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MINUTES - 01281997 - C12
CLAIM D E r 2 4 1996 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 1997 Claim Aga ins(E0th*TQ@tgA,6&r District governed by) BOARD ACTION the Board of A%FXW9Z6'n31,IFRouting 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: $6810.06 Section 913 and 925.4. Please note all "Warnings". CLAIMANT: California State Automobile Association Inter-Insurance Bureau ATTORNEY: Claimant: Bennett, Kelly R. Claim No. :O1-2FOO664 Date received ADDRESS: 3060 Hilltop Mall Road BY DELIVERY TO CLERK ON December 24, 1996 Richmond, CA 94801-0007 BY MAIL POSTMARKED: Hand Delivered; via Risk Mgnt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 24, 1996 JaIL Bep�HtyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: J�jAI 4 BY: W eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated:_/` 2 -9 7 PHIL BATCHELOR, Clerk, By. �/u�'`- ° ` , 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 ntay 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� BY: PHIL BATCHELOR byy-�/��"'�' Deputy Clerk CC: County Counsel County Administrator u P Claic to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , INSTRUCTIONS TO CLADIINT A. Clzi:.s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19,87, 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 a=te on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of. action. (Govt. Code 5911.2.) B. Claims must be filed xith the Clerk of the Board of Supervisors at its office in 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 FO�. RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) DEC 2 41996 District) CLERK BOARD OF SUPERVI ORS Fill in names ) CONTRA COSTA CO. The undersigned claimant hereby makes claimagainst the County of Contra Costa or the above-named District in the sum of &peg6 and in support of this claim represents as follows: 1. When did the damage or injury occur? '(Give exact date and hour) � 7-© 3 - ?c/ ate" 2. Where did the damage or injury occur? (Include city and county) fr5'C3Out1/�'1 S,_9-" P(�640 09M 6?OtW )A/ 77�9_ �l�h �-�W G✓�fl2 !'V-e-N2t,4/1cs &1?/K, 3. How did the damage or injury occur? (Give full details; use extra paper if required) y 2 /�v2111 � (Oe4o2Y �C7�a2 54-�`}�F�L 11,AcN� / i 2 �iW&W l��i✓ M.427"!f FI 7�`JoMfK /� s Ham. }� r&,Tv 771"� OF !'17`1 l N5uREa`s CI�Z C-y 6'6--2VAV7T) VEf�'1 G LC 4. What particdlar act or omission on the part of county or district officers, servants or employees caused the injury or damage? 1A,7UR-7 RNO G6u5 W g y /J/��Llfc�-n/i 00,l cl/ova, ON `fI12 04�1--f OP 0- COAIr-/4+ 605T,�- NOV 19 1996 5. wnat are "c nares of counmy or -district officers, servants or employees causing the �3::aae or injury? gig - 2 5. khat damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. Gtw&&E-s°41 ,16.3 '76W "'_ZS7• so . 2eYw-e-t = Xriso,eocl,-5,34 O'�39 OTC, 7. How was the amount claimed above computed? (Include the estimated amount -of any prospective injury or damage.) (LJi2 O63S� 150 $. !Names and addresses of witnesses, doctors and hospitals. w .'S� S ccrJNY✓I E'Zv D2 #3� I BI� ���c-t.iN�Si�SD6 �INOz�, C/a- qqq y 9. List the expenditures you made on account of this accident or injury: DATE ITEM; AMOUNT o,7-rd3-W 7a)7ftcY► �e�%I�- /v5. 1 pg-rfQb ��_lui� oma- rrrt (cs��7 = isn Gov. Code Sec. 910:2 provides: nThe claim must be signed by the claimant SM NOTICES TO: (Atto_rne ) orr by some n n his behalf." Name and Address of Attorney Claimant's Signature P© seJ X Imo `—` (Address) Telephone No. Telepbone No.lS p O(60 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 v=h it risonren and f-ine O o.. CQ {m N 24 5 pyyyy`����a .`��- c , J'_- Fft x!f:w W.,'a' Ra i- C?';• MR- Rt �•� � U tav�4 co 2 t i r z iLm?re QsQ t�Y y' s �{u sc�s� r c m �.MeN - Q.r , '4 _'�. £ _(+ -�: s. :nr ..tis• ,.,{ i✓'��s.-. .:. '`S i.T�"t"!4e''3 '�'t 'x44 rw, ,"^-i3 ,... .C] k, � r fsm.0 - vs�t - •Tl.4a4 4 T 1;y�..,'n„F. `tures {,T'£'�}' /47?a1Gt{.RM4 3 5 +,+'x'-t MI E SA h Y -1 4 SSS 3t},,� N0�43SSiO4N j I WIAS Estimate Good For 30 Days 415 3r_ Street Phone: .J_0: ,_-•L.I.-1.•._ _-. Richmond. C_• 14BO4, _ Fax . (510) -234-7302 . -'.:._... _ _ ',_ r y, VISIBLE MAMBO% Date . 07/09/96 Page 1 Est .: {_fit 00 B_2 Date Of Est . 07/09/56 -_. - Phone: (510) — ._ : (510) — _ ; ye 06/95, Paintsv 2_. i Colorg RED MET .:.r:_.:u: a California State Auto • :_.:._. Adjuster e _.. __ _._I L..l..:E!-`d Addr t 3060 Hilltop Mail Road Claim v City : Richmond Ca 94SCI-0007 Date of Loss : !o; t 2: (510) -253-8600 Fax (510) -222-0615 Deductible # Labor Repair D2SCription - Labor Parts Pain- R & 1 Bodv F7 BUMPER ASSY 1 . 5 Ref/R Body FT BUMPER h.. Daly : FENDER ✓COVER 1 . 2 t R & R Body, LT OUTER ROCKER PANEL 1. 0 66. 75 9 Rel/R Body LT HINGE PILLAR 2. 0 9 Ref/R Body LT OUTER CENTER PILLAR 6. 0 15B. 00 1 . 10 -. _. :. Bi.J:..1: LT LOCK PILLAR I-LE I N __ 1 . 5 107. 0(:-'1 - D/11 Body LT LOWER C E i'; f L'.;`' PILLAR - GARNISH 1 45 11 R & 1 Body HEADLINER 1 . 6 14 Repr Body INSTRUMENT PANE4 -- 1 , C) 5 L I�,� ti .. .=Cl Body LT FT SEAT i-;`_S`�� l n` 1`• , 1 & Body LT r'! DOOR SHELL .r 1 360. 00 3. 17 : _. R Body `,IDE MLD-G-3 (BLF:: AD'HIE,=..1YE) 0. 1 37. 25 19 O/H Body " OUTSIDE DOOR HANDLE 28. 75 9 O/H Body !' LATCH WIO POWEiR' LCCt:::S 4B. 25 - 20 2i `l L. ": Body " LOWER HIl'•GE 0. 2 30. 25 . f_'. 22 /` Body " MANUAL WINDOW REGULA i OR i 46. 25 23 Ref/R Body LT REAS; DOOR SHELL.' 3. S 302. 0Ci. 3. _:a _,';i Body y {! UPPER HINGE 49. 25 0. I 26 R R body 0 GIDE MLDG 0. 1 30. 75 . . . ' � ' VISIBLE` DAMAGE QUOTE � Labor Repair Description Labor Parts Paint �-- ----- ------ --------------------�-------------------- ----- ----- - ----- ~~ _ 27 O/H Body " WINDOW REGULATOR 56. 75 28 R & R Body LT 1)4 PANEL ~~ 467. 00 3. 0 ~� ~ 29 Ref/R Body REAR BUMPER COVER 1 . 0 2. 4 30 R & R Body GRAVEL GUARD 0. 5 12. 00 11 R & R Eody ANTI-CORROSION MATERIAL 0. 5 10, 00 32 Add! Body COVER CAR ` 5. 00 33 Addl Body RACK SET-UP 1 ' 0 34 Add! Fram PULL ROCKER & CENTER PILLAR 2. 0 4epair Additional Chargm.. Hours Labor Matrl __________ __________________ _____ _______ Refinish TWO STAGE CLEAR COAT 2. 50 ' ~ Paint 23. 5 Hours - 0. 8 Overlap ` _ Body Labor 56. 00 hrs @ 51 . 00 $ 2856. 00 ' Refinish Labor 22. 70 hrs @ 51 . 00 $ 1157. 70 Frame Labor 2. 00 hrs @* 51 . 00 $ 102. 00 Parts 1992. 20 Paint Materials . Tax @ 8. 25% TOTAL 6753. 32 ' Estimator: JG ` ��6 ~^ . \ r � = ` ' . KX 1 - _.... - ._ .. Estimate Good For 30 Days 41B 23rd Street Phone: (510) -234-i20-'!- Richmond , CA 9480f--. Fax (510) -234-7302 VISIBLE DAMASE NOTE Page 1 Date : 07/05/96 Est : 00006932 Date Of Est a 07/09/96 Color: RED MET lrsur2 California State Auto Ass Adjuster : SUE BOLDEN Addr ; 3060 Hilltop Mail Road Claim v City : . Richmond Ca 54SCI-0007 Date of Loss - _ Phone: '.'_.!i. .. _-- ... ......_ Fax (510) -222-0615 a _v 1-_•i.i 2._-- - -..1_.. a,. _.d_.._+.:..._.. .(.e Labor Repair Descriptioi- Labor - - in- 1 R & 1 Body F 7 BUMPER ASSY 1 z Ref/R Body FT BUMPER OVER 05 2. t R & R body LT OUTER ROCKER PANEL ". 0 66. 75 TNNER ROCKER' PX; 1 53 •..N_:-(.. : . B 1.J'._i. LT HINGE PIL_L: :ice•, 2. C., 158. 00 -. 1 . 10 A & R Body LT LOCK PILLAR REINF 1 . 5 107. 0) 12 D/H Body , LT LOWER CENTER PILLAR GARNISq 11 ..45 141Repr Body INSTRUMENT NS { R`_i ENT PY NEL 1 . 0 . 15 insp Body LT FT SEAT ASSY (OPEN) lb R i_K :, Body LT FT DOOR SHELL -" 4. 1 360. 00 _ . 1 . _. :. Body S 1 DE 11L1J' (DL ri i_ 1E. .L VE) 0. 1 37. 25 1B D/H Body " OUTSIDE DOOR HANDLE 2B. 75 19 O/H Body LATCH WIO POWER LOC�,-':S 48. 25 - R _. R Body UPPER ER I iINGE w 0. 2 30. 25 0n R & R Body 11 LOWER HINGE / 4_'e2 30. 25 .`..5 0. 22 O/;; Body MANUAL WINDOW REQ.ULA i OR 46. 25 2 gib. ._ - 2:.. of/R Body LT REAR DOOR SHELL ' 3. 8 302. 00 31 . . . . . . ' � ' VISIBLE DAMAGE QUOTE � Labor Repair Description Labor �arts Paint _=-__ _____-_ _____ �- .' ' 27 O/H Body " WlNDOW REGULATOR 56. 75 28 R & R Body LT 1/4 PANEL ~- 467. 00 3. 0 ~.~ . 29 Ref/R Body REAR BUMPER COVER 30 R & R Body GRAVEL GUARD 0. 5 12. 00 �1 ".1 MATERI AL 0. 5 10. 00 32 Addl Body COVER CAR 33 Addl Body RACK SET-UP 34 Addl Fram PULL ROCKER & CENTER PILLAR 2. 0 �epair Additional Charges Hours Labor Matrl �sfi�ish TWO STABE CLE^R COAT ~ Paint 23. 5 Hours - 0. 8 Overlap Body Labor 56. 00hrs @ 51 . 00 $ 2856. 00 Refinish Labor 22. 7J hrs @ 51 . 00 $ 1157. 70 Ft'ame Labor 2. 00 hrs i $ 102. 00 Parts 1992. 20 Paint Tax @ 8. 25% V�l L TOTAL 6753. 32 ' Estimator: JG 1Ac, \ ` vIA L [ � ^ . G Std ��✓cc,t.21� 7 5,"eE ENDORSAED ;TERON T} r'~ � R SIDE i" � `i'.J r £i'• "s'�s-- w• 3 � kz,c. •-•s �.z j1 rl � D w g <J El c �c` � ,Z•,W: I FLm qA z _ J cz I r � W 1 . o CD c Li , ¢ �• r zz i CCS U Q O Z L 7 1! O i jj v f W r •� 3�� �.� t � t "� oN.0 �D.M ,�c4��7•,� �1=-00��� Oyu z��rkr,-. r ._ rv_..�..�tYti�}4y,1...' T���'}�i��I.�,��yK��x��-�,;��il`..�F✓.1K?k t Vii' � . t s.; r. C ul LU rp mop �' I x 0 y 4 W 4 E.- J 1 C I � •' Oj� U��n r-4�w� ju.0a`LQF- QZ � h, �, � � L� ,�J✓ 5i r�._ _ s^,,�.' �i X fi.:>.i h ifi;te, .'� t ,.ti +.I!.w.� ._.,.-:.-�'t �.���'• r.> t „'t9Z6SE9.00B't 33kld 1101 Ue'J Z06 �'. S. O „oo � Fly � �et�P +•�%at-�./t =:r. rMIMI yy�� `Y.T.Yrt 2y ~�.,.�,. �y�-Ls�4n4sK N 'gj �I I. im i -, .1 -r'.Z m- - _ 'C+ O 'y'uu ^' �j�21• cx. - —.-.. ���� cf��:. ,.�'••+.•� �D m r� �- �.. 'fie-c °3' ���' �C7: .- -1 �4"t".1-s�,1 3 sb.1 s..'{s.� •�� �e � ��_ 7.4-� �� f.,'^f� f 1 "� r.r.,r5� 'C-}, -•--;�".'.r'•..� -ice''r`=.ri ,7-< '-�t'�r� '3 -..a $ _ i.i � r >�}.�'\ "'4e'�'r �.�y^"•u� { �"�'�� ,t �"� .r,.-.x:� �" � ' -rte- l Yz?a... f.'�.aasr�:ua3r:uu:.f .ai..`.�.5�.^ 7J�1��T-,�y��ey�".>t t�L i S ♦i 'S n.'- `F-t Z N !� ��R�4 cc i a3ansNi lnoN o m , L 3 ez ;�r-� G� GBe IV-1 a3188VO: 36ll molJl>i3 r I z P� v i,.N � s sss m +� 63/y t . We x 7,CYno W� ' Ss C )/t . i x 4 fir_ euoyd SOUejnsul m O eletS S �lJ DT U3 mD Nps 3 5 i. > .�' , �• ^*nsr•7"!�. ; CA gm , +s� i JIM �i-T-T'li�. I> . r t �301SSy3A3b f 7 RECEIVED ✓'• '- :Not`'i � . - � 1". rju - A CIVIC CENTER AUTO CARE � ' 1 PINOLE VALLEY TOWING TOWING EL San Pablo Dam Road EL SOBRANTE, CA 94803 REPOR_ T Phone (510)223-CARE (2273) Names D� R �• Address t City t to �^ Home Phone Insurance Company Insurance Phone J Business Phone M e IM Col Licgnse IS x - - . 5 "" {- CALL NO TOWED FROM6o�-7r_Sy Ck.) - .- < D�Ae .23 s P ' I� / �. TYPE OF CALL c/4-,/7)� EXTRA MAN ��/6TO2 MILEAGE START REMARKS _ /� L /r �O ['j START ❑ WRECK Gh ` ❑ BATTERY TOW Ute" p FLAT TIRE CARRIER G� 9 rt , (3 /+ t S' El GAS T BED.- ❑ LOCKOUT INSURED / R - ._TW G CHARGE {U" i j STORAGE CHARGE MECHANIC'S SI NATO E i A_VfA6WZED... - -.. ' SUB TQTAL X. OO V V _ � TOTAL -S"•.F�a i'� ��i= r• �" ) /V� OWVE! Fa'm N0.1013 tlD/E/A Int•One LIMA WW•C.W k D[XlBOS69Q2,,G�aM owwr y 4. J; (.'(j If T S Cit ;t awNa Road • " n: �n}v ft Marr.P....A W4W4of Doingnnrss Doing Busi " , P.Pgr 1131.4o Ave. Pinole, CA 9464 ,1P)Y741cTSW w. 799 83�z Service DATEo ''7 TIME A.M. REQUESTED BY -�, - Cl I r \ NAME ^� } _ 1 CITY .• STATE ZIP LOCATION OF VEHICLE ' YEAIL nE,MODEL - I OR DRIVER r STATE I LIC.PLATE NO, T VEHICLE LD.NO. REGISTERED OWNER MILEAGE SERVICE TIME EXTRA PERSON FINISH ` FINISH FINISH START 'L `J SART \y ~� ` oMRT .. s TOTAL TOTAL TOTAL REASON FOR TOW SPECIAL EQUIPMENT ❑ACCIDENT ❑ABANDONED ❑FLAT TIRE ❑SINGLE LINE WINCHING ❑ARREST ❑STOLEN CAR ❑OUT OF GAS ❑DUAL LINE WINCHING I l ❑UNREGISTERED ' ❑BREAK DOWN ❑IMPOUNDED ❑SNATCH BLOCKS 1 ❑TOW ZONE ❑LOCK OUT ❑ ❑SCOTCH BLOCKS ❑SNOW'REMOVAL ❑START ❑ ❑DOLLY 1 TYPE OF TOW TOWED PER ORDER OF VEHICLE TOWED TO f ❑SLING/HOIST TOW. ❑STATE POLICE FIRST TOW ❑FLAT BED/RAMP ❑LOCAL POLICE ❑WHEEL LIFT ❑OWNER SECOND TOW ❑ ❑DEALER f STORAGE FROM TOWING CHARGE 1 ( � 1 , i 7 To �� �}t DAYS e s MILEAGE CHARGE 1 PAID BY 1 ' j EXTRA PERSON ❑CASH la}G`HECK LIC.NO. SPECIAL 1 EQUIPMENT ❑CREDIT CARD ❑MC []VISA ❑AMEX DATE LABOR CHARGE 1 } CC NO. STORAGE 1 — OPERATOR'S SIGNATURE DATE I l TRUCK NO, SUB-TOTAL 1 AUTHORIZED SIGNATURE A TAX 1 VFNICLE AELEASEp TO.• DATE TOTAL T—_ Not responsihie for loss or damage to vehicle Thank You. in caca of lir••,thrift nr any oll'of cansr:"onrT our r-nntrol. l s �_",.,�.,Y_.�'•:;�1�j115TgE,FRCW�OE• � ': �� t.a��, se '' n �s�'�� z'r- ti >x. €..- rte` •$;;a c `J 1a ice ; ' CO y t— i J y co N Rr-i taj N 7-: o G � cts Arl Aq N y� � 1 � e ,t .,.v 1 �r# :� OZ,� k e �"�� a:{ t�y s^nk 'J,+l ash ✓ i f h ' W t�-..�"'•titL s CT�-�r t3•�.r�lr�xd ,��t�", �,` 'A�,'�W 7 4..°0 • ,�:, ,� � "Nut tln�y'� N� :A Wap 'ot/�otn8:. �u�•� �` r r, ,.� y.irvicAn - �� '-; �.�{ k � SF` DATE il�lr+�"•AM REQUESTED r PH�E�y ARE - _ ���� �G/}�� •I, _ )� .�/ � �� -_ r`y Orry - y. STATE ZIP("", /} a� . . ♦ N F VE. DEL. i.'DRIVER - i STATE LIC PLATE NO VEHICLE I.D.NO. - REGISTERED OWNER MREAGE ="' 3 - SERVICE TIME, EXTRA PERSON - ;. FINISH FINISH FINISH o START - START START x 77 - TOjAL ' TOTAL TOTAL Y SPECIAL EQUIPMENT ��#I r- .�,�" ���,�+�,*. .r. � � .� y. ., .r •'v'4Y"+?p'A..':. K- , ACCIDENT K❑ABANDONED - C�FLATTIRE ❑SINGLE LINE WINCHING ~ _ !❑ARREST- STOLEN�CAR 066 OF GAS ❑DUAL LINE WWCHING s r� • +� ti; }�UNR���TCtED: "^:C-E BREAK DOWN`��-9.iMPOUNDED ❑SNATCH BLOCKS TA 4NE ^❑LOCK OUT f CT Q SCOTCH BLOCKS - ss—..:: A -�e'. `�4 *•� M1 O.DOLLY `TYPE OF TOW'_ TOWED PER ORDER OF YEH TOWED TO _ M FIR 0 - .. ❑SUNG/HOIST 70W TSTATE POLICE 111 ]FLAT BED/RAM ❑LOCAL POLICE'' SECOND TOW + , WHEEL LI ❑OWNER - AROM.. TOWING CHARGE ' `I-� �to DAYS'a 5 MILEAGE'CHARGE PAID BY EXTRA PERSON DfttVERS' t . ASH ❑CHECK LIC.No.. SPECIAL �I EQUIPMENT ❑CREDIT CARD ❑MC ElVISA ElAMEX DATE LABOR CHARGE STORAGE /�'�j CC NO. \,J�C) I OPERATOR'S SIGNATURE DATE - 9UCK NO. - i SUB-TOTAL THORIZED SIGNATURE DATE TAX 'CLE R 6 . 16ztq LI y `A Y7(,' ` TOTAL LJ I'—"'"" :. ' Not responsible ss or damage to v e r Thank YQv'~` m case of fire,theft or any o our control: _14080 1 t r' s r t "ti;• s<' .r �: "` qty'' f�t t -rt e y, iia ' t r t ~? i. v_ Y + ✓ t, v a r . • J �1 4 5 � � w tjpr a_.. Fri 1 p" c. t`F� t� y� �.� �"'a�-r$�,'�'•* ,T+"�"-fix�..�,} t 'E 7'`'���r�` �_�m'd^4 7r'�,_, � 4rs ci,�y� s rsz ^ r'9.,r�{{a,.f^rl.�Y''i''�'�at�e:.'..t``�±.° t.�`�vw..:�.i:-E"r:�,��<'�':f�i✓ �,� "'�0 • "F R f t t 1 5 Y l t , - - _ 'a:xSb.0-r - -=.F._ d.n �7:� x..:rt.9.. .:A- ;_r.. ',f'.'•(JT I'i:C. • • ,tib �"-��" s � 1-t � •-awe-ate �f�. f, 77 TY S Mt • K C :.a. s1-aa•.ey Vcf w�s !,Q- 144 1 5 3: • • • INSURED CLAIM OR POLICY NO. 4 P ` ' F M! •r i - z `r • �At 1 } C- i - . ft q 4. � t. n .'+� ._Y � � a } t. �} '�� �} �• � r+�"a`�,��Y`Yt r '*"reH�4�X .:�,Y� • z e �, ,- � it /X�—(`.. dJ f rf � ,S � l 4 r f v � � r .:.�,� $ = 5:�z is - -�xtr•'� .. "� t�. Photo Page California Stale AutomobileAssociation Inter-Insurance Bureau D AIMANT 7. !J J!.. 4:1 FILM POLAROID POLAROID DATE 21 HOUR N CJ A.M. P.M. 9Y LOCATION PLEASE ATTACH PHOTOS WITH MAKE OF CAR—YEAR SCOTCH TAPE LICENSE NO. DATE HOUR A.M. SY LOCATION MAKE OF CAR—YEAR LICENSE NO. DATE HOUR A.M. P.M. BY LOCATION MAKE OF CAR—YEAR LICENSE NO. AMENDED CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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 Amount: $972.50 Section 913 and 915.4. Please note all nin? CLAIMANT: State Farm Insurance Companies DEC 3 1 1996 Insured: Bich Phuong COUNTY COUNSEL ATTORNEY: Claim No. : 75-C103-780 MARTINEZ CALIF. 3799 E. Burnett St. Date received ADDRESS: P.O. Box 93028 BY DELIVERY TO CLERK ON December 30, 1996 Long Beach, CA 90809-3028 BY MAIL POSTMARKED: via: County Counsel I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ( ,, DATED: December 31, 1996 g�.Il Bep�HtyLOR, C1er1`� II. FROM: County Counsel TO: Clerk of the Board of Supervisors (�) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 12./31 l�jt� BY: dXJ6144e, 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: 97 PHIL BATCHELOR, Clerk, 6yL�i1- - -e /i-a�'�"— Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. c Dated: /-3 0- 9`1 BY: PHIL BATCHELOR b�jt-e�..z-`-��- — Deputy Clerk CC: County Counsel County Administrator jq STATE FARM State Farm Insurance Companie INSURANCE State Farm Insurance Claim Office C 3799 E. Burnett St. DEC 2 3 1996 P.O. Box 93028 Long Beach, CA 90809-3028 December 18 , 1996 COUNTYCOUNl1. Phone Number: (310) 986-2000 MARTINEZ C Attn. : Victor J. Westman Contra Costa County Counsel RECEIVED 651 Pine Street, 9th Floor Martinez , CA 94553-1288 DEC 3 019 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. RE: Our Claim Number. / 5-0103- 780 - Date of Loss: July 2 , 1996 Our Insured: Bich Phuong Your Driver: Charles Jackson Dear Mr. Westman: This letter is in follow up to the notice of insufficiency of claim received by our office on November 15 , 1996 . Please be advised that our claim arises from an accident which occurred on July 2 , 1996 on Interstate 680, northbound in Pleasant Hill, California. Our investigation indicates your above-named employee of Contra Costa County made an unsafe lane change in front of our insured. Our insured unfortunately was unable to avoid your client's vehicle and the ensuing accident resulted in damages which we have paid on their behalf. Please be advised this claim does not exceed $10 , 000 . The amount owed totals $972 . 50 . This represents the cost of transporting of towing our vehicle from the accident scene. I hope this answers the questions that you raise in your letter. Should you have any further questions, please contact me at (310) 986-2007 . cerely, Sam rely, a//V_Z Claim Specialist (310) 986-2039 State Farm Mutual Automobile Insurance Company SE: 12/1218031cm HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA , January 28, 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 Amount: $1,000,000.00 Section 913 and 915.4. Please note all nings" 1EM)` CLAIMANT: Daneen M. Cali JAN 0 9 1997 COUNTY COUNSEL ATTORNEY: Carl Lindstrom, Jr. MARTINEZ CALIF. 653 North San Pedro St. Date received ADDRESS: San Jose, CA 95110 BY DELIVERY TO CLERK ON January 9, 1997 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 9, 1997 JYIL �ep�HtyLOR, ClerkII. FROM:FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ��D! 7 BY Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (x) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: - 2$ - '77 PHIL BATCHELOR, Clerk, By L�j� �/�-O`er Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: -3�._ 9� BY: PHIL BATCHELOR b��/s-e °"�— Deputy Clerk CC: County Counsel County Administrator 1 Zia 1C. to: HOARD of SJPEFt Lsom cF Cxw RA COs`?'A COUNTY it;STRUMONS 70 ri-AD-WiT A: Clai=s relating tocau:3cs of action for death or for injury to person or to per-- sonal.. property or'- gmwing crops and which accrue- on or before December 31, 19,87, must be presented not later than the 1.00th day .after the, accruai. of the cause of action. Claims relating to causes of action for death or for inrfjuto person er• to personal property or growing crops and which accrue cm or after January 1, .1988, must bepresented not later than sLx mcnth-3 after the accrual of the cause of action.. Claims relating to any other c=e-of action utast be presented not later than one year after the awruai of the cause.of. action. (Govt. Coda B. Claims-must be filed Frith the Clerk of the Board of Super visors at its office in Rocas 106, County AdmWistration Building, 651 Piste street, Martinez, CA 94553. C. If claim fs against a district governed by the Board of Supervisors, rattier than the County, the name of the District should be filled in. A. 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 claim;, Penal.. Code Seo. 72 at the end of this RE: Claim By ) Reserved for Clerk's filing stamp RECEIVE® Against the County of Contra Costa } oC or ) JAN - 91997 District) Fill t7 ,, } CLERK BOARD OF S PERVISORS CONTRA COSTA CO. 7he undersigned claimant hereby smokes claim against the County of Contra Costa or the above-named District in the. si-mu of $ $1 000 . ppnyQc) s-nd in support of V''li.s claim represents as follows: 1. When did the dame or injury occur? '(Give exact date and 'tour) 7/16/96 2. Where did the damage.or injury occur? (Include city MA county) Concord, Contra Costa County 3. Hou did the damage or injury occur? (Give full details; use extra, taper if required) See .Attached Labelled"Response to #3" 4. What particular act or ,,mission on the part of county or district officers, servants or employees caused the injury or damage? See Attached labelled "Response to #41, j. what are the ria-*fes or county or distr%lct: officer s, aerrants or employees causing or if4jw—y? Phil Batchelor, Scott y, Al .Tared p & Marta FQrt�p ,.._ 5. What damage or, injuries do you claim re-"ulted? (Give full extent of inJurle..s or damages claimed. Attach tuo estimates for auto damage. See Attached labelled"Response to #h,, — 7. How was the amount eJ.a and above c oMuted? llnc3_ude the. eztimated awmt 'Of "any prospective injury or damage.) Amounts were estimated based upon information_ known at this time . Claimant will amend this Claim once more exact damages are ascertained. 3. games and addresses of witnesses, doctors and hosplt.a ., See attached labelled "Response to #8,v 9. List the expenditures you made on aeoo=t of this accident or injury: DATE ITE? AMXM A complete list of ex --,-� ascertained ' �pendrtures will be provided once they are Gov:. Code Sec. 910:2 provides: "The claim mist be signed by the claimant SEM NMCES T0: (At.torne` )` orbY11's aye Person on his behalf " Name and Address of Attorney ^"p- ; Carl Lindstrom, Jr. 1! C1a11rrlt's Signature 653 North ' San Pedro Street San Jose, Ca 95110 1162 Saranap Ave , #28A Walnut Cr 94595 - Telephone No.(4 0 8 2 9 4- Telephone No. 510-256-0724 N O T I C E Section 72 of the Penial, Code provides: "Every person who, with Intent to defraud, presents for allowance or for payme.7t to any state hoard or officer, or to any county, city or district board or officer, authorized to allow or pay the same If genuine, atiy false or fraudulent claim, bill; account, voucher, or writing, is punishable either by imprisonment in the county ,fail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment In the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both :S 2.11 1T,,- i-d :ne. Daneen M. Cali Claim Response#3: In March 1995, Claimant, in her capacity as Acting Program Manager for the Head Start Program, reported numerous accounting and program problems with UCSSO,(a subcontractor with CCCCSD for the Head Start Program) to Phil Batchelor(County Administrator), Scott Tandy (Chief Assistant County Administrator) and Al Prince (Administrative Services Officer). Based upon her findings, Claimant indicated that the appropriate course under existing Federal and local quidelines and policies was to end the contract with UCSSO in 1995. This recommendation was made to the County Administrator, the Director of Community Services Department, Joan Sparks and the Funding Source (Maria Fort of Region IX,ACF, Head Start). Based upon this recommendation, a decision was made not to contract with UCSSO in 1996. UCSSO appealed this decision. The County's position was upheld by Region IX ACF, Head Start Shortly thereafter, Claimant became a target of harassment and retaliation of Phil Batchelor, Scott Tandy, Al Prince and Maria Fort. Claimant repeatedly came under siege by these individuals who subjected her to discriminatory treatment and created a "hostile environment". The above individuals directly interfered with Claimant performing the duties of her job, by continually undercutting her authority, humiliating her in front of her colleagues and subordinates and by failing to provide the support necessary for Claimant to perform her job duties. As a result of the discrimination, harassment and retaliatory conduct that was suffered at the hands of Phil Batchelor, Scott Tandy, Al Prince and Maria Fort, Claimant could not possibly remain in her position and was forced to resign and essentially constructively discharged from her position. Response to #4: There were a series of acts beginning in about March 1995, which resulted in the forced resignation and constructive discharge of Claimant. As stated in Response #3, after making.her recommendation about the UCSSO contract to the County Administrator, Claimant became a target of harassment and retaliation from Phil Batchelor, Scott Tandy, Al Prince and Maria Fort. Claimant repeatedly came under siege by these individuals who subjected her to discriminatory treatment and created such a "hostile environment." The above individuals directly interfered with Claimant performing the duties of her job, by continually undercutting her authority, humiliating her-in front of her colleagues and subordinates and by failing to provide the support necessary for Claimant to perform her job duties. In coming to work for Contra Costa County, Claimant gave up other career opportunities, based upon representations from County personnel that Claimant would receive adequate support in her Daneen M. Cali Claim job and would be in a discriminatory and harassment free work environment, where Claimant would be able to be promoted based upon her merit and paid commensurate with her similarly- situated male counterparts. These statements were false. Response to #6: Loss of Wages, Benefits and Retirement Benefits (past, present and future); Medical Expenses (past, present and future); Personal Injury and Emotional Distress Damages; Damages to Reputation; Loss of equal pay for equivalent work performed by Claimant as to that of her male counterparts. Response to #8: Witnesses: Joan DeMiglio, 27 Tahoe Place, Pittsburg, CA Gayle Bishop, 2800 Finley, Blackhawk, CA Doctors: Dr. Pollack, Ph.D., 391 Taylor Blvd., Pleasant Hill,CA Kaiser Hospital, Pleasant Hill, CA C ; n-- CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $1,000,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Beth Garrett ATTORNEY: Date received ADDRESS: 3749 Clayton Road BY DELIVERY TO CLERK ON January 9, 1997 Concord, CA 94521 BY MAIL POSTMARKED: January 7, 1997 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 10, 1997 JyIL gepuHtyLOR, Clerk���,���a , 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: BY:/�7 BY: 4 // Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: ` 9_0 -9117 PHIL BATCHELOR, Clerk, By. ODi`- — 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. J Dated: /-3a ' 97 BY: PHIL BATCHELORby`�ji-e �-�/��` —' Deputy Clerk CC: County Counsel County Administrator Beth Garrett 3749 Clayton Road Concord CA 94521Z VED UPERVISORS January 7, 1997 TA CO. CERTIFIED MAIL NO. Z 694 333 481 RETURN RECEIPT REQUESTED Clerk of the Board of Supervisors Contra Costa County 651 Pine Street Rm 106 Martinez CA 94553 Re: Beth Garrett Dear Sir/Madam: Beth Garrett hereby makes claim against the County of Contra Costa, Merrithew Memorial Hospital and Health Centers, Contra Costa County Health Services, for the sum of One Million Dollars ($1,000,000.00) and makes the following statements in support of her claim: a. Claimant's address is 3749 Clayton Road, Concord CA 94521; telephone 510/680-5631. b. The date and place of the occurrence giving rise to this claim are that on or about July 9, 1996, Claimant Beth Garrett received surgical care and treatment at Merrithew Memorial Hospital. At said time and place, agents and/or employees of Merrithew Memorial Hospital failed to properly examine, diagnose, operate, test, treat, or otherwise tend to the condition of Claimant. As a proximate result of said failure of examination, diagnosis, operation, testing and treatment, Claimant Beth Garrett sustained chronic and/or permanent impairment. January 7, 1997 Page 2 c. A general description of the injury or damage includes the chronic and/or permanent pain, disfigurement and impairment to the neck,jaw and mouth sustained by Beth Garrett. d. The true and complete name or names of all of the public employees causing the injury, damage or loss are not known at present. It is believed that the surgery in question was performed by Thomas White, M.D. e. The amount of this claim is One Million Dollars ($1,000,000.00). The basis of the above amount includes medical expenses to date, future medial expenses, loss of wages, future loss of wages, and all special and general damages as allowed by law. Beth Garrett Claimant BG:clr fi a t 1f IR k NCP N w 4Z I i.yl •n f .+ iVl1 L/�• n u 1 , G ..� ` CAP (l, t D• ...t t4� 9 t r �i .rte i y ti CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $955.00 Section 913 and 925.4. Please note all "Warnings". CLAIMANT: David R. Jeffords P.O. Box 391 ATTORNEY: Brentwood, CA 94513 Date received ADDRESS: BY DELIVERY TO CLERK ON December 23, 1996 BY MAIL POSTMARKED: December 21, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 23, 1996 IaIl Bep� HtyLOR, Clerf(���yeA II. FROM: County Counsel TO: Clerk of the Board of Supervisors k�) 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: 14 aw 1-16 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: /`a8 PHIL BATCHELOR, Clerk, ByL1/_/t-e� 5L_� 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 7 BY: PHIL BATCHELOR b � � ___ Deputy Clerk CC: County Counsel County Administrator 1 DAVID R. JEFFORDS P.O.Box 391 _ 2 Brentwood, CA. 94513 };' EC (510) 516-8636 rr ` }yy. 3 LCLERK 4 DEC 2 719rj BOARD OF SUPE,,:?k ':.. CONTRA COSTA CO. 6 7 LIABILITY CLAIM 8 9 In the Matter of the Claim of ) David R. Jeffords , ) 10 Claimant , ) vs . ) GOVERNMENT CODE SEC. 910 11 ) Contra Costa County Sheriff's Department ) 12 County of Contra Costa , ) 13 ) Respondants, ) 14 ------- -- - ) 15 I, David R. Jeffords hereby present this claim to the Contra Costa County 16 Sheriffs. Department and the County of Contra County pursuant of Government 17 code section 910. :8 1.) The name and address of claimant is: 19 David R. Jeffords P.O.Box 391 20 Brentwood, CA. 94513 21 2.) The address to which notices reguarding this claim are to be sent is: 22 David R. Jeffords 23 P.O. Box 391 Brentwood, CA. 94513 24 25 3.) On June 24, 1996 at approximately 4:30 p.m. I was east bound on Clayton Road towards Brentwood . As my vehicle approached a turn in the 26 highway I was immediately confronted with. a police vehicle on my side of the 27 highway. I vehicle was coming at me "head-on". I immediately took evasive 28 action and swerved to the right. In doing so my vehicle left the roadway . Y I After stopping I looked at the police vehile and it said Sheriff on the car. I the 2 waited for the deputy,to return to wear I was stopped . He did not . He continued 3 west bound out of sight toward the town of Clayton . I then enter the roadway and 4 proceeded to a "call box telephone" the Highway Patrol Dispatcher advised me to 5 contract the Sheriff's office . I then proceeded east bound at notice a sign for the Sheriffs Jail facility and I contacted the duty officer and made a report to him. He 6 told me to that he-would note my report and that I should contact the Sheriffs 7 Patrol Division. When I reached my home I telephone the Sheriffs Patrol Division 8 and made a report to the duty officer. He said he would investigate the matter and 9 call me. The following day I received a call from the Sheriffs Office , I failed to 10 write down the persons name I spoke to, he said he had found the detupy and 11 talked to him and indeed confirmed my report. He asked what I wanted done. I 12 told him that I was concerned because the deputy had not stopped to see if we were 13 all right. He said he would see that the deputy received some additional training. The following day I noticed my vehicle was pulling to the left and the front end 14 was making a noise. I subsequently took it to a repair shop to determine what the 15 problem may be. They said that the front end was damaged on the right side and 16 gave me a repair estimate. This estimate was for $955.00. I feel that the Sheriff's 17 office is responsible for the damage done to my vehicle when I had to run off the -_8 road to avoid hitting the oncoming Sheriffs vehicle that was on my side on the 19 highway in order to avoid a accident . 20 21 22 Dated: December 20, 1996 _ t ---- ------ ----- — ------ 23 David R. Jew- ds 24 25 26 27 28 1 JEFFORDS V. COUNTY OF CONTRA COSTA, et al. 2 3 I am employed in the county of Contra Costa, State of California. I am over the age 4 of eighteen and not a party to the within action: My address is 50 Camino Diablo, 5 Brentwood, Ca. 94513 6 On December 20, 1996 I served the attached: 7 8 LIABILITY CLAIM 9 10 By depositing in the United States Mail at Brentwood, California addressed as follows 11 12 CONTRA COSTA COUNTY SHERIFF 1980 Muir Road 13 Martinez, Ca. 94553 14 CONTRA COSTA COUNTY CLERK 822 Main Street 15 Martinez, Ca. 94553 16 CLERK OF THE BOARD 17 651 Pine Street Martinez, Ca. 94553 �8 19 I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct. Excuted this 20th day of December 1996 at 20 Brentwood, CA. 21 --Z07--- -- 22 Tamtny L. MY i11 23 24 25 26 27 28 Y �i � „� � � � -��. � t 4 ,�.`, � �. t A`A� !' `V t � C�q t '..��..+� 111777 �'t �s � � �+ 1 i +' �+ V-� '� �`1 ' -J 1� ^\ �V i_ ��� . � ff� n3 i`�� ���rrr111 j �-` i� — y� �' tf C� '� ,�.� s:a. e �V_ ����' = . �, � _.. t� �`^~ w � ; nn �i J l' 'fit` 1 2 RECEIVED 1 DAVID R. JEFFORDS DEC 2 3 2 P.O.Box 391 Brentwood, CA. 94513 (510).516-8636 CLERK BOARD OF SUPERVISORS 3 CONTRA COSTA CO. 4 5 6 7 LIABILITY CLAIM 8 In the Matter of the Claim of ) Da'v id R. Jeffords , } 10 Claimant , ) vs . ) GOVERNMENT CODE SEC. 910 11 ) Contra Costa County Sheriff's Department ) 12 County of Contra Costa , ) 13 ) Respondants, ) 14 ---------- - --- --- -— ) 15 I, David R. Jeffords hereby present this claim to the Contra Costa County 16 Sheriffs Department and the County of Contra County pursuant of Governn-iem 17 code section 910. i8 l.) The name and address of claimant is: 19 David R. Jeffords P.O.Box 391 20 Brentwood, CA. 94513 21 2.) The address to which notices reguarding this claim are to be sent is: 22 David R. Jeffords 23 P.O. Box 391 Brentwood, CA. 94513 24 25 3.) On June 245 1996 at approximately 4:30 p.m. I was east bound on Clayton Road towards Brentwood . As my vehicle approached a turn in the 26 highway I was immediately confronted with a police vehicle on my side of the 27 highway. I vehicle was coming at me "head-on". I immediately took evasive 28 action and swerved to the right. In doing so my vehicle left the roadway . 1 After stopping I looked at the police vehile and it said Sheriff on the car. I the 2 waited for the deputy to return to wear I was stopped . He did not . He continued 3 west bound out of sight toward the town of Clayton . I then enter the roadway and 4 proceeded to a "call box telephone" the Highway Patrol Dispatcher advised me to 5 contract the Sheriff's office . I then proceeded east bound at notice a sign for the Sheriffs Jail facility and I contacted the duty officer and made a report to him. He 6 told me to that he would note my report and that I should contact the Sheriffs 7 Patrol Division. When I reached my home I telephone the Sheriffs Patrol Division 8 and made a report to the duty officer. He said he would investigate the matter and 9 call me. The following day I received a call from the Sheriffs Office , I failed to 10 write down the persons name I spoke to, he said he had found the detupy and 11 talked to him and indeed confirmed my report. He asked what I wanted done. I 12. told him that I was concerned because the deputy had not stopped to see if we were 13 all right. He said he would see that the deputy received some additional training. The following day I noticed my vehicle was pulling to the left and the front end 14 was making a noise. I subsequently took it to a repair shop to determine what the 15 problem may be. They said that the front end was damaged on the right side and 16 gave me a repair estimate. This estimate was for $955.00. I feel that the Sheriffs 17 office is responsible for the damage done to my vehicle when I had to run off the -.g road-to avoid hitting the oncoming Sheriffs vehicle that was on my side on the 19 highway in order to avoid a accident . 20 21 f 22 Dated: December 20, 1996 23 David R/4fords 24 . 25 26 27 28 1 JEFFORDS V. COUNTY OF CONTRA COSTA, et al. 2 3 I am employed in the county of Contra Costa, State of California. I am over the age 4 of eighteen and not a party to the within action: My address is 50 Camino Diablo, 5 Brentwood, Ca. 94513 6 On December 20, 1996 I served the attached: 7 8 LIABILITY CLAIM 9 10 By depositing in the United States Mail at Brentwood, California addressed as follows 11 12 CONTRA COSTA COUNTY SHERIFF 1980 Muir Road 13 Martinez, Ca. 94553 14 CONTRA COSTA COUNTY CLERK 822 Main Street 15 Martinez, Ca. 94553 16 CLERK OF THE BOARD 17 651 Pine Street Martinez, Ca. 94553 :8 19 I declare under the penalty of perjury under the laws of the State of California that the foregoing is true and correct. Excuted this 20th day of December 1996 at 20 Brentwood, CA. 21 / 22 __1—r� - --I-- - Tammy L. err111 23 24 25 26 27 28 CHlro �V st v IRk - CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $25,000.00+ Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Lorenza Moncada ATTORNEY: Law Offices of Terence Daniel Doyle 571 Hartz Ave. Date received ADDRESS: Danville, CA 94526 BY DELIVERY TO CLERK ON January 8, 1997 BY MAIL POSTMARKED: December 20, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 9, 1997 ByIL BATCHELOR, Clerk II. FROM-. County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. i 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: ZBY: Deputy County Counsel t III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, ByL-YA-e— QQJ5-" — Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /` 3° - `�7 BY: PHIL BATCHELOR by Q__�rA_e�Or-'� Deputy Clerk CC: County Counsel County Administrator LAW OFFICES OF TERENCE DANIEL DOYLE Terence Daniel Doyle 571 Hartz Avenue Napa Office Stanley A.Fishman Danville,California 94526 Ann Riley (510)855-4330-FAX(510)855-4334 1804 Soscol Avenue,Ste. 100 Scott L.Woodall Napa,California 94557 (707)252-7422 v REPLY TO DANVILLE OFFICE e December 19, 1996 County Clerk RECEIVED . Contra Costa County County Administrator �`=-%If 651 Pine Street J Martinez, California 94553 CLERK BOARD O PERVISORS CONTRA COSTA CO. Re: Claim for Damages Our Client: Lorena Moncada Date Of Loss: 6/20/96 Dear County Cleric: I am writing this claim for damages on behalf of my client, Lorenza Moncada, who has retained this office to pursue a claim for personal injuries sustained on the above- referenced date against the City of Concord and County of Contra Costa. Accordingly, please direct all further communications regarding this matter to the undersigned. Ms,. Moncada was.personally injured when she returned to,her rental apartment.at 1070 San..Miguel .Road, Apt::#$13,. San. Miguel Apartments,.Concord; County of.Contra Costa, State of California:. As.she walked across the grass directly below her apartment, suddenly and without warning the drainage grate on which she stepped gave way, causing her to fall and fracture her right foot. The approximate location of the storm grate is near building B of San Miguel Apartments, on the public street side, near a black lighting post, approximately three feet from a pathway, and a sidewalk. The area is surrounded by grass. The incident occurred in the morning on the above-referenced date. Ms. Moncada is informed and believes that the County and City had a duty to maintain, inspect and keep safe the storm grate. In addition, the City and County had actual or constructive knowledge, through maintenance programs or otherwise, of the dangerous condition and failed to talce preventive or corrective steps to protect Ms. Moncada. Despite their. legal obligation to. maintain the grate, the City and County failed to remedy,the condition or warn Ms. Moncada. Ms. Moncada further believes that this failure to maintain'the grate and warn of its condition actually-.and proximately caused her injuries. d � C 0 t �Or. � d I s 4 t t ;t 1 t 15� � C � ^n � '- O ;r N 000 0,Q.0a 14 r 4 5 t i t i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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 mailet 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 Gove Amount: $283.78 Section 913 and 915.4. Please note all "Wa S11. CLAIMANT: Stephen "Parker JAN 13 1997 COUNTY COUNSEL ATTORNEY: MARTINEZ CALIF. Date received ADDRESS: 4005 Harding Way BY DELIVERY TO CLERK ON January 10, 1997 Oakland, CA 94602 BY MAIL POSTMARKED: January 9, 1997 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 13, 1997 laIL depuzyLOR, Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors (�I This claim complies substantially with Sections 910 and 910.2. (_\) This claim FAILS to comply substantially with Sections 910 and 910.2, and the 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: -'2 - % PHIL BATCHELOR, Clerk, By L�i�^`R-�� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: `3� - q7 BY: PHIL BATCHELOR Deputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CL.AIMAh'T A. Clai= 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 for- R£: Claim By ) Reserved for Clerks filing stamp Against the County of Contra Costa_ ) or ) District) Fill in nene ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the ,sum of $ Q-133 and in support of this claim represents as f6liars: 1. When did the damage or, injury occur? -(Give exact date and ho=) fJL' cn 2. Where did the damage or injury occur? (Include city and county) CJ Cl> 0 �V(1 C - CLQ 3. How did the damage or injury occur? (Give full details; use extra paper if required) -rVee wek-Q jmCks « - •e cQ J � �;vw;��t c -��� o .ZuMec-�us t,oc-\tS \ocQy� . i� -� e �iC mac -l'1,n�� v� Q�rociG- � �1 rviy �w WN Sti'i eA o o—, 3 m Cn� 6\J� Svc cu Q \off: ��c �n °'' ��o r 4-o tc-�e t'p 5� ac tc�e n� i��c��-1-�o� :�v � cs �'c w©-F-� �n u. What particular act or omission on the part of county or district officers, sez-vantsC�or employees caused the injury or damage? 0� �l-V v 1 1 c-OAs"k�uc._ Urt a-ce c, ' I �. wnat are the names of counLv or district officers, servants or employees causing theor Injury? ff 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ` ' " 1W i it If -7-7 CL CXek c.Jti s�� 1 IZ.11460, Is 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) $. Names and addresses of witnesses, doctors and hospitals. (EA 9. List the expenditures you made on account of this accident or injury: DATE ITEM 24OUNT SAGov. Code Sec. 910:2�gm dies. "The claim must be si { ed by he claimant SEND NOTICES TO: (Attorne ) or b so so ons is lf." Name and Address of Attorney Sed � c t zgnature Address. Cl Li 6vZ Telephone No. L5) Telephone No. EZ>� �p�g N O T I C E Section, 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, onto any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voupher; 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 s3,ch i riso�.�e^`� and fine CUSTOMER /SALES a❑❑❑V o opt aero GJ4� o u�G�Q�7GC� G��II� 4Q£3 lC�'I X99 `^L CGI GL�6 u(�TL�i 5� a-0 QD 7-® (C3 lL sW 5 5• It j� QUOTE INVOICE DATE C U STEPHEN PARKER S PURCHASE ORDER NO. PAGE NO. T D D OF ! b R � 1Qi)a3�—l?IG�i CUSTOMER NO. 1 CUSTOMER NO.2 B 299499 I ORDER DATE DATE OF LOSS L L ' 01/09/97 T CAUSE OF LOSS STATE D POLICY NO. JEXP.DATE CLAIMS/CONTROL NO. OK'D<BY DEDUCTIBLE °OL771 VIN LICENSE PLATE NO. I YEAR MAKE MODEL STYLE ODOMETER 1996 FORD EXPLORER 4D 0 o aU o rnTI m II©' l :o' o �u Wt% _.... ...... � ---0o ,.Wi,n _.Gv �_� B79. 3— 3344113s 3 SIKA LE r G_L!{ Tt�F 1E _._ _ �T :� F __.___ _ . __-___ _-_ ___. ...- __ u10 Cha9 °►alis tin 9m SUB TOTALS'> req s 40.Gt r; ..23 CA `'''°` SALES -0.04 ALAMEDA 8.33 TAX GROSS t f r* 7 . TOTAL 1' ' PAYMENT *;440T AN INVOICE DO NOT PAY, GOOD FOR 30 DAYS** RECEIVED REFERRED BYELLOW PAGES FOR OFFICE 01 4�}�°w•� USE ONLY STATEMENT OF FINAL AND SATISFACTORY COMPLETION AND AUTHORIZATION TO PAY THE UNDERSIGNED ACKNOWLEDGES RECEIPT OF THE ABOVE REFERENCED GOODS AND. SERVICES AND Primary ACKNOWLEDGES HE/SHE HAS INSPECTED SAME AND IS SATISFIED THERE WITH. THE UNDERSIGNED FURTHER Vision REPAIR COMPLETED? ACKNOWLEDGES ALL SERVICES WERE PERFORMED IN A WORKMANLIKE MANNER TO HIS/HER SATISFACTION AND Area AUTHORIZES THE INSURANCE COMPANY TO PAY VISTAR AUTO GLASS DIRECTLY FOR PAYMENT OF THIS CLAIM.THE ❑ YES ❑ NO UNDERSIGNED AGREES THAT HE/SHE IS PERSONALLY RESPONSIBLE FOR PAYMENT OF THIS INVOICE IRRESPECTIVE OF ANY INSURANCE COVERAGE WHICH MAY PERTAIN HERETO. GLASS INSPECTION SIZE&DESCRIPTION OF DAMAGE **NOT All INVOICE DO NOT PAY, GOOD vii DAVE*4•r NOTE:THERE IS A CHANCE THAT THE WINDSHIELD MAY FURTHER BREAK O SIGNATURE DATE DURING THE REPAIR PROCESS.VISTAR AUTO GLASS WILL NOT BE RESPONSIBLE IF THE WINDSHIELD SHOULD BREAK FURTHER WHILE ATTEMPTING THE REPAIR. YOU WILL NOT BE CHARGED FOR THE s VISTAR AUTO GLASS REPAIR. R 241E BROADWAY CSR OAKLAND CA 946.^12IY c E SERVICE TECH. SERVICE TECH.SIGNATURE D 0 (510) 835--8954 CUSTOMER SIGNATURE MOBILE SERVICE LOCATION INSTRUCTIONS: TERMS: PAYABLE UPON RECEIPT 4 h i tpo cmc D 0 n=r no m 0 o ! c < � ; ! m m 0 i � V FO r'r tib � nl f `r t E� a BAY-HI AUTO GLASS 15976 E.14th Street,San Leandro,CA 94578 (510) 278-1373 • (510) 351-1182 �' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $4970.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Trina L. Smith 141 Camelia Lane ATTORNEY: Walnut Creek, CA 94595 Date received ADDRESS: BY DELIVERY TO CLERK ON December 27, 1996 BY MAIL POSTMARKED: December 26, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. IL gATCHtELOR, Clerk DATED: December 27, 1996 �b: Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days. (Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: ��/ BY: �� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /— 2 8`9 7 PHIL BATCHELOR, Clerk, By��/ -��/�" o� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18;.and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: /-3 0 - 9 7 BY: PHIL BATCHELOR b�/�'i`e-�i�-O`O�'�J Deputy Clerk CC: County Counsel County Administrator WALNUT CREEK LAMP REPAIR 14 1 j: Trina L.Smith Tice Valley Plaza ���� E— 1800B Tice Valley Road,Walnut Creek,CA 9459 Phone: 510-933-5518 DEC 211996 December 26, 1996 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Cleric of the Board of Supervisors Room 106 County Administration Building 651 Pine Street - Martinez, Ca 94553 To Whom It May Concern: Enclosed please find estimates and claim form to be filed with your office. Please send confirmation of receipt of my claim, and advise me of further instruction for proceeding. Sincerely, Trina Sm' I Cla_-- 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 nom, later than one year after the accrual of the cause of. action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 551 Pine.Street, Martinez, CA 94553• C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal. Code Sec. 72 at the end of this for--. R£: Claim By ) Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) or ) DEC 2 71996 District) CLERK BOARD OF SUFEP,V!S;; 5 Fill inn ) CONTRA COSTA CO. s The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ ✓-76) '•' and in support of this claim represents as fol-lv4s: 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) - Q n � Com?L V lD <P W I�d4r e e C-r- ry 1 J a /aue2e 7"/ How di� o Give full details; use extra paper if 3 damage or injury occur, ( , required) 4.. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? �u�c��•� /moi sew P a�e,r G ��� -� Ide,:� y lowdilf-W .o-/ L ea c i ,t� 7 4r e e �D {�c�7� a it c� �`h /� d, 5. wnat; are the nanaes of county or district officers, servants or employees causing the - ca,_ae or injury? uN�n�r� 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto Oamage. )) <_'e.,r�.¢✓- e.q�. �o�m�..y-e 13-e���( - /LZP4%f` - /�p/4�e�a-e.-�7" ✓�i.iQ 7. How was the amount claimed above computed? (Include the estimated unt of any prospective injury or damage. a-�- p�l lc.���L 1-, s-ee 2s f, c. s x/-74 9 13. NTames. and addresses of :witnesses, doctors and hospitals. �uC407 pe-t l-0 V 7<-41 3 9. List the expenditures you made on account of this accident or injury: DATE ITEM. AMOUNT Gov. Code Sec. 910:2 provides: „ "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) ';' or by some person on his behalf." Name and Address of Attorney ids Signature Address- �. � c� Telephone No. Telephone No N O T I C E Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment -and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both si2ch iupriso-g-x-- and fine. i 1 3 9 5 3 i I I j . COOKS LOLL=S=ON FOR PEOPLE WHO CARE I 1414 PINE STREET WALNUT CREEK, CA 94596 (510) 935-4041 Fax: (510) 935-2508 I DAMAGE REPORT 13 9 5 3 by JOE I Date; 03-14-1996 Time; 11:41 Date Written;03-14-96 Customer Informatiori Val-iicla JEriformatiori. Name TRINA SMITH Make 1983 TOYOTA PICK-UP Address 141 CAMELIA Style MOJAVE Cty,St,Zp WALNUT CREEK, CA. 94545 License 3AO9232 Home Phone 933-5518 Work: 933-5518 Ser # JT4RN44S4Dll27779 SCRIPTION EST PRICE i LABOR i PAINT 1 REPAIR COST EXCEEDS VALUE. TOTAL LOS ----------------------------------- ------ i GE REPORT SUMMARY Labor Descriptive Items BODY LA 0.0 60.00 0.00 ! MATERIALS 0.00 GLASS LA 0.0 60.00 0.00 SUPPLIES 0.00 FRAME LA 0.0 $ 75.00 0.00 HAZARD WASTE 0.00 j MECH LA 0.0 @ 75.00 0.00 SUBLET 0.00 BODY-S 0.0 @ 75.00 0.00 USED/RECOND 0.00 ELECTRICA 0.0 @ 75.00 0.00 ! TOW CHARGES 0.00 IMPORT 0.0 @ 60.00 0.00 MISC W/TAX ' 0.00 DETAIL LA 0.0 60.00 0.00 STORAGE 0.00 i OVERHEAD 0.0 0.00 0.00 ! USER-DEFINED 0.00 a or Ers. ems Labor 0.00 j Subtotal 0.00 Tax . Grand Total $0.00 PARTS PRICES SUBJECT TO INVOICE We made a decision long ago that it would be better to explain price once than to apologize for quality forever If you have any questions about the repairs proposed for your vehicle, please feel free to ask. Our staff can assist you in contacting your insurance company. ASK ABOUT OUR LIFETIME GUARANTEE! j DAMAGE REPORT authorized by----1------------------------------------ date-------------------- WE ARE IN THE SERVICE;BUSINESS, AND WE ARE HERE TO SERVE YOU! Collision Shop is a trademark of Kitchell International Copyright 1991,1992 All Rights Reserved I i + I Date: 03/13/96 01:05 P.M. Estimate ID: 1383 Preliminary Profile ID: Mitchell Standard j MAGNUSGELJ'S WALNUT CREEK AMOBODY MAGNUSSEN BUICK PONTIAC 1435 PINE STREET WALNUT CREEK CA 94596 (510) 935-2220 Damage Assessed By: TREY WATKINS CUSTOMER ID: TRINA SMITH Mitchell Service: 910741 Description: 1983 TOYOTA LONG BED LONG BED i VIN: JT4RN44S4Dll27779 License: 3AO9232 CA i Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation { Description Part Number Amount Unit 1 AUTO BODY OVERHAUL FRT BUMPER ASSY 1.6 # 2 000950 BODY REMOVE/REPLACE FRT BUMPER FACE BAR RECHROMED 125.00* INCL 3 000990 BODY REMOVE/REPLACE R FRT BUMPER END CAP 52102-89102 60.36 INCL 4 001010 BODY REMOVE/REPLACE FRT BUMPER FILLER PANEL 52501-89101 103.67 INCL 5 001020 BODY REMOVE/REPLACE R FRT BUMPER MOUNTING ARM 52011-89104 83.41 INCL 6 001030 BODY REMOVE/REPLACE L FRT BUMPER MOUNTING ARM 52012-89104 83.41 INCL 7 001890 BODY REPAIR *UPR COOLING TIE BAR 1.5* 8 AUTO REFIN REFINISH UPPER TIE BAR 0.5 9 001960 BODY REPAIR *R COOLING RADIATOR SIDE PANEL 2.0* 10 AUTO REFIN REFINISH R RADIATOR SIDE PANEL 0.5 11 002750 BODY REMOVE/REPLACE R H/LAMP ASSEMBLY 81110-39755 135.49 0.3 12 AUTO BODY CHECK/ADJUST j HEADLAMPS 0.4 13 006360 BODY REMOVE/REPLACE HOOD PANEL 53301-89115 251.07 1.0 14 AUTO REFIN REFINISH j HOOD OUTSIDE C 2.6 15 AUTO REFIN REFINISH HOOD UNDERSIDE C 1.3 r 16 006690 BODY REMOVE/REPLACE R FENDER PANEL 53801-89164 218.95 1.5 # 17 AUTO REFIN REFINISH R FENDER OUTSIDE C 2.0 18 AUTO REFIN REFINISH I R FENDER EDGE C 0.5 19 007300 BODY REMOVE/REPLACE R FENDER SKIRT PANEL 53875-89102 59.21 0.5 20 900500 BODY *REMOVE/REPLACE *ALIGN FRONT END SUBLET 44.95* 21 900500 BODY *REPAIR *REPAIR W/S POST RS 2.5* 22 900500 REFIN*REFINISH/REPAIR*REFINISH W/S POST EXISTING ' 1.0* 23 000058 GLASS REMOVE/REPLACE W/SHIELD GLASS 56111-89122 203.69 2.5 24 016980 GLASS REMOVE/REPLACE W/SHIELD WEATHERSTRIP 56121-89113 68.57 INCL 25 017970 BODY REPAIR i *R CAB CORNER PANEL 0.5* 26 AUTO REFIN REFINISH R CAB CORNER PANEL C 1.5 27 018270 BODY REPAIR *CAB ROOF PANEL 7.0* 28 AUTO REFIN REFINISH i CAB ROOF C 2.2 29 019900 REFIN BLEND R FRT DOOR OUTSIDE C 0.9 30 900500 BODY *REMOVE/REPLACE *TIRE G/Y 2057OR14 NEW 95.00* 31 900500 BODY *REMOVE/REPLACE *MOUNT & BALANCE SUBLET 14.95* 32 AUTO REFIN ADD'L LABOR OPR CLEAR COAT 3.0 33 933003 REFIN ADD'L LABOR OPR TINT COLOR 0.5* i ESTIMATE RECALL NUMBER: 00/00/00 00:00:00 1383 Mitchell Data Version: DEC_95_A . i Copyright (C) 1990, Mitchell International Page 1 of 2 All Rights Reserved Date: 03/13/96 01:05 P.M. ' Estimate ID: 1383 Preliminary i Profile ID: Mitchell Standard 34 933018 REFIN ADD'L LABOR OPR MASK FOR OVERSPRAY 6.00* 0.3* 35 AUTO ADD'L COST jPAINT MATERIALS 403.20* * Judgement Item N Labor Note Applies ; C Included in Clear Coat Calc i marks TE: ALSO DAMAGE TO SHELL ASSY. I i Add'l Labor Sublet Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 18.8 '54.00 1,015.20 Taxable Parts 1,487.83 Refinish 16.8 154.00 6.00 913.20 Sales Tax a 8.25% 122.75 Glass 2.5 154.00 135.00 Non-Taxable Parts 59.90 Labor Subtotal 2,063.40 Total Replacement Parts Amount: 1,670.48 Labor Summary Totals 38.1 2,063.40 I. Additional Costs !' Amount IV. Adjustments Amount Taxable Costs t 403.20 Customer Responsibility: 0.00 ,Sales Tax a 8.25% 33.26 Total Additional Costs: 436.46 l I. Total Labor: 2,063.40 I II. Total Replacement Parts: 1,670.48 i III. Total Additional Costs: 436.46 I I { Gross Total: 4,170.34 I IV. Total Adjustments: � �-0.00 Net Total: 4,170.34 I ! This is a preliminary estimate. Additional change's to the estimate may be required for the actual repair I I. I ' I i i I . I 1 , I iSTIMATE RECALL NUMBER: 00/00/00 00:00:00 1383 litchell Data Version: DEC-95_A - Copyright (C) 1990, Mitchell International Page 2 of 2 All Rights Reserved i a r 1i �i 4 t. a O'aY,i S ,.. o I*t tg W C w t9 r � 4 O• vim► ��y 9 ia19 - 4a w _, wx ap SM a r ,aa ''ws NO e a � low aIn - VW PIP 2W,. > t y< . t �� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $2500 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Monty Starks 396 Chelmsford Dr. ATTORNEY: Brentwood, CA 94513 Date received ADDRESS: BY DELIVERY TO CLERK ON December 26, 1996 BY MAIL POSTMARKED: December 24, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 26 1996 QQHHIL gATCYELOR, Clerk BY: Depu y II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days. (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: z,�L_vlf� BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: - g `�7 PHIL BATCHELOR, Clerk, By�iu-A-4-Q-)ED - 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 1'10 Deputy Clerk CC: County Counsel County Administrator ' b Claim to: BOARD OF SJPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMANT A. Cla4L s relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 19871 must be presented not later than the 100th day after the accrual of the cause of action. - Claims relating to causes of action for-death or for injury to- person • or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause, of. action. (Govt. Code 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, Cotmty 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 Fo= RE: Claim By ) Reserved for Clerk's filing stamp RECEIVED 3 DEC 26 Against the County of Contra"Costa' or ) _ CLERK BOARD OF SUPERVISORS Z:/,5-rryd,_U _ CONTRA COSTA CO. ��<� ��.��L`f�s'�.(/ District) Fill in hame) ) Mie undersigned claimant hereby makes claim against the County of Contra Costa Or the above named District in the sum of $ 2 CO-� and in support of this claim represents as follays: 1. When did the damage or injury occur? -(Give exact date and hour) g( 2. Where did damage or injury occur? (Include city and county) /,1 v,/y, y 44,10 /3 Avg r)vlL 3. How did the damage or injury occur? (Give full details; use extra paper if /�?c •ice% �"<� required) GA/Z 4CaGA/7 / 6✓ L cNr 4. Wha., ,` �'�r✓__G<r-,�/i ; '�S �iZG"�� - ` particular act or omission on the part of county or district officers, se.-Vants or employees caused the injury or damage? j. Wnat are zne na-mes of county or district officers, servants or employees causing the da:,:ae or X;niur)? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or. damages claimed. Attach two estimates for auto damage. VC-HICZ,c Tarw46/--�) 7. How was the amount claimed above computed? (Include the estimated amount 'of any prospective injury or damage.) /10 $. !dames and addresses of witnesses, doctors and hospitals. �U�•u/ 1314 y 9. List the expenditures you made on account of this accident or injury.- DAM— njury:DATE— , —ITE�,r �:.,_. AMOUNT t n y x.�1 :111 Gov. Code Sec. 910:2 provides: vThe claim Faust be signed by the claimant SEND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney _ Claimant's Signature (Address) T PVadl.) (104 qy.5/ S- Telephone No. Telephone No. \+ � N ,OTICE 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 ane year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in' the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by f C v Com. 4 3 3`s ll� i CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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 maile4Lto 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 CCoodee��� Amount: $100,393.00 Section 913 and 915.4. Please note all "W , CLAIMANT: Brenda Stoy JAN 13 1997 ATTORNEY: COUNTY COUNSEL Date received MARTINEZ CALIF. ADDRESS: Paul Kleven BY DELIVERY TO CLERK ON January 13, 1997 1604 Solano Ave. Berkeley, CA 94707 BY MAIL POSTMARKED: hand delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 13, 1997 QQHHIL BATCHELOR, C1erk�9 Bl': Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors 9<11 This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and the 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: eputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: —2 —9'r PHIL BATCHELOR, Clerk, B�iw'�`��`-�` Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 3 97 BY: PHIL BATCHELOR by -// / Deputy Clerk CC: County Counsel County Administrator i:i.ait ;x,: MAN) OF SUPERVISORS OF COtTM COM 00turi'Y YtisT MMS 'rO CLAIMANT A. Clzi= relating to cau9es of action for deeh =- for Injury to Pef's� or to Per- sonal, property cr groaning crops and rich accrue en or before December 31, 1987, must be preseated riot later thag the 100th day after the ao=val of the Cause of action. CLa#.nns relating to causes of action fbrAeath or Ar Wml to Pwam . or to per-sA= . property or grv4.ng cs'ops and i&ich warue o0 or afterf =X19 1988, must be presented test later U= Six =anths after the awl of actioa. CJaiuts relating to any direr c=se of motion mist be presented not later than one year atter the nocrwl of the cause of action. (Govt. Code B. can, a must be tiled nth the Cleric of the Board aP -at its of ift in Kowa 106, > y Administration Dom, 651. Pine Sheet, Martinez, Ca 9553. C. If claim Is-against a district governed b3' the Board of Supervisors, rather than the Courtty, the maze of the District should be filled in. D. If the claim is .against more than axe public entity, separate clai mast be filed against each public entity. E. FraW.. See penalty fcr fraudulent claims, Peiaal.•Code Ser. ?Z at the end of this R£: Claim $y ) Reses�ved far Qer3c�s giUng stZOP Brenda StD ) j RECEIVE® Agalrat the y of Qxrtra costa or JAN 131997 Office Of The. Sheriff District) CLERK BOARD OF SUPERVISORS (nil rm tomo } CONTRA COSTA CO. The undersigned claimant hereby makes elaim'against the County of Contra Costa or the above-rood. District in the sum of $ 100,393.00 aid in suppoz't of this claim represents as .folivrs: 1. Tin did the damage dr injury o=n--9. '(Give exact date and hour) July 13, 1996 approximately 1:15 pm 2. When did the damage a' injw7 ocaur? (Znalude city =d-County) Teakwood Drive, Oakley; California,. Contra Costa County 3. now di4 the damage or injury occur? (Give full. details; use extra per` if required) See Attachment ti. mat particular act or omission on the part of eouaty or district officers, _ . servants arc employees caused the injurY .or damage? Violation of civil rights, false arrest, false imprisonment, malicious prosecution, intentional and negligent infliction of of emotional distress, slander, stx ua( k a✓a.SSWe14. • .. � __ 1_ ♦L 1-.Vim: V. �- Wnat are the vanes of counLy or district 4c)1Y-icers, servants or employees cau3ing the dar-3 - oe or �r,jur5•? DEPUTY RASMUSSON DEPUTY SIMPSON 5. Uhat damage or injuries do you claim resulted? (Give fUU extent of i.njvries or damages claimed. Attach tWO estimates for SMW 43MMe. Special Damages of $393.00 General Damages of $100,000.00 7. Sou Uas the amount claimed above computed? (Include the estimated am=t of any prospective injury or damage.) Special Damages by receipt as incurred. General Damages as allowed by law for emotional distess, physical. distress dams a to re utation. $. N=eS and addresses of vit nesses, doctors and hospitals. WITNESSES: (All live on Teakwood Drive) Hospital: ' Nicole Colonia Nicole Leggat Delta Memorial Hospital Jeffrey Rice- Catrin Lowery 'Jessica Hunter Brandon Richey 9• List the e:peaditu es ym made on account of this. accident or injury., DAM ITEM IST 7-13-96 Bail $250.00 7-13-96 Medical $143.00 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SM NOnCES TO. or by some on M behalf." Nae Sad Address of Attorney Paul Kleven Claimantts Signature) 1604 SOLANO AVENUE BERKELEY, CA 94707 1604 Solano Avenue . • Addz'esS. Berkeley, CA 94707 (510)528-7347 Telepbone No. (510)528-7347 +F � 1E fE iE � 1F f iE iF � i� � ♦F � aE � iE NOTICE Seoticn 72 of the Penal Code provides: "EVer7 ppm mho, with intent to defraud, presents for allowance or for PapmesYt.to any state board Or officer, or to any county, city cr district board or officer, authorized to allow or pay the same if genuine, anY false or fraudulent claim, bi31; account,. votes, or writing, is'puuisbable. either.by iMrisO went in the county jail for a period of not more than one -year, by a fine of not exceeding Me t OUsand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceedingten thousand dollars ($1.0,000, or by' both sl=ch l.1;riso:unent and fine. TOTAL P.02 ATTACHMENT Claim by: Brenda Stoy 3 . How did the damage or injury occur? On July 13 , 1996, claimant encountered Deputy Rasmusson outside her neighbor' s house . Although claimant properly identified herself, Deputy Rasmusson falsely accused her of contributing to the delinquency of minors and of obstructing arrests . Deputy Rasmusson falsely claimed claimant was resisting arrest, grabbed her by the hair, pushed her off the front steps and repeatedly slammed her body and face into the chain-link fence . All of this took place in front of various neighbors and witnesses who could observe Deputy Rasmusson' s actions, including claimant' s minor children. Deputy Rasmusson then roughly pushed claimant down the sidewalk, and forcefully clamped handcuffs on her right wrist, causing intense pain. When claimant asked about her children, Deputy Rasmusson falsely and maliciously stated that "C. P.S . will pick them up. " In the course of searching claimant, Deputy Rasmusson raised her shirt, exposing her breasts for the witnesses to see . Deputy Rasmusson then continued to force claimant down the sidewalk, refusing to slow down when claimant informed him that she hada broken toe . Once again, Deputy Rasmusson falsely and maliciously threatened to have C. P.S . pick up her children. When claimant arrived at the street, Deputy Simpson falsely and maliciously stated that she was a "fuckin' liar" when she truthfully answered the questions, stating that he did not believe a word she had said. These false and defamatory statements were published to claimant' s neighbors and other witnesses who were observing this incident . She was then put in a vehicle already occupied with an unknown man in custody, and Deputy Rasmusson called C. P. S . to pick up claimant' s children. Claimant was then transported to Martinez where she was charged with a crime and placed in jail . Claimant was not released from jail for over 7 hours . C:\W PFILES\CASES\CLAIM.160 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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 MinftTIM)'Amount: $10,000.00+ Section 913 and 915.4. Please note all CLAIMANT: Larry Swafford JAN 13 1997 ATTORNEY: c/o Law Office of Jay Chafetz COUNTY COUNSEL 2033 N. Main St. , Ste. 750Date received MARTINEZ CALIF. ADDRESS: Walnut Creek, CA 94596 BY DELIVERY TO CLERK ON January 10, 1997 BY MAIL POSTMARKED: hand delivered via; Risk Mgnt. I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 13, 1997 �aIl �ep�HtyLOR, C1erL��s.e�,.� 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: yLIq BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (x) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: / - ,�S- 97 PHIL BATCHELOR, Clerk, B�-�jl-��-�/LJ 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: /-30 -9 7 BY: PHIL BATCHELOR b�/u-'�e� Deputy Clerk CC: County Counsel County Administrator n RECEIVED GOVERNMENT CLAIM i AlONT TO: Contra Costa County CLERK BOARD OF SUPERVISORS 651 Pine Street, 6th Floor CONTRA COSTA CO. Martinez, CA 94553 i Attention: Risk Management Division i The following claim is submitted pursuant to Government Code section 910. 1. Claimant' s name and address: Larry Swafford c/o Law Office of Jay Chafetz 2033 N. Main Street, Suite 750 Walnut Creek, CA 94596 2 . Send Notices To: Law Office of Jay Chafetz 2033 N. Main Street, Suite 750 Walnut Creek, CA 94596 3 . The Occurrence: a. Date: 7/13/96 1 b. Place: Berry Drive at intersection with Mobil I Drive in unincorporated area of Contra Costa County in Mt. Diablo Judicial District. C. Circumstances: About 11:05 a.m. on 7/13/96, claimant, Larry Swafford, was a passenger in a vehicle being operated by Frank Siino. The Siino vehicle was on Mobil Drive at the intersection with Berry Drive. Si no-"btarted to make a left turn. Mid-way through the � le was struck by a vehicle driven by Miguel tarn, his veizi Morales Deluna and owned by Contra Costa County. It is believed Deluna is a government employee, and that the accident occurred because of his excessive and improper speed. Claimant is filing this claim to protect his rights against the named governmental entities, and any others that may be involved, in case Deluna or the County are found to be entirely or partly at fault. Claimant intends to assert all possible causes of action and theories arising out of the above circumstances, including but not limited to that the governmental entities have not adopted a policy for the safe conduct of vehicular pursuits that complies with Vehicle Code section 17004 .7 or other S 1 pertinent 'st'atutes or ordinances, that any policy that has been adopted fa l's<:to meet one or more of the criteria of section 17004 .7 (c) ,,- that section 17004.7 is unconstitutional or invalid j for other reasons, that the entities and their employees were R negligent in the operation, ownership, maintenance, and entrustment of their vehicles, that they were negligent in i the delegation of one or more of their duties, and that they were negligent in the maintenance or ownership of their property generally or because visibility was poor at the intersection because of overgrowing trees or otherwise, and that the County knew or should have known of the poor visibility before the accident but failed to remedy it or give warning. 4 . General Description of indebtedness, obligation, injury, damage or loss: Damages for personal injuries, including medical expenses, wage losses, and pain and suffering. 5. Names of government employee(s) causing the loss: Miguel Morales Deluna. 6. Amount Claimed: The amount claimed would fall within the jurisdiction of the superior court. Dated: January 6, 1997 Jay Chafetz Attorney for Claimant R CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: Unknown Section 913 and 915.4. Please note all 1 7 , CLAIMANT: David Wilkes BK#'95221233 JAN 10 1997 ATTORNEY: IR# 200016600 Date received COUNTY COUNSEL MARTINEZ CALIF. ADDRESS: 901 Court St. BY DELIVERY TO CLERK ON January 8, 1997 Martinez, CA 94553 BY MAIL POSTMARKED:via:County Inter-Office Transmittal I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: January 10, 1997 IYtl DeputyloR, Clerk���,���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: `/A BY:t�g (/U Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 7 - 2 c77 PHIL BATCHELOR, Clerk, By�/i-� �ji-� — 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: / _ &0 9 7 BY: PHIL BATCHELOR Deputy Clerk CC: County Counsel County Administrator RECEIE� JAN — 81997 C`E K 80 RD OF CO iSORS a � r (3k 5,)�.p {�t+s��y R 00-0 i tv (POD h+a.wA- vhkvtaa� -6 i,\ . j r Li SSC}< S C. cy� AbA A Kofi 6131/ 4 AIN ... 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D 36 A Incident Occurred > Fac: MD Module: Q Section: A Location: OTHER "Q" MODULE- BUNK #36 Action Taken: INMATE TAKEN TO S/C #2 . PROPERTY MOVED TO CELL#8 RECC: 10 DAY L/D 3 WEEKS LOP AND REASSIGNMENT TO "D" MODULE Disciplinary? Y Inmate Violence? Y CS Violence? Y Contraband? N Fac Damage? N Sgt. Action: Waiver: Findings: 0 Adjusted Type (s) Submitted By > OID: 52880 Name: SANTIAGO Date: 12/14/96 Updated By > OID: 00000 Name: Date: 01/01/01 Approved By (Sgt) > OID: 00000 Name: Date: 01/01/01 Approved By (OD) > OID: 00000 Name: Date: 01/01/01 . Narrative: SYNOPSIS: I-WILKES WAS DISRUPTIVE AND ASSAULTIVE TOWARDS STAFF ON "Q" M 1ODULE. NARRATIVE: SGT HUGHES WAS ON THE MODULE CONDUCTING HEARINGS. I-WILKES WHO WAS ASSIGNED TO BUNK #36 WALKED UP TO THE DEPUTY STATION AND STARTED TALKING TO SGT HUGHES. I TOLD WILKES HE WAS NOT SUPPOSED TO LEAVE HIS BUNK OR TALK TO THE SGT WITHOUT PERMISSION. THEN I TOLD HIM TO GO ROLL HIS PROPERTY UP BECAUSE HE WAS MOVING TO CELL #8 . WILKES STARTED WALKING TOWARDS HIS BUNK WHILE TELLING US HE JUST WANTED TO TALK TO THE SGT. HE CONTINUED TOWARDS HIS BUNK BUT SEEMED TO GET MORE AGITATED AND MORE VOCAL. DEPUTY GAUL TOLD HIM AGAIN TO ROLL UP HIS PROPERTY. WILKES YELLED, "FUCK THAT, YOU COME ROLL MY FUCKING PROPERTY UP, I'M NOT DOING IT. " WHILE WILKES YELLED THIS PHRASE HIS ARMS WERE FLAILING AND HE BECAME VERY ANIMATED. DEPUTY GAUL AND I APPROACHED WILKES TO ESCORT HIM TO CELL #8 . DEPUTY GAUL TOOK AN ESCORT POSITION ON HIS LEFT ARM AND WILKES TURNED AWAY FROM HER IN A Facility: MD Page 2 Date: 12/15/96 08 : 34 42625 SKUCE CONTRA COSTA COUNTY DETENTION FACILITY Incident Report Incident Number: 200016600 - AN ATTEMPT TO BREAK FREE. I ATTEMPTED TO TAKE CONTROL OF HIS RIGHT ARM AND HE LOCKED HIS ELBOW AND PULLED IT TIGHT TO HIS BODY. WILKES STARTED TO TWIST TO HIS LEFT WHEN I RELEASED HIS RIGHT ARM AND ATTEMPTED TO PLACE HIM ON THE FLOOR. ***CONT*** WHILE DEPUTY GAUL AND I WERE ATTEMPTING TO RESTRAIN WILKES WE GAVE HIM SEVERAL VERBAL COMMANDS TO GET DOWN ON THE FLOOR. WILKES CONTINUED RESISTING AND PLACED HIS ARMS UNDER HIS CHEST SO WE WOULD BE UNABLE TO HANDCUFF HIM. WE WERE ABLE TO PULL HIS ARMS OUT AND HANDCUFF HIM WITHOUT FURTHER INCIDENT. WILKES WAS TAKEN. TO SAFETY CELL #2 AND RESTRAINED AT THE ANS KLES AS A DANGER TO STAFF O r. �•��t �S [ � WILKES HAS' A HISTORY OF MENTAL HEALTH .TREATMENT IN THE PAST. HE TOLD ME HE WANTED TO "STICK" ME AND TOLD DEPUTY GAUL SHE BETTER WATCH OUT. RECOMMEND 10 DAY L/D WITH 3 WEEKS LOP AND PLACEMENT ON "D" MODULE. WILKES SHOULD BE INTERVIEWED BY MENTAL HEALTH. COPY TO CLASSIFICATION. USE OF SAFETY CELL APPROVED BY SGT HUGHES. SAFETY CELL LOG INITIATED. *** End of Report *** -- W v-j I IC j 0 cA I � cl s c%--o-CA Ct OL Ck ao- ccy-y (41J, Ay A-c u r �- 4© tl 1 r x YN ACA C� �tAj I CAC, 44, DAViD <C- Liz, c\ v--k- C�,u V\ of -o Tc sill I C, 1 -7 Ck r e, cf cj- c A- yl q r (4 lil nicie' L n + rj,� Cc•"j, v CA\ sc- (,I g- A A t pi 4 o o-tt,--, AA 30 C., 6 5 c+0 64, '7' 5;5, r, V\clt ok r 4 r 4 i Jc�c I u A vkl V-C. Vjj cc r f `OFFICE OF THE SHERIFF A; X-co Warren E. Rupf `,./ ����,.`a7 f�?`--,, � Contra Costa County ; SHERIFF 4` `-. Robert Henderson Custody Services Bureau �� Undersheriff 1000 Ward Street Martinez, California 94553 (510) 646-4860 CosTA ; r-- January 7, 1997 RECEIVED JAN 13 Igg7 Board of Superviosrs 651 Pine St. CLERK BOARD OF SUPERVISORS Martinez, CA 94553 CONTRA COSTA CO. Attn: Clerk of the Board Dear Clerk of the Board: You will be receiving a complaint-grievance in the name of David Wilkes Bkg. #95221233 , which was actually prepared by Inmate Gary Mosbarger. Inmate Mosbarger has designated himself as an advocate for inmate rights and is sending out various complaints-grievances either pertaining to specific allegations he perceives are occurring against him and also other inmates. In this particular matter re: David Wilkes, Inmate Wilkes was personally contacted regarding this complaint-grievance. Inmate Wilkes indicates he is aware of the complaint-grievance prepared by Inmate Mosbarger, however he desires to withdraw it. See attached inmate request prepared by Inmate David Wilkes. The intent of this letter is to keep you informed of the disposition of this particular complaint-grievance. Sincerely, Wm. D. Shinn, Commander Custody Services Bureau by: LieutenantRay Ro igues Martinez Detention Facility Commander Memo Form R 2/91 SBH AN EQUAL OPPORTUNITY EMPLOYER V24920 VALLEY BUSINESS FORMS—CALISTOGA(800)435-1100 P CONTRA COSTA COUNTY DETENTION FACILITIES ( ) INMATE REQUEST OR(INFORMATION ( ) MEDICAL REQUEST To: LT 1 From: + >,A `^+I ' Y-h�?Bkg.#: A (DOB) ref / p' Date: ' / // Housing Assignment: V— C'GY/ p i;:<:•: Check One: O Request Grievance O Appeal O Other Request: Wo l/� T� CANC 1 7 )6-yAwl- 11/41?245PASVZIOM 06A,17—Y r Lj,S 14 NOT V 2Sy r--- CI V r' i `►"S 0- r` Wol! rf"O/V a A 9 Ctl nS T' b 5Ha/41' r- O FFr C Date Received: Received By: 1005 14 "'e ti Routed To: ANSWER: (KAPPROVED O DENIED,(State Reason) z �S oo By: Date:z-L2—P . Distribution-Pink:Kept by Inmate;Yellow:Reply to Inmate;White:To Booking DET 024:FRM Rev.1/2/91 i { lf1 E > A j 4-1 L) W N Co CO 0 Lt pa �O 00 1 1�] �y V LO W O } 41 � x D C V w r: w cr- O cO N e0 U W O H 0 V V O ev ri LU d a c 0 �1 AMENDED *CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA January 28, 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: $250,000.00 Section 913 and 915.4. Please note all "Warnings". CLAIMANT: Alex Bantugan ATIORNEY: Reilly Atkinson, Esq. Tehin + Patrners Date received ADDRESS: 555 California St. , 33rd Flr. BY DELIVERY TO CLERK ON December 26, 1996 San Francisco, CA 94104-1609 BY MAIL POSTMARKED: December 20, 1996 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. DATED: December 26, 1996 IVIL �ep�HtyLOR, Clerk 11. FROM: County Counsel TO: Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( \) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days.(Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: O" "l BY: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present (X This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 2 - 77 PHIL BATCHELOR, Clerk, Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. * For Additional Warning See Reverse Side Of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 3� — 97 BY: PHIL BATCHELOR b��ji-�A-�j�- Deputy Clerk CC: County Counsel County Administrator .I W. A Professional Corporation Bank of America Center Ir D a �- TQ ER U M[I Q ii 555 California Street 33rd Floor ATTORNEYS AT LAW SAN FRANCISCO AND HONOLULU San Francisco California 94104-1609 Fax 415.951.8808 Tel 415.951.8800 December 23 , 1996 - RECEIVED Clerk of the Board of Supervisors DEC ? 6 199fi Room 106 County Administration Building CLERK BOARD OF SUPE 'vl17G•RS 651 Pine Street CONTRA COSTA CO. s.. Martinez, CA 94553 �� Re: Alex Bantugan v. Merrithew Memorial Hospital Dear Clerk: Enclosed please find the plaintiff/claimant Alex Bantugan' s Claim Against the County of Contra Costa . Kindly have said document filed and return a filed-endorsed copy to the undersigned. Thank you for your anticipated cooperation in this matter . Very truly yours, �� Kelly MCAndrews Legal Assistant : km Encl . r r Reilly Atkinson, Esq . 2 TEHIN + PARTNERS Attorneys at Law 3 555 California Street , 33rd Floor San Francisco, California 94111 4 Telephone : (415) 951-8800 5 Attorneys for Claimant 6 7 CLAIM AGAINST COUNTY OF CONTRA COSTA AND ITS 8 GOVERNING BOARD, CONTRA COSTA COUNTY BOARD OF SUPERVISORS 9 The following claim for damages is hereby made by Alex 10 Bantugan against the County of Contra Costa and in' support of this claim represents as follows : 11 A. NAME AND ADDRESS OF CLAIMANT: 12 ALEX BANTUGAN 13 3858 Harbor Street Pittsburgh, CA 94565 14 B. THE ADDRESS TO WHICH NOTICES ARE TO BE SENT: 15 Reilly Atkinson, Esq. 16 Tehin + Partners 555 California Street , 33rd Floor 17 San Francisco, California 94104-1609 18 C. AMOUNT OF CLAIM: 19 $250, 000 . 00 general damages , plus special damages . 20 D. DATE AND PLACE OF OCCURRENCE: 21 That on or about December 10, 1995 , and thereafter, claimant Alex Bantugan was under the care and treatment of 22 Merrithew Memorial Hospital , 2500 Alhambra Avenue, City of Martinez , County Costa County, California, 94553 . 23 E . OTHER CIRCUMSTANCES OF OCCURRENCE: 24 That on or about December 10 , 1995 , and prior thereto 25 and thereafter, claimant Alex Bantugan was admitted to Merrithew Memorial Hospital of Martinez , California, for a 26 laparscopic nisson fundoplication surgical procedure . I 1 That Merrithew Memorial Hospital of Martinez , its 2 physicians and other medical personnel undertook and agreed to diagnose and to care and treat claimant and do all things 3 necessary and proper in connection therewith, and said Merrittew Memorial Hospital of Martinez thereafter entered into 4 such employment , individually and by and through their 5 employees and agents . That Merrithew Memorial Hospital of Martinez , in 6 conjunction with others , were negligent and careless in and about said care, treatment and diagnosis of claimant , in that, 7 among other things, they failed to provide proper supervision, thereby proximately causing the injuries and damages herein 8 alleged. 9 As a proximate result of the acts and omissions of 10 Merrithew Memorial Hospital and its agents and employees , Alex Bantugan was caused to sustain bodily injuries , including but 11 not limited to, damage to the vagus nerve a's a result of physician negligence during the surgical procedure, causing 12 permanent and irrepairable damage to claimant . 13 At all times mentioned herein, claimant did not know, and did not reasonably have grounds upon which to know, that 14 the medical care described hereinabove was negligent and otherwise careless and improper , and that said care proximately 15 caused said injuries and did at all times rely upon the medical personnel involved, and each of them, and, until October 28 , 16 1996 did assume that the care and treatment claimant had received from said medical personnel was in all respects 17 proper .. Prior to that time, claimant had no cause to believe that his injuries were the result of negligence on the part of 18 the Merrithew Memorial Hospital , its agents and employees , and each of them. 19 F . ITEMIZATION OF INJURIES: 20 As a further direct and proximate result of the 21 aforementioned matters , claimant Alex Bantugan suffered further injuries as follows : permanent damage to the vagus nerve, 22 emotional distress and other injuries currently undiagnosed. 23 G . EMPLOYEES CAUSING INJURY AND DAMAGES: 24 The employees of Merrithew Memorial Hospital of Martinez responsible for the occurrences identified herein are 25 presently unknown. 26 1 H. NATURE AND EXTENT OF DAMAGES: 2 The amount claimed as of the date of the presentation 3 of this claim is $250 , 000 . 00 , representing general damages for personal injuries and emotional distress plus special damages 4 including medical expenses and loss of wages according to proof . 5 DATED: December3 , 1996 TE HIN + PARTNE S 6 7 By: AT SON 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 PROOF OF SERVICE 2 I , the undersigned, declare that I am over the age of 18 and 3 am not a party to this action. I am employed in the City and County of San Francisco, California ; my business address is Bank 4 of America Center, 555 California Street, 33rd Floor, San Francisco, California 94104 . 5 On December 23 , 1996, I served the attached document(s) 6 entitled: 7 CLAIM AGAINST COUNTY OF CONTRA COSTA AND ITS GOVERNING BOARD, CONTRA COSTA COUNTY BOARD OF SUPERVISORS 8 9 on the parties in said cause by serving : 10 Clerk of the Board of Supervisors Room 106 11 County Administration Building 651 Pine Street 12 Martinez , CA 94553 13 X (BY MAIL) I caused said document, enclosed in a sealed envelope, to be deposited in the mail at San Francisco, 14 California . The envelope was mailed with postage thereon fully prepaid. 15 I am readily familiar with the firm' s practice for collection 16 and processing of correspondence for mailing , which is that correspondence is deposited with the U. S. postal service on that 17 same day in the ordinary .course of business . I am aware that on motion of party served, service is presumed invalid if postal 18 cancellation date on postage meter is more than 1 day after date of deposit for mailing in affidavit . 19 (BY HAND) I caused said document, enclosed in a sealed 20 envelope, to be delivered by hand to the addressee listed above . 21 (BY OVERNIGHT MAIL) By placing a true copy thereof 22 enclosed in a sealed envelope for delivery via Federal Express to the addressee listed above . . 23 BY FACSIMILE I caused a true ( ) copy to be transmitted 24 via facsimile to the addressee(s) noted above at the FAX number noted after party' s address . 25 I declare under penalty of perjury under the laws of the 26 State of California that the foregoing is true and correct , and that this declaration was executed on December 23 , 1996, at San Francisco , California . ,,I Jr r Ke ly P1. McAndrews P v � • O T, J P � .-i ;P (D 0 pCD +'h U) o C °t V' 1 tN W V LP Q O K lip N o . W is t tttt`. • k 4 ---0 J: