing. If he is convicted of the current charges that he is facing, he may be 28 Danielle Clevenger, J96-02785 Page 21 1 sentenced to a lengthy prison term, and it would then not be possible for the minor to 2 be reunified with him prior to the expiration of the statutory time limit. 3 There is ample justification for including requirements for substance abuse 4 5 treatment and drug testing in the father's reunification service plan. He may enroll in 6 the Deuce Program, a substance abuse counseling program available to County Jail 7 inmates. Several of the other requirements in the father's reunification service plan, 8 9 e.g., undergoing urine testing, completing a parenting class, etc., would only be 10 applicable if the father is released from jail. 11 FAMILY REUNIFICATION SERVICE PLAN: 12 Plan For Reunifying Minor With Mother: 13 1. Undergo a psychological and/or psychiatric evaluation, as approved by 14 Social Service Department, in order to determine her capacity to become 15 an adequate parent to the minor. 16 2. Continue to participate in program of psychological counseling and 17 psychiatric treatment, focusing on the objectives of stabilizing her emotional state, controlling her delusional ideation, and interacting with 18 the minor without being physically and verbally abusive towards her, and complete program requirements. 19 20 3. Take all prescribed medications, as directed by her psychiatrist. 21 4. Enroll in, participate in, and complete a Social Service Department 22 approved parenting class. 23 5. Sign exchange of information authorizations as requested by social 24 worker. 25 6. Maintain suitable housing for herself and the minor. 26 7. Maintain contact with minor per visits arranged by the social worker. 27 28 Danielle Clevenger, J96-02785 Page 22 1 8. Meet with social worker at least once per month in order to arrange required services and to review progress in complying with service plan 2 requirements. 3 Social Worker's Activities: 4 5 1. Arrange for mother to undergo psychological and/or psychiatric evaluation. 6 7 2. Periodically confer with mother's psychologist regarding mother's participation and progress in her counseling program. 8 3. Periodically confer with mother's psychiatrist regarding mother's use of 9 medication as prescribed by psychiatrist. 10 4. Refer mother to parenting class resources. 11 12 5. Verify mother's completion of parenting class. 13 6. Verify that mother is maintaining suitable housing for herself and the minor. 14 15 7• As appropriate, refer mother to community resources for financial and housing assistance. 16 17 8. As necessary, provide bus rickets to mother for service related transportation needs. 18 19 Plan For Reunifying Minor With Father: 20 Father's Activities: 21 Commencing When Father Is Released From Jail/Prison: 22 1. Enroll in and participate in a program of substance abuse counseling, as 23 approved by Social Service Department, and complete program 24 requirements. (Father may commence this activity while detained in County Jail.) 25 26 2. Refrain from the use of alcohol and illegal drugs. 27 3. Test clean for alcohol and illegal drugs for three consecutive months; comply with random urine testing requirements. 28 Danielle Clevenger,J96-02785 Page 23 1 4. Enroll in, participate in, and complete a Social Service Department 2 approved parenting class. 3 5. Sign exchange of information authorizations as requested by social worker. 4 5 6. Establish suitable housing for himself and the minor. 6 7. Meet with social worker at least once per month in order to arrange required services and to review progress in complying with service plan requirements. 8 Current Activity: 9 10 8. Maintain contact with minor per visits arranged by the social worker. Visits to continue to be arranged while father remains m custody within 11 a fifty mile radius of Contra Costa County. 12 Social Worker's Activities: 13 Commenciniz When Father Is Released From Jail/Prison: 14 15 1. Refer father to substance abuse counseling resources. 16 2. Periodically confer with father's substance abuse counseling regarding 17 father's participation and progress in the counseling program. 18 3. Arrange for random urine testing of father. 19 4. Refer father to parenting class resources. 20 5. Verify father's completion of parenting class. 21 22 6. Verify that father has established suitable housing for himself and the minor. 23 7. As appropriate, refer father to community resources for financial and 24 housing assistance. 25 8. As necessary, provide bus tickets to father for service related 26 transportation needs. 27 28 Danielle Clevenger, J96-02785 Page 24 1 RECOMMENDATIONS: 2 1. Continue 300 (a) (b) and (g). 3 2. Adjudge dependent child. 4 5 3. Court determine that return of the minor home would create a substantial risk of detriment to the physical or emotional well-being of the minor. 6 4. Reasonable efforts have been made and will continue to be made to 7 prevent or eliminate the need for removal of the child from the home and g to make it possible to return to the home. 9 5. Find 361B, subsection 1. 10 6. Court admonish parents according to 361.5 (a). 11 12 7• Court order care, custody, control and conduct of minor to be under supervision of Social Service Department for placement in an approved 13 relative, certified or licensed home, exclusive use home or licensed group home per W&I Code 361.2. The minor is presently in the home of 14 her maternal greataunt, Phyllis Wood, and may remain there. 15 8. Costs by Contra Costa County; parents to reimburse. 16 17 9. Social Service Department be authorized to return minor home temporarily pending next review. 18 19 10. Court order Family Reunification Service Plan. 20 11. Parents' visitation arranged and supervised by adult approved by Social Service Department: Minimum of two times per month visitation, one 21 hour each time. 22 12. Social Service Department to authorize medical, dental or other remedial 23 care per W&I 369. 24 13. Court set six months for Review per W&I 366. 25 26 27 28 • Danielle Clevenger, J96-02785 Page 25 1 Respectfully submitted, 2 3 4 MARTIN GUTHE ocial Casework Specialist II 5 Contra Costa County Social Service Department 151 Linus Pauling Drive, Hercules, CA 94547 (510) 262-5134 6 7 Read and Approved by: 8 9 L 10 Charleen Raines, Social Work Supervisor II, (510) 262-5221 11 MG/CR/bev dsk:23/matteri.crt 12 13 Read and Considered by: 14 15 16 Juvenile Court Judge/Referee 17 18 19 20 21 22 23 24 25 26 27 28 • CLAIM e aZ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,000,000 Section 913 and 915.4. Please notp all "Warnings". CLAIMANT: William Piper ATTORNEY: Matthew Kumin, Esq. JUL 2 8 1997 870 Market St. , Ste. 1262 Date received COUNTY COUNSEL ADDRESS: San Francisco, CA 94102 BY DELIVERY TO CLEkVAff1NEZCk�y 25, 1997 BY MAIL POSTMARKED: July 24, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 28, 1997 PpHHIL BATCHELOR, Clerk BT: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( WThis 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: 3 0 BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ✓) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:-9 - 9 - 97 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: 9 - 10 9 7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator • 1 M ED PERVISORS CO. CLAIM AGAINST THE COUNTY OF CONTRA COSTA To: The Board of Supervisors, County of Contra Costa, for Claim Against the County of Contra Costa and certain County employees. William Piper hereby submits his claim against the County of Contra Costa,for the sum of one million dollars($1,000,000)for physical and emotional harm, for wage loss, and for constitutional violations, and makes the following statements in support of such claim. 1. Claimant's post office address is in care of Matthew Kumin, 870 Market Street, Ste. 1262, San Francisco, CA 94102. 2.Notices and correspondence concerning the claim should be sent to: Matthew Kumin,Esq:._ 870 Market Street, Ste. 1262 San Francisco, CA 94102 3. The date and places of occurrence giving rise to this claim are: Dotty Stakenburg's home at 423 Clark Street, Crockett, CA, 94525. The date was January 31, 1997. 4. The circumstances giving rise to this claim are as follows: On January 31, 1997 Officers Black and Yeates made a warrantless search of Dotty Stakenburg's home(see#3 above)for the purpose of locating William Piper. A report had been made that earlier that day William Piper had allegedly committed a battery in violation of his parole agreement. After locating William Piper in the house,the officers ordered him onto the ground and struck him with their batons even though he was not resisting arrest and was fully complying with the officers' orders. William Piper's girlfriend,Kristen Rose,who witnessed these events,was ordered by the officers to walk away from the room while the beating occurred. .She did not comply. Dotty Stakenburg called 911 for other police to come and restore order after the beatings had begun. The requested police never arrived. William Piper Was eventually handcuffed and lead out of the house. On the way out the officers made demeaning remarks to Kristen Rose, and William Piper was again beaten and placed in a hobble. 5. The Claimant's injuries include: a)physical injuries resulting from his arrest and detention b) psychological damages including,but not limited to, emotional distress and other impact on his psychological state of mind;c)violations of his constitutional rights; d)damage to reputation and peace of mind; and e)wage loss. 6. Potential causes of action include: 1)violation of his federal rights under 42 U.S.C. section 1983 encompassing: a)violations for use of excessive force in violation of the fourth amendment to the United States Constitution;b) deprivations of life and liberty without due process in violation of the fifth and fourteenth amendments of the United States Constitution;c)the right to be free of unreasonable searches and seizures as guaranteed by the fourth amendment to the United States Constitution; d)the right to equal protection of the laws as guaranteed by the fourteenth amendment to the United States Constitution; e)the right to be free from cruel and unusual punishment as guaranteed by the eighth amendment to the United States Constitution;and 0 the right to be free from interference within the zone of privacy, as protected by the fourth and ninth amendments to the United States Constitution. 2)42 U.S.C. sec. 1983 Monell claim. 3)Assault and battery. 4)Intentional infliction of emotional distress 5)California Civil Code sec. 52.1 6)Violation of parolee's contractual rights 7)Negligence 8)Negligent supervision, selection,training, retention, investigation and discipline 9)Negligent Infliction of emotional distress 10)Violations of the California Constitution 11)False arrest/false imprisonment 12)Failure to provide medical care under Cal.Govt. Code 845.6 13)Injunctive relief 14)Trespass 7. The names of the public employees causing claimant's damages include: Officer Black and Officer Yeates in their official and personal capacity, and as of yet undetermined officers who failed to respond to the 911 call. DATED: Nfattliew Kumi on behalf of William Piper 4 0 n -4 it, ry • t�� N tr ,d _ H } � 7 � Z un fi N N r' i } N N ti- O fi 9 � � o 80-Z£�b1006 7:- 0 000 ,�j�. y�rna�s ivlsoa ' ' lNnOWJ LL6 'bz lnf $Oibfi HT T V1.1 3gt3lSOd �s n CLAIM C BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $1,00 7.30 Section 913 and 915.4. Please note ammiximm'10 CLAIMANT: Kristen M. Rhoad AUG 0 7 1997 ATTORNEY: COUNTY COUNSEL. Date received MARTINEZ CALIF. ADDRESS: 2531 .Lynn Avenue BY DELIVERY TO CLERK ON July 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. Au ust 7 1997 PpHHIL BATCHELOR, Clerk DATED: g BV: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors Ox� 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: (� TBY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present ( ' ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 9 -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 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: 9 - ) O — 9:7 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator KRISTEN M. RHOAD 2531 Lynn Avenue Concord, CA 94520 510-686-4492 RE EIVE di 311997 July 25, 1997 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Public Works Department Maintenance Division 2475 Waterbird Way. Martinez, CA 94553-1457 Attn: Stan Matsumoto Dear Mr. Matsumoto: I received your letter dated June 19, 1997, and was pleased to hear that your department has acknowledged that there is an erosion problem caused by the drain on the County's side of the fence. Recently, your department has repaired the fence with chain link fencing. However, this repair has come too late in the series of events that lead up to your department taking action. In November of 1996, I made several telephone calls regarding the problem, that the erosion was causing gaps in the fence and causing an unsafe, and unfenced yard on the property. Enclosed you will find copies of a Judgment against me in the amount of$887.30 for the medical costs of Julie Shelton's cat. These medical bills are a direct result in the gaps in the fence allowing my dogs to escape, and run free. I am also enclosing copies of $120.00, the costs associated with obtaining my dogs from the Animal Control, due to the gaps in the fence, causing my dogs to escape. Therefore, I am requesting your department pay these associated costs in the amount of $1,007.30. I would appreciate an answer and these costs paid by no later than August 8`h. Should you wish to discuss this matter,please respond in writing by no later than the above date. Sincerely, Kristen M. Rhoad /kmr Enclosures July 15, 1997 Kristen Rhoad 2531 Lynn Ave Concord, CA 94520 Dear Ms. Rhoad; As per the decision of Superior Court of California,you are liable for the medical costs and court fees in the amount of$887.30. Please forward a check to me at the following address by July 31, 1997 or I will be forced to proceed with further legal action and/or a collection agency. Julie Shelton 1724 Oakmead Drive Concord, CA 94520 I hope that we can take care of this matter without further legal action. Sincerely, Julie S el a COST , L i jai E'�t, P. O . __O:_ ji� j Artinez , CA 94553 sone (510) 646-2950 Julie Shelton EiiK Plaintiff S.L. E{R, fir,;;�;i cc WTR}Ev;t i ;NTY vs Bt� iri Kristen Rhond C _- Defendant S.C.# 0221-9----- JUDGMENT AFTER TRIAL DE NOVO ON APPEAL .FROM JUDGMENT OF THE SMALL CLAIMS COURT The appeal of Defendant Appellant herein from a. Judgment of the Small Claims Court of the Mt . Diahln Judicial District, County of Contra Costa, State of California, duly came for trial before Honorable David Hnlromh Judge Pro Tem of the Superior Court, on 7/10/97 . Appearances: Plaintiff Defendant Evidence having been adduced and the cause submitted to the Court for decision; IT IS ORDERED, ADJUDGED AND DECREED that For plaintiffs and against defendant Kristin Rhoad $806 . 30 principals plus $21 .00 costs : Total 887 . 30 This judgment and the appeal is eby orde ed transferr d to the Mt . DiabloJudicial Distr'c for pur o e of enf rcement and other proceedings. C P )16.780 (d) Dated: 71164-2 Ju ge Pro Tem of the Superior_Court- Clerk's Certificate of Mailing I certify that I am not a party to this cause and that a true copy of the foregoing JUDGMENT was mailed, first class, postage fully prepaid in a sealed envelope addressed to each person whose name and address is given as follows: Julie Shelton Kristen Rhoad 1724 Oakkmead Dr . 2531 Lunn Ave. Concord , CA 94520 Concord, CA 94520 and that the foregoing was mailed and this certificate was executed at Martinez, CA an Superior Court by i�� �� ��' deputy clerk. Ka Aleen Shambaugh artment J. Michael Watford Contra Public Works De p Public Works Director CostaMaintenance Division 2475 Waterbird Way Milton F. Kubicek County`,,�' Martinez, California 94553-1457 Deputy-Engineering FAX: (510) 313-7014 Patricia R. McNamee Telephone: (510) 313-7000 Deputy-operations June 19, 1997 Maurice M.Shiu Deputy-Transportation S. Clifford Hansen Deputy-Administration Our File: Galinda Creek Mr. Joe Giannini 1147 Heavenly Dr. Martinez, CA 94553 Dear Mr. Giannini: As a follow up to your recent telephone conversation with Barry Porter of our office, we inspected the drainage situation on your property at 2531 Lynn Avenue in Concord. Our inspection revealed that only minor erosion is occurring along your westerly property line. The greater problem appears to be the gap that exists in certain areas between the bottom of the chain link fence and the depressed areas on the ground surface. We are planning on bridging the larger gaps with fencing material from the Flood Control District's side of the fence. If you have any questions, please call Barry Porter at 313-7037 or me at 313-7006. Very truly yours, i� Stan Matsumoto Senior Civil Engineer Maintenance Division SM:fp:rs C:NMyFiles\W O R KEG linda.wpd cc: Supervisor, DeSaulnier G.Connaughton,Maint. B.Porter,Maint. Kristen Rhoad G01161T CONTRA COSTA COUNTY _ ANIMAL HISTORY NO. 1 Q 9212 N T /�r ANIMAL SERVICES DEPARTMENT 1.J -AP.-.DEOOZ '-ESS E IQ AT DMOrr � Pit. ❑ FINOER WANTS ❑ DATE@(TURNED "'POUNDING KENNEL DATE _ 1404 AT TIME: NO: OUT: r_ NAME StRAyt�j SURRENDER ❑ 91TER RELEASE y O DATE: OWB Q Q ADDRESS IDEMOct r10 E LIC. OTHER ❑ PIIONE I IMPOUN01 GRSHERIFF OTHER t OFFICER CP FOR: ❑ IFF C] tREOUESTING GATE OF VICTIV'S SITE NA% ADDRESS "whe A ADDRESS Zq3 Li4 i,, PNpNE _ 2 NEW OWNER ADDRESS f:��E// `' BREEDLOR 'r' SMALL ❑ MEDIUM ❑ LARGE OP COLLAR L.. DETAILED /w J DESCRIPTION 'ry ��J7 NAMF SEX AGE F-S BROKEN SE. y❑ ❑ NEUTERED yF S NO IGO❑ ES NO ❑ GNILD EINH y❑ ❑ SNOTS ES -I DIST y❑ Q CAUTION I I DO N SIGN THIS FOR TIL YOU HAVE READ IT COMPLETELY I am the owner at outhorired the own W20-12 I¢od ;,f*e G.irnlGI described herein.1 hereby I PTS outhwite If.e County Io dispos f rite In any manner it sees fil..wrthour prior oor:ce !15oVm f e lar the owned•o h itolion a notice mqueemew imposed by any3 I Presenf04 statute 0,ordinance.1 •Apt emem under CaLfornio Food and Agrculvrol Code f I (Returned 31108 or CMdin section 4 6 . M seq,that the animol be kept 9 s Ihe�1(ime be. fore being killed and any requirement under Food and Agricultural Code section 71 107 or dinonce - P- = I Code 416.8.006 fol that I lot 1 owmrl receive notice of any such action.I further assume 911 responsibil- NewOwner iry and release the Count from all risks and damages which may ante from whatever cause.Unless noted . = I yI ($ lon Ilsis form,,certily the herein describxd animal to the best of my knowledge hos not bitten any porton f during the post 14 dogst10daysfo,dogsorcots., ee $ IN G HH TOTAL CHARGES SI lotI J SIGNATURE AS THE NEW OWNEROf THIS ANINULL I General Receipt Is L REASON FOR HEREBY AGREE TO THE CO ,OITIONS ON TME I A,Large ❑ GIVING UP ANIMA REVERSE SIDE OF THIS FORM. I I NoUcena ❑ i•_•j. :L %t Ti r.5_r': 12)`��/V '1/ 1 / ignoture o w wrier I Other ❑ IMPOUND NOTICE IN OUT ASO#$$IB-22 R.,S/87)30M 1 SENT lot DATE BY CONTRA COSTA COUNTY ANIMAL HISTORY NO. 9 1 ANIMAL SERVICES DEPARTMENT 1 IN, a0?'E SS ❑5vNjkjjyC n � P&avir AV GATT 117111"AD IMPOUNDINGKENNEL DATE too"V(T TIME. Q NO: OUT NAME ATO STRAY SURRENDER ❑ BITER ❑ RELEASE Y kS OATEN OWH ❑ ADDRESS /GENT. pt CE LIC. ❑ OTHER ❑ PHONE 1 IMPOUNDING CHP RIFF OFFICER SHERIFF ❑ OTHUt REOUESTING DATE OF VICTIM'S SITE NAM ADDRESS c PH OWNER AOORESS Z J 3 , h R NEW I 7S OWNER ADDRESS SMALL BREED ED r I'-A-- 13 MEDIUM C1 LARGE O�COLLAR EV WAILI OESCRON A� LY I(/ k, NAM SEX ACE HOUSE YET NO yES NO GOOD WITH YES NO DIST YES NO BROKEN ❑ ❑ NEUTERED Q ❑ CHILOREN ❑ Q SNOTS ❑ ❑ CAUTION ! 1 00 NOT SIGN THIS FORM UNTIL YOU HAVE READ IT COMPLETELY I am the awne,or haired by the ow his stead,of t on, 1 esctibed herein.1 hereby r I Pis =authorize the Covert t disrax a!rhe I '•• s I.I.w•rhoul prt_r notice im rtg Fee S I a me lar the owner n y o r v,remenr,mppsed by any B d S /� Present Owner statute or ordino wo, re K Co. oad and Agricultural Code t a T f �T I (Returned) section 31 108 0 0 ct,On 4 6.2.002 M stp.that the onimpi be,kepe o srili d lime be. fo killed and any requirement under food and Agricultural Code section 31107 ar dinonce t Spa De . S I Code 8.006 lot that Ito(the owner)receive noltce of any wch action.I lvtiher ossume oK retpOnslbd- New Owner ity and release the Cavnty from all risks and damages which may arose from whatever mute.Unless noted ob V Do S i (Sol*) ❑ on IN%form.1 certify the herein described oo,mol to the best of my knowledge hos nor b aten any person en e Z I during The post 14 days 110 days for dogs of cats.# V Quor.Fee ! 1 TOTAL04ARGES = I NATURE AS THE NEW OWNER Of THIS ANIMAL I General Recetpl Ft REASON FOR HEREBY AGREE TO THE CONDITIONS ON THE I Al Large ❑ GIVING UP ANIMA REVERSE SIDE OF THIS FORM. I I No License ❑ 1'?-1+— a i(`ti .afl O Signature of Now Owner I Other IMPOUND NOTICE .. - I OUT ASO e55IS.22R".SrB2130,AA I SENT to^`i DATE J BY J� -&rIX3 2-. 5 / R aotA.D K 21 SQA) CnNTRA COSTA COUNTY Anima caner AaIIMAL..SFR,'ICES DEPARTMENT 2531 Lynn Ave CASE REPORTCOMPLAINT �lD Address `; c{ Concord 60(0-- 4q1- " City Phone SUMMARY OF PROBLEM Two dogs described as husky types , were at large on x :37 : The dogs came onto PRs property and attacked her cat, causing severe injury. 1.551.12 ROA p• OFFICER' S REPORT ILItfCa c�; (7wn�wr� /�i9S IcF�vS D /4K r'I'}s, SHE is Cv1c2-e11•°rLY we2KI VG w rH rHE Clry of cows-oao fo CiY TItE =-ASFEM,F-Ji" TI-fitY i3 Ac-g VP I•fc& ;,UC6:. D//?,r /--5 E/Zvv��kI4 ,4 1? vwn.es2 f/i.=i2 FE10 LE T SvGG�`sTFr� ��Gu2lnv(, AO S I.v�TH Cb/i9iiJ Uul'iL GcNt2Ec%T�`�. T A�v,s r� tN��2 APl) Date and time investigated 2111197 �lqzs les, Investigating Officer -tfosS '` Z Refer to for other action + Witness SAC/foN, e Ozzknpalf Name AddIress Phone Received by CCannon Date 2-14-97 Time 310pm ASD 7 14 Rev. 8/82 UUN1rtR tau'01X WUNTI ANIMAL SERVICES DEPARTMENT CASE REPORT COMPLAINT Animal 0•rrner 2531 Lynn Ave. , Concord Name Address City -PE one Reported by Shelton, Julie 1724 Oakmead Dr. ,Concord 676-3627 Name Address City Phone Received by CCannon 2/14/97 310pm Clerk Date Time Summary of Problem: Two dogs described as husky types , were "at large on 2/13/97 . The dogs came onto PRs porperty and attacked her cat , causing severe injury. Issue P.D.A.P. ASD 714 Rev. 8/82 CONTRA COSTA COUNTY ANIMAL SERVICES DEPARTMENT Additional. Pertinent Information ADDENDUM TO: Ka S1—.,--N ( ) Bite Report Case Report DEFENDANT Name LYNAJ A%11 ( ) 24A ( ) AIIIJ Address p `/ CU-NC.� �o Y 119-u ( ) Other City Telephone (specify) zjt�-j (Cod—,) of=:- 1 dr- Gy•2. L�,q (3, i.1'T7�S s' u� CC�VtiJ V`�( 02�, SHE AUG-13-1997 14:56 CONTRA 1 MGT P.01/02 Claim to: BOARD OF SUPERVISOR.$ OF CONTRA COSTA COUNTY JN"UrrTO N Z 'M Ct. IMWr A. Claims relating to causes of action fer 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 1^0th 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 cross and which accrue on or after January 1, 1988, must be presented not later tlan s.ix months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of tbe Board of Supervisors at its .office in Rooth 106, County Administration Bul dlri3, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Hoard of Supervisors, rather than the County, the name of the District 'r-_, ld 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. cla=as, Penal Code Sec. 72 at the end of this form. RE: Claim By > Reserved for Clerk's filing s - -- KRISTEN M. RHOAD RECEIVE.D--- - ' Againthe nty Couof ntra Cost ) AUG 15 1997 st or CLERK BOARD OF S�1r'FS`/3SORS C.C.C. PUBLIC WORKS DEPT. District) CONTRA COST^v0. —(FUI 07M45 The undersigned claimant hereby ma%es cla-1m against the County of Contra Costa or the above-named District in the sia cf $ 1,007.30 and in support of this claim represents as follows: 1. When "did the damage or injury occur? Give exact-date and hour) Judgement 7/10/97, incident happened 2/14/97 at 6:00 p.m. 2. Where did the damage or injury occur? (Include city and county) 2531 Lynn Avenue, Concord, CA 94520 Contra Costa County --w-----Y—......r..r_..—wa_�....Y_w_+r.�-+..-...r-�...._.d.�.•--.r...-wr�sn.r•.-'--.w+.w�.._.._�..a.__��....r_��.__�_ 3. How did the damage or injury occur? (Give full details; use extra paper if required) Fence not properly maintained, allowing dogs to escape yard, and incident occurred with third Part 's animal. County owns fence. YYYYrW.r ----- --w--_ _�.�_ .�++.+.www.M..+....e._r.._�__.w----wY_____y Y.W�w_____..Mr—.+.✓_1w�_ 4. What particular act or omission cn be part of county or district officers, servants or employees caused the inJ,,u7 or damage? County's omission to perform due care allowing unsafe conditions and defects in Defendant's property. Defendant owes Plaintiff a legal duty to protect Plaintiff from harm of affected conditions and failed to take affirmative action to control condition of Defcndant's property. - (over) AUG-131997 14:57 CONTRA =+ r " _k ' NGT P-02/02 J 7. wnat are the names of county or d1-3Cri1--t officers, servants or employees causing the damage or injury? MAINTENANCE DIVISION PUBLIC WORKS DEPARTMENT FOR GALINDO CREEK ......_......-..._..—------------------------...._-_—------_._.-----------_ ------------------- 5. What damage or injuries do you clalk- resulted? (Give full extent of injuries or damages claimed. Attach two esti=t=�s for auto damage. ANIMAL SERVICES..........................$120.00 JUDGMENT7/10/97.........................$887.30 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ACTUAL DAMAGES. S. Names and addresses of witnesses, doctors and hospitals. N JULIE SHELTON 1724 Oakmead Dr, Concord, CA 94520 DR. LENTZ ALL BAY ANIMAL HOSPITAL 1739 Willow Pass Rd, Concord, CA 94520 9. List the expenditures you made on account of thin accident or injury: DATE ITEM AMOUNT 07/10/97 Judgment for damages to Shelton $887.30 11/11/96 Animal Services $120.00 * � � � � � � � � .* * � # iF � * � � ?l � .� � * � It_ � � � 1litiF • ! iF * 1t • ititit * � Gori. Code Sec. 910:2 provides: "The claim trust be signed by the claimant WO NOTICES TO: (Attorney) or per;on on his behalf." Name and Address of Attorney Claimant Is Si ure i 1 (:address Telephone No. Telephone No. 510-686-449 2 " N 0 T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allose or pay the same if .genuine, any false or fraudulent claim, bill, account, voucher, or writi-nZ, 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 ($1.0,000, or by both such imprisonment and fine. TOTAL P,02 F j A i t{{ 1 r a i s O: 0 :0 0 � ..so O ma f ` a OL fah a � cn =� CL to ( s ! a #� A E " j;� t CLAIM e, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $2,634.35 Section 913 and 915.4. Please note all .1W1092TIVgI) CLAIMANT: State Farm Insurance Companies +'IL�i�I(Clf(�bJ� �i Claim Number: -,05-7906-422 AUG U T 1997 ATTORNEY: Insured: Barbara Griesau COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 6400 State Farm Drive BY DELIVERY TO CLERK ON A„gust 5, 1997 Rohnert Park, CA 94928 BY MAIL POSTMARKED: Hand Dpl i vPrPd via- Ri ck MQmt_ I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. August 7, 1997 QQHHIL BATCHELOR, Clerk DATED: BY: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: p v 2 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). 1V. BOARDS ORDER: By unanimous vote of the Supervisors present ( �) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 9 - q 92 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 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 mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 9 - 9 BY: PHIL BATCHELOR by Deputy Clerk CC: County Counsel County Administrator ESTAPTEFARMState Farm Insurance Companies RECEIVE® North Coast Office August 1, 1997 w°'" 6400 State Farm Drive Rohnert Park,California 94926-0001 Contra Costa County Fire Distric' AUG - 5 1997 2010 Geary Rd yea Pleasant Hill, Ca 94523 CLERK BOARDOFSUPERVISORS CONTRA COSTA CO. ****IMPORTANT**** PLEASE WRITE OUR CLAIM NUMBER* ON YOUR REPLY OR PAYMENT THANK YOU RE: Claim Number: *05-7906-422 Date of Loss: May 23 , 1997 Our Insured: Barbara Griesau Dear Sirs: State Farm Mutual Automobile Insurance Company on behalf of Subrogee, Barbara Griesau hereby makes claim for $2634 . 35 and makes the following statements in support of claim: 1. Notices concerning this claim should be sent to: State Farm Insurance Companies 6400 State Farm Dr Rohnert Park, Ca 94928 2 . The date of accident occurring on May 23 , 1997 at Eastbound Route 4 , near Alhambra St exit in Martinez . 3 . The circumstances giving rise to this claim are as follows: Firetruck crossed freeway without any sirens or other warning. Our insured broke but could not avoid collision with the firetruck. 4 . The injuries reported consisted of none. 5 . Our total claim is as follows: Company's Net Payment $2384 . 35 Insured's Deductible Interest $ 250. 00 Total Property Damage $2634 . 35 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 STATE FARM State Farm Insurance Companies 4 42,MI) Contra Costa County Fire District INSURANCES Page 2 August 1, 1997 North Coast Office 6400 State Farm Drive NOTICE: Rohnert Park,California 94926-0001 This form is to provide notice of our claim for damages in accordance with the 180 day statute. If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. State Farm Mutual Automobile Insurance Dated:— By:AUG 0 11997 Emplqy- e- e Name Employee Title Employee Phone Number Enc: Supporting Documents cc: Levinson 2662 09 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Y^i.r. n..i-• .. Y.,.e• r...•.r. x a S ,.,�.. .•... ..y.. [.'T�'Y. V.. f -..� ._a.y.•,,rita••v{{w'ri r.Y. .') Y "'Y Jr•:.. s u3�r rti r.,�i�':n-�6•e x x. '� K 1... !A N ,,a "�^ M1',++ h;�.•} >: •yrX;,..,,*,;"7 ' I`€�^tt'" ,..ff.E,.0 r,+;tx}.7,y5dty{kn�'f!^>'.•�STYk r.r �: n', Rr4t).rrf't.. ��u;y.t5„`a k..H1. )..::ty; "ai....1'`.a.4�•ltr�f a.n4�t.Sa. A .Tri. .;{< y:rn'� ...,..�,a 4.i+t ,.r,:t,7' a"l"•4 t..�.. i arc ,. yIrl ,4�'t, ..1, d's�t �n `}�"nW '�,yr's t 5t ti4'i?y i t "t, rt i.. r,5,�C"rcr.,. .lr. R -r t'F$ ,,Yj ji ,:.5 r.:�'J* .J Sr Y•✓ y�It .� iE"itll { 4.1.:ffi.i` r,.+. Y: .'. y-•}V-0••i 4,'r t^�;ln r.r ,'r [`"r•:rt r,R>-Yl ..tl<�•l ; j4t`r �i. :Jl trod '^A ^ 1 1 h .s.• L . .�\V'1'} t r !1?. 'r:,1:•} 7�..T�d� R��t�'stip§�t[�i �P.Ft 1#I.ta(r.. )/) j.T-,l tt f fi ��':h4ts �� Y i t r '.d d f::7.`� !}.'.rh.. ..o. ��rY4> Ir .r-•L J.. s, c /�(xf��gh. tg� j'#I i r�� M1t 6 )¢b1t1P' �E, rq,A iir z [ zFr,{ ) .�r t rt [sn .: r. CLAIM NO 05-7906-422 POLICY NO 1794-104-05 LOSS DATE 05/23/97 DRAFT NO 1 02 850167 Jr PAYEE DATE 07/02/97 BARBARA GRIESAU AMOUNT $****2,384. 35 668 KEY ROUTE BLVD ALBANY CA 94706-1423 COVERAGE T14 COLLISION ( ) 400V $2,384.35 REMARKS TOTAL LOSS SETTLEMENT CREATED BY Deborah Calhoun r �a•�.�••M , STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY 1,402 850167 J NORTH COAST OFFICE BANK OF AMERICA NT & SA 11-35/1210 ROHNERT PARK, CA CUSTOMER SERVICE AMERICAS 1233 " DATE 07/02/97 �w. iAMq CONCORD CA Pleas Hill Auto 02-103 COVERAGE ZVI COLLISION ,(LOMV) CLAIM NO 05-7906-422 POLICY NO 1794-104-05 CLAIM UNIT `35A 400-1 $2,384.35 LOSS DATE 05/23/97 INSURED GRIESAU, BARBARA , •up " . ****************************************EXACTSLYW0,31HOUSAND THREE WEIGHTY-FOUR-AND AND 35/100 DOLLARS �Ft : Pay to the Order of. BARBARA] GRIESAUri 668 KEY' ROUTE1BLVD ALBANY CA 94706-1423 TIN AUTH DCALH APP OVED BY HICL INSPEC =, PORT 1-TOTAL="LOSS -REPORT­ STATI.AR �r aim Number I j,. Claim RepTp6e4tatiuo_ Claim Unit INautAMC� r7F Owner d-�J f Phone Number / FAX Number -f3 )jeAfi(21ft Insured j, Loss CodeDate of Loss Date Reported I I Location Addresst� f ;Phone Number Towing$ let �,JYe( A! l CC/ L `- � ;�5 l v � S'� 2- C� Storage$ Per Day Cause—of Loss -!J Collision ❑Theft ❑ Flood ❑ Vandalism / 11 Hail ❑ Fire ❑ Other VEHICLE DESCRIPTION Year Make MoeriesBodysy tle License Plate Number ; Expiration Date Ste 2 �u l l / c� y t l %/AJ /- W VIN Color:'€�� `c I L r7 .r- Engine Disp. No. Cyl. as ❑ Diesel ❑Turbo :Trans.: ❑ Auto. (3-4) aSTD. (3-4 6) ❑ 4 WD Mileage Mfg• 1/�-(_eA-e—Ce wA i %orf �� -71 ,7� Tires: / �P Size ( tee! Belted dial lN/W ' LF LR_��fiF_/� P EQUIPMENT/ACCESSORIES SEATS STEERING BRAKES ROOF GLASS WHEELS ❑ Power ❑ Power Power ❑ Vinyl ❑ Tinted (OEM/Non-OEM) ❑- andard ❑ S lit 4_= 1, ❑ 4 Wheel Disc El,Sun(Power/Manual) ❑ Shaded ❑ Alum/Mag Alloy Bucket ❑ 4 Wheel ❑ ABS ❑ T-Top ❑ Heated(Frt./Rear) (OEM/Non-OEM) Q'Cfoth Steering ❑ Convertible ❑ Heads-Up Display ❑ Chrome ❑ Vinyl ❑ Telescoping (Power/Manual) ❑ Power Windows ❑ Wire ❑ Leather ❑ Luggage Rack ❑ Rear Glass Wiper ❑ Full Wheel Cover(Wire) ❑ Heated ❑ Hub Caps ❑ Lumbar Adj. RADIO: ❑ OEM Non-OEM Brand Model No. ! 10f-FM Stereo 12"fape Deck ❑ Amplifier El Equalizer ❑ CD Player ❑ Power A09qna CB: ❑ OEM ❑ Non-OEM Brand Model No. CELLULAR PHONE: [],OEM El Non-OEM Brand Model No. OTHER INTERIOR OTHER EXTERIOR PICKUP/VAN-EQUIPMENT/A SS RIE Q ❑ Power Locks El Cruise Control El Power Mirrors El Step Bumper ❑ Aux. e(Tank ❑ Trunk Release (OEM/Non-OEM) ❑ Special Mldgs. ❑ Sliding Rear Window ❑ Too Fog ights ❑ A/C ❑ Air Bag: -. - El Ground Effects ❑ Removeable: ❑ Bed Li -.❑ •Tr er Tow Pkg. ❑ Rear A/C ❑ Driver ❑Pass. ❑ Luggage Rack ❑Soft Top ❑ Hard Too' ❑ Roll Bar ❑ mper Shell ❑ Digital Dash_.. ❑ 3rd. Seat: ❑ Spoiler ❑ Running Boards ❑ Light Bar Captain Chairs ❑ Trailer Hitch ❑ Gri!la Guards El 2 El 4 -' ❑ 6 a:. ❑ Theft Alarm Paint: Original ❑ Repaint(+/-)$ ❑ Pinstripes/Graphics ❑ 2-Tone ❑ Custom ❑ Wood Grain Motorcycles: ,❑Fairing(Full) ❑ Fairing(Handle Bar) ❑ Luggage Carrier ❑ Saddle Bags ❑ Headers ❑ Side Car ❑ Crash Bars Use this space to explain or describe Equipment/Accessories listed above and/or list and describe additional Equipment/Accessories. iMAY 2 8 -1937 SEE CPG: 2700,270 CONTINUE ON REVERSE SIDE ;* Page'l G-5326a Printed in U.S.A. ItrPRE=LOSS CONDITION INTERIOR: (Ex in if other than average condition for year,make a mode►vehicle)- - -- - - - Above Avg. -Ayg.: .Below Avg. Seats: �- &�./LY ❑ CEJ Carpets: "C-a�"� ❑ ❑F ❑ Glass: ❑ ❑ ❑.. Dash: ❑ El.- ❑ Headliner: ❑ [}— ❑ EXTERIOR: (Explain if other than gverage con Bilin for year,;make and model vehicle) Sheet Metal: C ❑ C3-- ❑ Paint: �* � ❑ F=- ❑ Trim: ❑ Q ❑ MECHANICAL: (Explain if other than average condition for year,make and model vehicle) Engine: ❑ 13•—• ❑ Transmission: ❑ 13-- ❑ Prior Damage PRIOR DAMAGE: El Yes GJ,N Estimate Written: El mount$ Damage Location:- R - A OVERALL CONDITION: E! Above Avg. fAvg. ElBelow Avg. r Salvage will be: Rebuilt ❑�r parts El Scrapped INSPECTED DATE TOTAL LOSS SETTLEMENT =. Method used to determine base price. (Check one) Computerized Evaluation ❑`Comparable Vehicles'.. ElBook'Value'. Evaluation x Name of Vendor CCC 'Amount' Did youpay the computerized evaluation amount? - -❑ Yes- ❑ No - If No, explain: `• ` �'��- '• Adjusted Amount$ Souece&Telephone Number Quote By Date Make & Model Available Selling/Sold YES NO Price 3. Circle vehicle number(s) used to determine base price: ( 1. .2 v3. ) Explain any adjustments for difference insmileage, equipment, condition, prior damage, etc.: t `°• , . '._:..R, . ..... Adiusted Amount Book(s) used. ` Basic Book.Price$ List additions or deductions for equipment, mileage, etc. and prior.. -damage:_ Adjusted Amount Did you pay this amount? ❑ Yes ❑ No If No, explain: - - - --SALVAGE Name of Purchaser Base Price - - -- $ S�(o� -c-a ---• - - -- - - DISPOSITION"'.]�' .�(,( Tax . _.. .. _.....+ Fees + l (9 D Date Sold I `/ Z� _ Remarks; Actual Cash Value .- 2 Date Remittance Received Owner Retained Salvage ' Deductible 5Z. LrC� Nigh Salvage Bid $ - - - - ' Lienholder Payoff - Towing Expense —�__.� . ' •• Amount Paid owner $ 3sSLl. .TO Storage Expense Disposition of Title: Date Se led ., . . . Z � /.j��^ Miscellaneous Expense `'� l�G•�I/ .._,...... .. . ..... 1Net•SaNageRetum.,..e___S �e `•'(i Date y_ r__ _ �..� __....__.._-....._..... CLAIM REP.SIGNATURE .3.- see CPG`LI700-270 Page 2 . • Page 1 STATE FARM MUTUAL INSURANCE COMPANY PLEASANT HILL SERVICE CENTER 333 CIVIC DRIVE P. 0. BOX 45: 11 CONCORD, CA 94524 ( 510) 68i?-410() CD LOG NO 0000211 DATE- 05/29/97 CLAIM# o5-7906-42201 POLICY# COMPANY STATE FARM CLAIM REP MATT FINERTY INSURED BARBARA GR I ESAU CLAIMANT LOSS DATE 05/23/97 TYPE OF LOSS COLL/DRV INSP DATE 5/28/97 LOCATION PHSC APPRAISER MARGARET WISE COMPANY NAME BARBARA GRIESAU WORK PHONE (510) - ADDRESS 668 KEY RTE BLVD CITY STATE ALBANY CA ZIP 94706 PHONE ( 510)525-5248 LIC# 1NAW6222 VIN JHMAG4313GSoO7548 ENG/COLOR: BLUE MET MILEAGE 16o878 CONDITION GOOD ACCT' NG CTL# E=NEW PART EC=QUALITY REPLACEMENT PART EU=EQUALITY RECYCLED PART EP=SEE PX REPORT P=CHECK I=REPAIR/ALIGN/SUBLET L=REFINISH N=ADDITIONAL OPERATION TE=FART/PARTIAL REPLACE ET=LABOR/PARTIAL REPLACE- IT=LABOR/PARTIAL REPAIR AA=APPEARANCE ALLOWANCE RP=RELATED PRIOR DAMAGE UP=UNRELATED PRIOR DAMAGE 1986 HONDA CIVIC DX 2 DOOR HATCHBACK H0222B/C OPTNS F/2 OPTIONS: TWO-STAGE - EXTERIOR SURFACES OF, GDE MC DESCRIPTION MFG. PART NO. PRICE AJ% HOURS R E Po05 - COVER;,FRONT BUMPER ** QUALITY REPL FART 120 0 p 1 ,4 1 L 005 09 COVER,FRONT BUMPER REFINISH -_s - 2.4, 4 E 030 4i� PANEL,HEADER 6118C?SB3661 Z Z 22. .83 ,QYF , . 1 L 03o PANEL,HEADER REFINISH 3,9 2. 5 4 E P055 LAMP,S I DE MARKER RT *?k QUALITY REPL FART 4 8 1 E P083. PANEL,HOOD ** QUALITY .REPL PART 137.Cac_? yi� i . 1 L oB.Y PANEL,HOOD REFINISH 3 3 4 E 5:?74 07 PANEL,RADIATOR SIDE RT 04601SB3731 Z Z 71 .72. .6 1 L o74 PANEL,RADIATOR SIDE RT REFINISH ,6 4 E U82 07 CRSMBR,RAD PANEL UFR 60841SB366OZZ 42.75 .; 2.6 1 L 082 CRSMBR,RAD PANEL UFR REFINISH .2 4 E: 071 BAFFLE,RADIATOR PANEL 6i?867SB2o2o 31 .4B .4 1 I 111 PANEL, INNER FENDER RT REPAIR/ALIGN 2.0*1* L 111 PANEL, INNER FENDER RT REFINISH ,8 4 E Io4 457 FENDER,FRONT RT 61oloSB366oZZ 21 - 8 1 L 1(--)4 FENDER,FRONT RT REFINISH ECEIVED 2. 5 4 E 15_i7 40 SKIRT, INNER FENDER RT 611.4oSF7oI0 ., y 2 8 1997 , 5 1 E 113 SHIELD,FRONT SPLASH RT 60512SB2�X157 E 13o BRACE,FRONT FENDER RT 61116SB3()l(-)Z Z .90 1 N 974 SUSPENSION ALIGN,FRT ' ADDITIONAL OPERATION BBY 1 5 2 1 171 PANEL,HINGE PILLAR INR RT REPAIR/ALIGN 2.0*1* i • =HATCHBACK: Page 2 HONDA CIVIC DX '2 DOOR CD LOG -NO 1000211 Date 05%21j/97 OP GDE MC DESCRIPTION MFG. FART NO. PRICE AJ% HOURS R L 171 FANEL,HINGE PILLAR INR RT REFINISH .5 4 EU 2C_)8 DOOR ASSEMBLY,FRONT RT QLTY RECYCLED FART 350.00* 2.71 L 2�y8 DOOR SHELL,FRONT RT REFINISH ?i_.3 4 EC: CORROSION PROTECTION QUALITY REEL PARI" 5.0{)-* .'#1 N COLOR TINT ADDITIONAL OPERATION . 51 EC COVER CAR :QUALITY REPL PART 5.00 1 N FLOUR SETUP ADDITIONAL OPERATION 1 .0*1* EC STRIPES QUALITY REEL FART 15.(-)C)* `. 5*1 29 ITEMS MC MESSAGE 07 STRUCTURAL FART AS IDENTIFIED BY I-CAR o9 INCLUDES 0.6 HOURS MAJOR PANEL TWO-STAGE ALLOWANCE 40 FX.N SEARCHED BUT NOT COMPARED FINAL CALCULATIONS & ENTRIES GROSS PARTS 668.76 OTHER FARTS 680.88 FAINT MATERIAL 350.00 PARTS TOTAL 1 ,699.64 TAX ON FARTS P. MATERIAL C 8.25o% 140.22 LABOR RATE REPLACE HRS REPAIR HRS 1-SHEET METAL 53.00 16.0 5.5 1 , 139. 50 2-MECH/ELEC 5.3.00 1 .5 79.50 _-FRAME 53.00 4-REFINISH 53.00 16. 1 853.30 5-PAINT MATERIAL 23,ir0 LABOR TOTAL 2,o72.30 TAX ON LABOR C .0o0% SUBLET REPAIRS TOWING & STORAGE GROSS TOTAL 3,912. 16 LESS: DEDUCTIBLE 250.00- `NET TOTAL 3,662. 16 ' FXN:YY/06/03/03/00 SEARCH AREA: PLEASANT HILL GEOCODE: 94523 DEVICE #78147-484 ADP AUDAFOINT U ES LOG 0000211 DATE 05/28/97 08:39:03 R2.5S CD 04/97 Copyright, 1995 Automatic Data Processing - ESTIMATE CALCULATED USING PRE-SET MAXIMUM ALLOWANCE FOR FAINT MATERIAL 2.4 HOURS WERE ADDED TO THIS ESTIMATE BASED, ON ADP' S TWO-STAGE REFINISH FORMULA: 20% OF REFINISH HOURS, AFTER OVERLAP, PLUS 0.6 HOURS FOR THE FIRST MAJOR PANEL, WHERE NOTED. "NOTICE - REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC WELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER" TOP LEFTfC RE TOP RIGHT PICTURE f r, �UCK'N STICKagPHOTO STATIONERY s f � 1 fI } i Q f 6 V BOTTOM LEFT PICTURE BOTTOM RIGHT PICTURE i �t0 F I R P.G.S. FORM 200-4,REVERSE P.G.S.INDUSTRIES,P.O.BOX 1348,ASBURY PARK,NJ 07712/1-800-484-7419-S.C.7474 FAX 1-908-919-7319 Lola 1 111, r n � t i r�r , •.� �• �.:...-�< ...rte • // r • i • • , i, 1 • • • ' • , • r h- Sill lbbl ' CLAIM C, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant to Government Code Amount: $10,000,000.00 Section 913 and 915. ��3�►��J�arnings". CLAIMANT: Richie Tavake hT1J U L 2 8 1997 ATTORNEY: Steven James Choi NSEL Attorney at Law Date received MARTINEZ CALIF. ADDRESS: 1440 Broadway, #306 BY DELIVERY TO CLERK ON July 22, 1997 Oakland, CA 94612 BY MAIL POSTMARKED: Hand Delivered via: Risk Manap_ement I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 28, 1997 gaIL BAATTCHELOR, ClerkKI 10.ur uty II. FROM: ,County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ( ? BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (✓ ) This Claim is rejected in full. ( ) Other: — I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.s Dated: -I ' C� _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. .r Dated: ID — 92 BY: PHIL BATCHELOR by Cc�Deputy Clerk CC: County Counsel County Administrator G Clain to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY IN,STRUCTTOMS 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 t,"An one public entity, separate claims oast 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 k' filing tamp Richie Tavake ) RECEIVE® Against the County of Contra Costa ) JUL 2 2 1997 or ) District) CLERK BOARD OF Su E. ISOPIF Fill in name ) CO.NTRA Cosrp CC— The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ 10 ,0 0 0 ,0 0 0 -0 0 _ and in support of this claim represents as follows: 1.. When did the damage or injury occur? (Give exact date and hour) 1 -23-.97 at 2255 hours 2. Where did the damage or injury occur? (Include city and county) 38 Greensboro Way, Antioch, CA, Contra Costa Counts-�__ ,_�,_� 3. How did the damage or injury occur? (Give full details; use extra paper if required) Fire in residence. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? Failure to timely rescue and adhere to proper procedure. i w ;iSI�j ,ll=! HiSO=l tid-LN00 VO:cT 66Z-eT-inf J C 20*d -11d101 ;5. wnat are the names of county or district officers, servants or employees causing the damage or injury? The names of the fire department personnel is unknown. 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Riche Tavake suffered burns over his body and is hos itali 7.t-rl 7. How was the amount claimed above Computed? (Include the estimated amount of any prospective injury or damage.) Current medical bills amount to over $1 , 000,000 .00 . -...._.._w-..���.._..__ _.._----------- 8. ------- -_3. Names and addresses of witnesses, doctors and hospitals. Childrens, Hospital, 747-52nd St. , Oakland. Dr. Jerrold Kaplan, M.D. Bob Kile, 42 Greensboro Way, Antioch, CA Vera Tavake- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Medical expenses exceed $1 ,000 ,000 .00 . ;eeltee ;e � * .* � * � ;� ;w ;� JM �•� *,e � � * � eeIF ;M � e � * � � 1r � # � * ;>t � Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES T0: (Attorney) or by some-Person his behalf." Name and Address of Attorney Steven James Choi a.imant S Signature Attorney at Law 1440 Broadway, #306 Oakland, CA 94612 Address Telephone No, 1r7-q 4 Telephone No. N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for a'lowance 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. 'Zr--11-70'd iow :iS I .l,i HiSCCI daih•lCi-1 b4J:0 T -�6�J --�;T--if i T CLAIM e" . a' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given pursuant toGovernment Code Amount: $25,000.00 + Section 913 and X6 1 "Warnings". CLAIMANT: Vera Tavake J� L�7� J U L 2 8 1997 ATTORNEY: Date received COUNTY COUNSEL ADDRESS. 38 Greenboro Way MARTINEZjuly 22 1997 BY DELIVERY TO CLERK ON Y � Antioch, CA 94509 BY MAIL POSTMARKED: Hnnrl nPl ivPrPd ,Ti,q- Rigk Management I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. gy DATED: ,hi1)T 28, 1997 IL eputyLOR, Clerk ` : II. FR%ounty Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: - Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (J ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: - 9 —9 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. 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: 9 - 10 - q 7- BY: PHIL BATCHELOR by eputy Clerk CC: County Counsel County Administrator Claim to; BOARD OF S"ERVISORS OF CONTRA COSTA COUNTY INSTRUCTIOMS TO CLAIMAW 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 Roam 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims m-ast be filed against each public entity. E. Fraud. See penalty for fraudulent claias, Penal. Code Sec. 72 at the end of this form. e * HE: Maim By } Re d f r 1 k's fil n6 stamp } ry :Ap— FIVE� Against the County of Contra Costa ) JUL 2 21997or 1 #' District) CLERK BOARD OF SUS v i50f;; C Fill in name � ) CONTRA COSTA The undersigned claimant hereby makes claim again the County of Contra Costa or the above-named District in the sum of $ u n z6 e 6 w and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) t- 23 -87 a_,t 411'-1 2. Where did the damage or injury occur? (Include city and county) 38 G�e��.� ���o ���� 3. How did the damage or in,jur occur? (Give full details; use extra paper if required) -—-----------------------__...------ 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 6n, 4 �5 � �,,`� 1)-e- 7A;_0_Y R cl Gee_ wnat 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? (Include the estimated amount of any prospective injury or damage.) —----------- 6. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of nis accident or injury. DATE ITEM AMOMT e e � e � e � � e .� t� +t � � �t tt e e •� *,e �t �r � � e e �t e � e �► �c � � � �r �t e e at e Gov'.* C de Sec. 910:2 provides: "The laim must be signed by the claimant SEND NCTICES TO; (Attorne ) simm per-wn on his behalf," Name and Address of Attorney aimant�s Signature Address Telephone No. Telephone No. e �► ee * * xe * e * �► * N O T I C E Section 72 of the Pedal 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 fraudu?ent 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. O.-`ItJ'd 1[,J :1S I;� ?,l-1 Hi, 0-1 tjaih,l0-1r�1 I"T _F_,F CLAIM C_ BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors $300,000.00 (Paragraph IV below), given pursuant to Government Code Amount: Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Antoinette Watson ATTORNEY: Law Off ices of Michael C. Cohen J U L 3 U 1997 Michael C. Cohen Date received COUNTYCOUNSEL ADDRESS: 1814 Franklin, #506 BY DELIVERY TO cYffl7I�&ZCA ity 30, 1997 Oakland, CA 94612 BY MAIL POSTMARKED: July 29, 1997 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JpyH1L DATED:— July 30, 1997 ATCHELOR, Clerk 8Y: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (This claim complies substantially with Sections 910 and 910.2. ( } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: OF Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (.( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. r _ Dated: - - 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: 9- lo - 97 BY: PHIL BATCHELOR b ei�QDeputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADOM 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 dayafter 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 Antoinette Watson ) ) RECEIVED ) - Against the County of Contra Costa ) JUL 3 0 1997 or ) District) CLERK vCARD OF SUPERVISORS Fill in name - . ) I CONTRA cosTA co. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ n n and in support of this claim represents as follows: 1. When 'did the damage or injury occur? (Give exact date and hour) June 8 . 1997 at approx. 12 : 30 or 1 : 00 p.m. ~ ~ 2. Where did the damage or injury occur? (Include city and county) Sidewalk area . immediately adiacent to curb at 3803 San Pablo 3. How did the damage or injury occur? (Give full details; use extra paper if required) Claimant was steppinq onto the sidewalk. at the time of the accident . 4.�What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? The sidewalk area , immediately adiacent to the curb. where claimant fell , is approx. 41, lower than the curb. Ittappears as (over) a portion of the cement pavement has been removed . 5. what are the nasties of county or district officers, servants or employees causing 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. Riqht knee. torn liqaments in right knee . multiple bruises and loss contusions . scrapes ; medical expenses , past and future : wage loss . of _��---- _---------- -�.»_M_-___� �_���--------- ------- 7. How was the amount claimed above computed? (Include the estimated amount of any in com� prospective injury or damage.) Estimate of damages is based on nature and extent of injury;. medical expenses , income loss . past and future. $. Names and addresses of witnesses, doctors and hospitals. Mel Rodrigues; 510-758-3025 - -------------------- -..�_- _..___�_..-.� --------------------- ----- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Undetermined ,, , ' .' 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 LAW OFFICES OF MICHAEL C. COHEN Clai is Signature Michael C. Cohen 1814 Franklin #506 Oakland . CA 94612 0 m 510-832-6436 (Add Jess) Telephone No. Telephone*N 1C7 `a—GJo2� 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. LAW OFFICES of MICHAEL C. COHEN A PROFESSIONAL CORPORATION 1814 Franklin Street,Suite 506 Oakland,CA 94612 Fax No. (510)832-6439 Tel. No.(510)832-6436 July 29, 1997 (510)83-COHEN Clerk of the Board of Supervisors Contra Costa County County Administration Building, Rm. 106 651 Pine Street Martinez, CA 94553 RECEIVED JUL 3 01997 Re: Our client : Antoinette Watson Date of Accident : June 8, 1997 CLERK BOARD OF SUPER Subject : Administrative Claim CONTRA COSTA VISORS CO. Dear Sir/Madam: My office has been retained by Antoinette Watson to represent her concerning her bodily injury claim arising out of her above referenced accident occurring on June 8, 1997 . Enclosed please find Ms . Watson' s administrative claim against Contra Costa County. Please return a filed endorsed copy of this claim to my office in the enclosed self addressed stamped envelope . Thank you for your courtesy and cooperation. Very truly yours, LAW OFFICES OF MICHAEL C. COHEN G Michael C. Cohen CC: Antoinette Watson r r O O O A N 00 l(FA .r P. �n el Cr O N� mrn CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA September 9, 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 Supervisors (Paragraph IV below), given ur ftp Government Code Amount: $750,021.50 Section 913 and (t ��gy�,,' j e—nb6a "Warnings". CLAIMANT: Harrison Wills aka James Simms JUL 281997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON July 23, 1997 Martinez, CA 94553 BY MAIL POSTMARKED: Interoffice Mail I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: July 28, 1997IaIL eputyLOR, Clerk : II. FROM: ounty Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). f., 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. q p Dated: 9 ' 1 - 1� 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: — D 9 7 BY: PHIL BATCHELOR by_ Deputy Clerk CC: County Counsel County Administrator r, 1im to: BOARD OF SUPERVISORS OF' CONTRA COSTA COUNTY M1' ; INSTRUCTIONS TO CLAIMANT f �► r.. lairis 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. U. lr the claim is against wore 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: 1i By Reserved for Clerk's filing stamp ��1��.�'►`�5�(�,�,A1..�C�me�����,� j .. f,� RECEIVED Against the County Qo1f Contra Cosi:a) JUL 2 3 1997 or ) CLERK BOARD OF SUPERVISORS _ 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 $ and in support of this claim represents as follows: 1. When did the dama.ae or injury ncrur.? rr --a agar.+ gats and h... l a mip ( 61r)tK)n) � Q 2. Where did the damage or injury occur? (Include city and county) n F�m PZ rxioAnn fuer\AA\1 P A Cer a 0ouc��a 3. How did the damage or injury occur? (Give full details; use extra paper if required) See, (i�N'lW P Q10"Ge, 1 �IAAAMO'Alj ��4Cxq' 4. What particular a tor 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? A o-t” r.A�C, V t 6. What damage or injuries do you clai-i resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. )C°3kj_oM�, -N) &QQN- mc:') t-ks \ \JVI.,, ;3'% c\QX �\JNC� t\kt\c - 71 How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) 3e,-- QUOMA 8. Names 'and addresses of witnesses, doctors and hospitals. Leo &A-f 9. List the expenditures you made on account of this accident or injury. ATE TIME AMOUNT Gov, Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES O: (Attorney) behalf. " Name and Address of Attorney ) (Claimant's Signature) ` 1 ) (Address) Telephone No. ) Telephone No {�!� �a �o� � f 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 :cth a`ch imprisnrmnent and. fine. F . evi fA kA )XAA,� , i �IA A) ,c t- V)oCA IA,,f ��.j•',i�1� t` �=".t �l�` \�_�-e; ,� � �`.�.�o �.�r<�.t.-:?_ l_,��, �.:�ti,;�,c�r� e _� v�°,�--?, �� 4 k.�•�E.1 ! 4, . l rV .�, r -, a K_ 9 `� • !� f, as - +�- 1` r•�q p\ �' f t - - — _ �� i r A�A-_� '.� �L' c�, _r �1���11` ` _`�.S t _�_�t�. •t _�� _ �.. - ` ___ � ._- y\'�•^{ l t r .., -X��..e1...1.1 _ `•K�� _\mss `✓{ - ,�'. _ - � t w.,i r � JUL 2 a-1997 JERK BOARD OF SUPERVISORS - - - CONTRA COSTA _ _! ( Vitt cija • ' L 2 C7 Q 9 ¢ { E I I 1 J r -� ?D D O N n .� m A'- m 1 (� n x m � � 1 .� v O fi ti jh