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HomeMy WebLinkAboutMINUTES - 10061998 - C31 CLAINt } BOARD OF SUPERVISORS OF C'ONMAA COSTAMMl CAI,IFORNIA +` BOARD AC` IOR October 6, 1998 :'lain Against the County, or Oistrict Governed by ) 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings„ AMOUNT: $82.80 ', CLAIMANT: Kathryn Brennan S F p _ 2 1998 ATTORNEY: DATE RECEIVED: 'Ty COU,,4SEL m4R`t!NEZ CAUF. ADDRESS: 4070 Live Oak Ave BY DELIVERY TO CLERK ON: September 1, 1998 Oakley CA 94561 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHE R, Clerk Dated: Sept 2 , 1998 By: Deputy H. FROM County Counsel TO: Clerk of the Board of Supervisors ( �/J"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: r�_- 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 ent in its minutes for this date. Dated ` PHIL BATCHELOR, Clerk, By : puty 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 MAKING 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, dressed to the claimant as shown above. Dated: n� / By: PHIL BATCHELOR Beputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLADWIT A. Clam 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 tb 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 ether 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 f orm. RE: Claim By ) Reserved for Clerk's filing stamp Against the County of Contra Costa ) or District) `> . 7711 in name � The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of $ and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) _ U'u�0 , t w 2. Where dial the damage or injury occur? (Include city and county) 1 n� L.\vkz bj�,L. Alm ,,L Q-LL�_ ,.s+, ck, C 3. Hoer dial the damage or injury occur? (Give full detail , use extra paper if required) I Lc( JJ l yl "<CJY• 0)1 11 �4 N �v \ 4. What particular act or cmission on the para of county or district officers, servants or .employees caused the injury or damage? (over) 5. what are the names of county or district officers, servants or employees causing the damage or injury? 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Names and addresses of witnesses, doctors and 20spi�8�4. 9. List the expenditures you made on account of this accident or injury: DATE ITEM,. AMOUNT �- - �AC)L� 2. . g0 Gov. Code Sec. 910:2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or b some on s. behalf." Name and Address of Attorney Cl! ' is Si tune �O �1 Oaq_ _N)P�- Address C-1 Rqe�a( Telephone No. Telephone No. 92-5 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 imprisoriment in the county fail for a period of not more than oneyear', by a fine of not exceeding one thousand ($1,000)0 or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by. both such imprisonment and fine. k-. Ea r�€� X>irt � , 13TWO068 EAR 211t nTfiL f a i € s i Ali material sold on ties invOicO is -,Iuarariteed to be as spec€€ted; and is rot su ety gia'zed materiaE X ?; so marked. It is sold witt,, the Linderstanding that this material wM not be O, axed °n a hazardous ca't€e^ # a;;defined by ^onsumer Product Safety Comm.ssicrf, � Ai merchandise rewrned for credit, refund or exchange must be sr resalePbia ccndlticn, auttsorixrd fir i }, :return, acc;om-gaaniec by this receipt, and tray be subject to restocking fee.No returns will be authorized icer "Ef , ' spec*i cirders or out flat-jgIp %,Ter s of payment arN day::Frew invoice daze.R Fervjce charge t CWF {µflu per -n-onsth f � �x �Jo annum) wili be added to pat due accounts. E EiV w Y: The i�#ass lis ec has bags;repiaeepairedwzqh qua.i.y J try 9,7e res v- i si authorlize my insurance c.^.rrPar•y to oay #?a_rp7r/^,fess Ca many'vireo?#Y for?he i gia s and iiatp;latfcn charess,or rape;rs. N 40- T� I ILO W � 0 z ct1 Er i fi t? tr cn .T -� cc Ul C33 cr o.° _. _... ..... _. .. _... _ .. ............ . . CLAM 1 BOARDOFF SUPEPMSORS OF C0Nr1 RA CD TA. COUNT CAIHQJRNIA- BOARD AO # Oct 6, 1998 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICETO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". 16 1998 AMOUNT: $530.77 €3UNIIFlL M"MITINY0 GALt�-0 CLAIMANT: Steve Dardin ATTORNEY: DATE RECEIVED: ADDRESS: 2159 Mt. Diablo Street BY DELIVERY TO CLERK ON: Concord CA 94520 BY MAIL POSTMARKED: 2 Sept 1998 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, erk Dated: Sept 3, 1998 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. { } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: By: ;% ';" Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. 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 en ed in its minutes for this date. Dated: I.Q t jj PHIL BATCHELOR, Clerk, By , Deputy Clerk WARNING (Gov. code se(Kion 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 Po tal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, ddressed to the claimant as shown above. Dated: F ' By: PHIL BATCHELOR JBy y Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISM OF CONTRA COSTA t�7IiN'1`Y IhSI RUCTIONS TO CLAN A. Claims relating to causes of action for Beath 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:actio for.death or for injury to person or to personal property or growing crops and uhich accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not latter than one year after the accrual of the cause of action. (Govt. Cade 5911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its .office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of Vne District should be: filled in. D. If the claim is against more than one public entity, separate claims rpt be filed against each public entity. E., Fraud. See penalty for fraudulent claims, Penal. Code Se.. 72 at the end of this RE: Claim By Reserved for Clerk's; filing stamp Against the County of Contra Costa or ? District) 1 in nam_ 7 The undersigned claimant hereby makes claiminst the County of Contra Costa or the above-rammed District in the sum of $ �� ►= and in suppor* of this claim represents `as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the doge or injury occur? (Include city and county) 8. How disc the damage or injury occur? (Give full details, use extra paper if required) c..3# `7"dr✓ " ',l-�...t S ©k.... t -,J 4. What particular act: or omission on the part: of county or district officers, servants or .employees caused. the.injury or.damage? (over) �. wnat are the names of county or district officers, servants or employees causing the damage or in jury? U 1410V 0t..>Xf __.»......_... -----_...-- --------- 5. rWhat damage or injuries do you claim resulted? (Give Hall extent of injuries or damaSes claimed. Atqoh two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any perspective injury or damage.) G 5-ti .f4.40� 'r� 7�`'•'`-7" 5 `?��`f.1 B. _Names-and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this MOUNT or injury: DATE ITEM --- Gov. Code See. 910:2 provides. "The claim must be signed by the claimant SEND NOTICES TQ. (Attorney or some erso on his.behalf." Name and Address of Attorney � �' ].aimant's Signature Z�G Address Telephone No. Telephone No. * * * * NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if .genuine, any false or fraudulent claim, bill, aao=t, voucher, or writing, is,punishable either by imprisoziment in the county jail-for a period of not more than one year, by a Pine of not exceeding one thousand ($11000)9 or by both such' imprisonment and fine; `or'by imprisonment in the state prison, by a fine of not exceeding ten thousand .dollars ($101000$ or by. both such imprisonment and fine. ESTIMATE OF REPAIR COSI SHEET NO.-OF� _ SHEE R.O. NO. _ DATE �s CAR OWNER - y �00RESS � PHONE MAKErYaEAr YIH r MOTOR NO. BODY STYLE MILEAGE LICENSE NO, FAINT NO. TRIM NO. INSURANCE CO. �r .T Ap.JUSTER PHONE NO, — FILE NO. .m-+•rr.S.+err... ......r.�...�..few...Krr+., I�.mn:.,.v/rv.>+r.. .... :•: ::::...T,tt.......s.�fw.vhw*i+a.1•r+srtmn.,.i::v:�ii:::.::�::::.. nm wvrrtvmw. •rte;.;mr "..............�is i'•::::::•..... .:: .. .:.... .•,."{•;•: .,.:.....v...r}i:Y;•i:•....... :.........:v:::•�::::::::.:. ...�:i`••:i:i....:. .....'.. ..:. �.. t;/,::{•i^i.r:i::l REPAIR 'EPLAC�' E S T I MA TE O F Fir-PAIR COST LABOR PARTS misc. SLJBLE' HOURS10 4,5;061 I TOTAL f w 1 1 i The Undersigned agre�,•s to complete the above repairs for$ LABOR $ f�J Of this amount, the above named insured is to pay PARTS $ insurance deductible miss, $ depreciation SUBLET $ - work not covered by insurance SALES TAX $ 3-71 _ DAMAGED or WORN parts removed from car will be junked unless owner instructs us other,nse in ESTIMATE TOTAL $ rewriting.If NEW;PANTS fisted herein or required are NOT available,we reserve the right to REPAIR t:uch damaged or wart parts,,where possible,the CHARGE for which will be made on an actual time ADVANCE CHARGES $ !`oasis at our prevailing labor rate per hour. The above is an APPROXIMATE estimate of repairs � � •fir 1 required,based on inspection.made.ADDITIONAL parts,or labor,may be required after work has GRAND TOTAL star ted,which were`tat ev!dent cn the first inspection.SUCH ADDITIONAL LABOR AND MATERIAL WILL DE CHARGED FOR IN ADDITION TO THE ABOVE. By: C.. �-C _ r'� SLr��J C f ` 5 C cr-�`' p�fi"�' `�� 25717 JIMS CALIFORNIA AUTO BODY 2520 MONUMENT BOULEVARD CONCORD, CA 94520 (925) 689-6117 Fax: (925) 689--7836 Visible Damage Quotation #25717 by RICK TORRES on 08-31-98 STEVE DARDIN 2159 MT. DIAELO ST Style Insurer : OP Lie. Plate: 3D`.CM871 Adjuster : CONCORD, CA 94520 Paint Code: Appraiser: Phone: 925-689-7213/ Prod. Date: 6/78 Claimant : 78 DATSUN 28OZ Profile : STANDARD Insured VIN: HLS304684877 Deductible: 0.00 Policy # : Mileage: 62651 Claim # Options: # Labor Op Description Price Labor Paint Labor Group Price Group 1 REF/REP RIGHT FENDER CHIPS ONLY AT FRONT W/0 0.00 0.0 2.0* REFINISH 2 REF/REP LEFT FENDER CHIPS ONLY AT FRONT W/O 0.00 0.0 2.0* REFINISH * 3 ADL OPER CLEAR COAT 0.00 0.0 0.0 REFINISH 4 ADL OPER TINT COLOR 0.00 0.0 0.0 REFINISH 5 ADL OPER MASK FOR OVERSPRAY 5.00* 0.2* 0e0 REFINISH * Judgement Item Summary .Add'l Lbr Sublet Totals REFINISH 4.20 54.00 5.00 231.80 PAINT MATERIALS 88.00T Non-Taxed Labor 231.80 Taxed Costs 88.00 Tx 8.250% 7.26 Labor ( 4.2 units) 231.80 Add'1 Costs/Materials 88.00 Tax 7.26 Grand Tote. 327006 OWNEREPORTS VEHICLE RICHT AND LEFT FENDERS AT W/OPENING DAMAGED DUE TO ROAD DEBRIS.NOTE DUE TO EXTENSIVE EXTERIOR PAINT PELING AND PAINT FADING DUE TO PREVIOUS REFINISH-CANNOT GUARANTEE ADHESION AND COLOR MATCH. UNDER CALIFORNIA CODE OF REGULATIONS, TITLE 10, CHAPTER 5, SUBCHAPTER 8, SECTION 2695.8.D.2C., YOU ARE ADVISED, THAT YOU HAVE THE RIGHT TO HAVE ANY REPAIR FACILITY OF YOUR CHOICE TO DO THE REPAIRS TO YOUR VEHICLE. HOWEVER, YOUR INSURANCE COMPANY CAN REASONABLY ADJUST ANY WRITTEN ESTIMATE PREPARED BY THE REPAIR SHOP OF YOUR CHOICE. IF YOUR CHOOSE TO USE A REPAIR FACILITY SUGGESTED BY YOUR INSURANCE COMPANY, THEY WILL GUARANTEE THE DAMAGE VEHICLE TO BE RESTORED TO ITS PRE-LOSS CONDITION AT NO COST TO YOU OTHER THAN AS STATED IN THE POLICY (I.E. POLICY LIMITS OR DEDUCTIBLE) OR ALLOWABLE DEPRECIATION. EPA# CAD981159171 NO CREDIT CARDS *****PARTS PRICES SUBJECT TO INVOICE***** ESTIMATE RECALL NUMBER: 08/31/98 12:35:16 25717 Xitchall Data Version: SEP-98 EstiX&te Plus is a trademark of Mitchell International Copyright 1991-1997 All Rights Reserved DIM `REPORT D:ARDIN 07, 3/ 08!31/,98 at 13: 14 D.R. 17908-0016142 Est: D. HERBERT MIKE ROSE'S AUTO BODY INC 2001 FREMONT STREET CONCORD, CA 94520- (510) 586-1739 Cotner: STEVE DARDIN Day Phone: (925) 486-6598- Address: 2159 MT.DIABLO ST. Other Ph: (I } - - CONOCORD CA 94520 Deductible: $ N/A Insurance Co. : Phone: Claim No. : Adj . : 78 FATS 2802 2D SED MAROON MET 6-2.8L-FI Vin: HLS30468487000000 License: 3DYM871 CA Prod Date: 6/78 Odometer: 162653 5 speed transmission Clear coat paint Metallic paint -------------------------------------------------------------------------------- PART NO. OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 FENDER & LAMPS 2 Refin RT Fender 1 0 .00 0.0 2 .2 3 Acid for Clear Coat 1 0.00 0.0 0.9 4 Refin LT Fender 1 0.00 0.0 2.2 5 Overlap Major Non-Adj . Panel 1 0.00 0.0 -0.2 6 Add for Clear Coat 1 0.00 0.0 0.4 7* R&I FNDR.PARTS FOR PNT. 1 0.00 0.5 0.0 8* Refin COLOR TINT 1 0 .00 0.5 0.0 , 9* Refin COVER CAR 1 0.00 0.2 0.0 T 5.00 -------------------------------------------------------------------------------- Subtotals =-> 0.00 1.2 5.5 5.00 Page: 1 REPORT DARDIN a/98 at 13: 14 D.R. 17908- 0016142 Est: D. HERBERT MIKE. ROSE'S AUTO BODY INC 2001 FREMONT STREET CONCORD, CA 94520- (510) 686-1739 Parts 0.00 Body Labor 1.2 units @ $56 . 00 67.20 Paint Labor 5.5 units @ $56.00 308.00 Paint/Materials 5.5 units @ $25 .00 137 .50 Sublet/Mise 5.00 -------------------------------------------- SUBTOTAL _-.,._..._...-...-__..___.._...___...__v....._...._..........,_......____.,._.., -SUBTOTAL $ 517.70 Tax on $ 142.50 at 8.2500% 11.76 -------------------------------------------- GRAND TOTAL $ 529 .46 -------------------------------------------- INSURANCE PAYS $ 529 .46 2HIS IS A PRELIMINARY ESTIMATE AND ADDITIONAL CHARGES MAX BE REQUIREQUIRED FOR THE ACTUAL REPAIR. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Non-asterisk(*) items are derived from the Guide ACE3507. Database Date 10/47 Double asterisk(**) items indicate part supplied by a supplier other than the original equipment manufacturer. CAPA items have been certified for fit and finish by the Certified Auto Parts Association. NAGS Part Numbers, Prices and Labor Times are provided from National Auto Glass Specifications, Inc. EZEst - A product of CCC Information ,Services Inc. Page: 2 1 n 7 J - '7k � llll VL y w � r N CLAIM A-,-COUNM CAIHOMIA, BQARD OF SIXEMSORS 0EWNTRA COST BOARD AO —October 6, 1998 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this docun-ent mailed to you is your California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". RT, AMOUNT: $150 �,S=TIVIEM) CLAIMANT: Jill Goldreyer SFP - -1 10Q8 COUN TY SEL ATTORNEY: DATE RECEIVED: MARTINECZ CAOUNUF� ADDRESS: 2230 Browning St BY DELIVERY TO CLERK ON: Berkeley CA 94704 BY MAIL POSTMARKED: 31 Aug 1998_ L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA=R, Clerk , Dated: Sept 2 , 1998 By: Deputy H. FROM: County Counsel TO. Clerk of the Board of Supervisors LThis claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). Claim is not timely filed, The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ) Other: Dated:- q- By: _j�? Deputy County Counsel Elt. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). W. 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 e red in its minutes for this date. Dated: /2&E/2&E PHIL BATCHELOR, Clerk, By eputy 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 MAU-JNG 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 I certified copy of this Board Order and Notice to ClaimaZnt, a Iressed to the claimant as shown above. Dated: S By: PHIL BATCHELOR By eputy Clerk CC-. County Counsel County Administrator C airn to: BOARD OF SUPERVISORS OF CONTRA COSTA CCXIM INSTRUCTIONS TO CLADW4 T' A. Claims relating to causes of action for death or for injury to :person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes oaf action far.death or for injury to person or to personal property or griming crops and which accrue can 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 neat later than one year after the accrual of the cause of action. (Govt. Cade §911.2.) B. Claims must be filed with the Clerk of the Hoard 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 Beard 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 farm. RE: Claim By ) 'Reserved for Clerk's filing stamp R-1 9 . Aga—IFF he County of Contra. Costa ) SEP 'N or ) o , c . . District) -- ill in The undersigned claimant hereby makes claim against the County of Contra Costa or the above—named District in the sum of $ 1 =-' and in support of this claim represents-as follosm: 1. When did the dat ge or injury occur? (Give exact date and hour) .. . .. .. .,..�.._.....-------....— Where did the damage or injury occur? (Include city and county) CM Can ic�%i Int t v e nese -H-rz tv)-Vc vs&c+ioY-) rT- K_t W i4c o4- o g ��=✓R ��c� 3. How did the damage or injury occur? (Give full details; use dextra paper if required)"txr;, aver ol.`er�cJvW3r�c i�1� R� 1c��e u �r,,c�t€ }V' A r: ev, Ail r. 4. What particular act or omission on the part of county or district officersq . iervants pr.emp¢loyees caused. the.injury or.damage? t (over) �. gnat are the names of county or district officers, servants or employees caua >% the damage or injury? u «r - fie �T`� Je s� " i�k c rr n� +eta �n co., Za ear kA Gt�c s ctc <3 A ivy yes ft p f A ht WA i+� i v� b v`-4(+qCL1 t 5. What damage or injuries do you claim resulted? (Give .. i extent of injuries or damages claimed. Attach two estimates for auto damage. �r�cShi�tc o� `-ff`��v `` �h g or C d tv� r n 1, .$ lou#t) �.��v�S�ttig� S 4i/ n�;1n1 d, .► fL Vt fe4IVZOP6 L` ^fid u t,k iv� Mc i t t U�GCrj 1rMc Cc�dv1 � \fur kcN+/1e CCx"Slt s t CV_ in 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. A- wu,� �.OVV��ui-e ��' :�c,�1\ ffft a.0 f'CA .._........w___. $—-Names and addresses of witnesses, doctors acid Hospitals. � ZZ30 ... f- 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 1n1s��ttl i�sel rC i�ftfimCs�� i�1 0�"" Gov. Code Sec. 910:2 provides. "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or ome erson on his.behalf." Name and Address of Attorney imantts Signature 2-23 Bitr�crrti �. Addres 2 Telephone No. Telephone No. t'=r 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 , is punishable either by imprisonment in claim, bill, aecotmt, voucher, or writing the county jail-for a period of not more than cmc year: by a fine or,by not exceeding t in one thousand ($11000),, or s chimexceeding ten d fine -lars ($10,000, by. the state prison, by a fine o both such imprisonment and fine. AYTvise ; v? i `~� _ c r_ cam. _`'� _ t rt ;ndOivet ce wrC) as .5��,On as � y ti�i� . �h�;r� �r�, � �����a�. .�� � � �?1�?�3� .................... .............. _ .... _ ............ ........... _ ....... ........ .......... ........ ...... ......... ................ ........... _ _........ ........... _. ......... ........: ._................. _._............. .........._...... ......... ........ . ......... _ _ _ ...... ............. _ ..................... _. Safety AIN Sr Lowest Price Cir ranleed! 1 � GATE: 1421 Ault Center Dr. INVOICE# wainut Creek,CA 94596 PH:(925)933-9666/L925)939-0414 PH:(610)234-9666/(610)893-9W BAR#192006 Fax-(925)939-0528 j} PHONE NO. ', ` ESTIMATE NAME STREET ADDRESS ^I CITY ZIP CODE ILA J1 YEAR MAKES 4 MODEL VEHICLE LIC.NO � MILEAGE - - Tech, Name: Special in ruction Cross street ° O%NSt3RANCE CASH 0 CHARGE CARD Authorization # w QN ACCOUNT POLICY NO. � CLAEM,'PURCHASE ORDER NO. VERIFIED BY AGENT BROKER � PHONE NO. INSURANCE CO. PHONE NO. JADDRESS OTY. SIZE t PART NO. DESCRIPTION COLOR LABOR NET MATERIAL INTERSTATE SAFETY GLASS CO.authorized to perforin the above work,with terms and TOTAL MATERIAL � condition on reverse side SALES TAX SIGNATURE __- _ _.. _ _--DATEV 5�0 LA208 The above work has been done to my complete satis€action. SIfiaNATt1RE _ _DATE �- TOTAL DUE 1 authorize MY INSURANCE COMPANY to make payment to INTERSTATE SAFETY GAL.AS5 to on thier invoice to Wow,full amount due me underthe terms oi n'y poiicy covering said loss.I understand that it for any raa"a my ir�suran.ce company does DEDUCTIBLE hat pay this claim I will be responsible for payment iof same, Non-refundable DEPOSIT SIGNATURE _ _ DATE_LL_ ir< ♦S. -:5-n l ViVI " r r ✓Y .r' S ,S ........_ .. . .... ...... ......... ....... ......... CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA CQUNTY, CALIFORNIA �f BOARD A00 Oct 6, 1998 Claim Against the County, or District Governed by } 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 California Government Codes. ) notice of the action taken on your claim by the q, T Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". file AMOUNT: $254.99 � TY COUN EL CLAIMANT: Michael W. Harless ATTORNEY: DATE RECEIVED: ADDRESS: 4555 Fieldcrest Drive BY DELIVERY TO CLERK ON: EI Sobrante CA 94803 BY MAIL POSTMARKED: Sept 4. 1998 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, C r Dated: Sept 9 , 1998 By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Supervis rs ( ) 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 filedlate and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: 16— e By: '«' °- - Deputy County Counsel III. FRONL 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 en red in its minutes for this date. Dated: y PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney; you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, a ressed to the claimant as shown above. Dated: t ,/, By: PHIL BATCHELOR By uty Clerk CC: County Counsel County Administrator - -'Clailt to: Dom OF SU MMRS OF CORTRA COMA COUNTY nanumow To CLJ DWtr A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing amps 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 craps and which acann on or after January 1, 19889 must be presented not later than six myths after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year atter the accrual of the cause of action. (Govt. Code 5911.2.) B. Claims =Ast be filed with the Clerk of the Board of Supemisors at its office in Roam 106, County Administration Building, ,651 Pints Street, Martinet, 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 am public entity, separate claims mast be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this e a a c e a a e e e ss ss s e e ar ss s e a is a aF e a s e ss a e +� st e e ss e a e a s: :s a s RE: Claim By ) Reserved for Clerk's 'filing stamp `Inst the MuEnty of ntra rosta or } 0 ,Y'up, District} ; Fill in name3 } The undersigned claimant hereby makes claim against the ty of Contra Costa or the above-named District in the sumcif sand in support of this claim represents as follows: ,q1 waMafrYwrwraralbariYralrrW�+Irwi4lUalYts/Iri�+r1r+r+Ia.r�rr..rrNir 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or ln�w7 occur? (Include city and county) 3. How did the damage caw injury occur? (Give full details; use extra paper if required) 4 a. What particular act or remission w the part of county or district officers, servants or employees caused the injury or damage? (aver) 5. tWhat are the names of county or district officers, servants or employees causirlig ._ the damage or injury? ........__ !' /1f f_�' C r i1` X17"r .: ..L....-..------ 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. Now was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) J& Lit Y 1 i> 8. Names and addresses of witnesses, doctors and hospitals. g. List the expenditures you made on account of this accident or injury: ` DATE ITS'! AMOUNT c _ ' ,.. _y "(prGov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne ) or by opme perqqn hi3 behal ." Name and Address of Attorney4 U- �4 i ° Claiman s Signature. Address t � Telephone No. . Telephone No. f ' " apt • est * N0TICE Section 72 of the Penal. Code provides: "Every person who, with intent to defraud, presents for allowance or for payment to any ,state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by both such imprisonment and fine. y � z►f- ri� ' as a � ,c tv ` { ,,�[[// Xezz " OAP lYetilt Tg'i itg Jack 4 guilt 7nugh, vt Expensive fly his)euptiuty,PIVotirtg trailer Jack is constructed nt � a heavyOe sleet with a enc T�c€tPtateTM tft�}sh for ' Aft for extra strangler ar+d durabiitry. rotates to a towhiq ripriag-1caQep1. A tyuci�ing`m,�aeh$n♦�myy���tts ,5 # i� i iiia€6 tottgr�a Weight csm ty.10" #tam 2d't�"till j 2mPM— Trailer,iack . t ti Y "f t CLAIM BOARD O Er, S PER'VISORS OF CONTRA. COSTA COUNTY, CAI LFORNTA Sh. eriff Ruh eta . BOARD ACTIOOct 6, 1998 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document rnailed to you is your California Government Codes. } notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings". AMOUNT: $1,000,00 CLAIMANT: Michael Tyrone Ivory COUNTY COUNSEL ATTORNEY: DATE RECEIVED: MIAR'INEZCALrl". ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON: Martinez CA 94553 BY MAIL POSTMARKED: Sept 8, 1998 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR lerk Dated: Sept 10 , 1998 By: Deputy � .--•k II. FROM: County Counsel TO: Clerk of the Board of Sup visors (Yo 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: �}, c "� Deputy County Counsel M. 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 OrdeZered in its minutes for this date. Dated: PHIL PHIL BATCHELOR, Clerk, ByZA19"puty 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, 91ressed to the claimant as shown above. Dated: ' By: PHIL BATCHELOR B eputy Clerk CC: County Counsel County Administrator ............I................................................................................................................................................................. Clain -tot BOARD 07 SUPIRVI8OR8 OF CONTRA COSTA COUNTY XNSTRUCTI M IQ CLKIKANT A. Claims relating to causes of action for death or for injury to person o to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the .100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to Personal property or growing crops and which accrue on or after January 1,, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pint 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 and of this form. RE: Clain By Reserved for Clerk's filing stamp orx—) R E Against the County of Contra Costa) or Se 9 1,99x' `X District) (Fill In name)' A The undersigned claimant hereby makes claim against the CoTt'y Of r. Contra Costa or the abov*-named District in the sun of and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) .e, 2. Who-re-dEtthe damage or injury occur�?, (Inc lude city and county) CN 3. How did the damage *7 �nju:ry occur? (Give full details,- Use extra paper if required) 1-1 r 4Ly 4. What particular act 6f amissi6n on the part of county or district offic*r& --;.-.&qrv&nts or employees caused the injury or damage? e Q 41 X"> o (over) . ............... ........................... .............................................................................I........................................................................................................ 5. What are the names of county or district officers, servants or employees causing the damage or injury? Sf: E-11C 6 'Wit'Idimage OF injuries do you claim resulted? (Give full extent of injuri*p or damages claimed. ,Att;ch two estimates :for auto -oc damage. ) UJ ', P / nec,/( 7. How was the amount claimed above computed? (Include the estimated amount of any prospect.ive injury ox damage. ) ex S. Names and addr*s&69 of witnesses, doctors and hospitals. /4 s. 9. List the expenditures you made on account of this accident or injury. V r) Gov. Code See. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (AttorMeyl b2half." Name and Address of Attorney (Claimant's Signature) 10 t a U (Address) Telephone No. j Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud,, presents for allowance or for payment to any state board or officer, or to any county,, city or district board or 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, bafine of not exceeding one thousand ($1,000) , or by both such imrisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ton thousand dollars ($lor000, or by both such imprisonment and fine. «mss„�.,....:... : .. .... .. ..... S CL c. N Lcr �- 1 0 Cl t . ' clTl t y r C Ir '.2 •A R^ .ice § log CLAIM BOARD OF SUPER-VISORS OF +CONMA COSTA C IO NTY, ALWDENIA BOARD AG'Tt(R October 6, 1998 Clam Against the County, or District Governed by } 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 California Government Codes. ► notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: 258.00 CLAIMANT: Robert Moitoza P - 1998 ATTORNEY: DATE RECEIVED: COUNTY COUNSEL MARTINEZ CALIF. ADDRESS: 200 Bear Oaks Court BY DELIVERY TO CLERK ON: Martinez CA 94553 BY MAIL POSTMARKED: 25 Aug 1998 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELO , Clerk Dated: Sept 2 , 1998 By: Deputy H. FROM: County Counsel TO: Clerk of the Board of tupervisors ( 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: Deputy County Counsel 1H. 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 ent d in its minutes for this date. Dated: ,� PHIL BATCHELORle , Clerk, By Deputy Clerk R 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 MAHJ NG 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: a By: PHIL BATCHELOR B eputy Clerk CC: County Counsel County Administrator Clt to: BOARD OF SUPERVISORS 4F C MT'RA COSTA CMM INSTRUCTIONS TO CLADVNT A. Clams 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 actio for.death or for injury to person or to personal property or ming crops and which awxue 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 aceml of the cause of actio.. (Govt. Code 5913.2.) B. Claims must be riled 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 game 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 Cade Sec. 72 at the end of this farm. RE: Clain By } Reserved for Clerk's filing stamp } R k Bk.'-, K Against E County of ntra Sta or District) ME' The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum. of :'�S _, ' and in support of this claim represents -as follows. .1. When dial the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. Row did the damage or injury occur? (Give. Hull details; use extra paper if required) &4e- Y- 4. What particular act or omission on the'part of county or district offkaer , servants or.employees caused. the_injurer or. e? (over) Wnat are the names of county or district officers, .servants or employees cawing the damage or in, ury? Uk-- OL-0 GLA._* _.. ._...._-----..»....w---—.._W.�,.................�....__ 5. What doge or injuries do you claim resulted? (Give Hall extent of injuries pr damages claimed. Attach two estimates for auto damage. L.� 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) _....._..________—........�w...... ...__...�.__ _..�.__ _.._...._..r_...._.._........_..__.._.._____ R. Names and addresses of witnesses, doctors and hospitals. 9. List~the expenditures you made on account of this accident or injury: DATE ITEM .AMOUNT_ Gov. Code Sec. '91D:2 provides: "The claim must be signed by the claimant SAID NOTICES T0: (Attorne } or same erson on his.. f." Name and Address of Attorney Claimant' Si Address) Telephone No. Telephone No. Ir.2� 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 beard 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 ,fail-for a period of not more than cne-year, by a fine of not exceeding one thousand (tl,000)1, or by ,both such imprisonment and f ine;:`or'by imprisonment in the state prison, by a fine of not exceeding ten thousand .dollars ($10,000, or by. bath such imprisonment and fine. < 4aAAW 3 F- VES 11 NO 0 WIN Zip PHONE GUAN. 0 3 ------------------ ROAARKS d TOTAA. �; 7 . i ADMINISTRATIVE OFFICE ..... F0,WX 61 D4 C 0,NCORD,CA 94-5211 '80 696. 9 ? e¢at N PURCHASE w S, ns x :GYEF I t4C. j C 1uTt)69E{2 ' ;.1 N0. — AttW.t oor !.•UX-SUAN:.:t. 7Ai`EA TAKEN iiY�,,',WTAU.E-,LY k FFAj } >w CLAW NC. CAUL & _.. .._._._ VENiFIED EY OA'CE OF LOSS �a a x i.ctCk# 1 dLRhd06EL EldoradoYEAftk u r s4ET, °3 Cl UNSE x JEsi: E£ its:y Plar`t Color (3ree.TTl El"Tom`. Oty Pa+ -t Nuarber Description QUOTE ONLY i A Tf tORIZATl+ON TC)RAY hereby authorize and smpower the above named insurance ccrtpany to pay this invo4e in t;iii seWlement, sav,,#action and r isdmrge of at!ions under the above p044,.UPOM soon payment,all rights 1 may nava for c!a;m 4 and aernand for loss and damage descnbed above against the above Warned insurance comowv snai; bF i `orever discharged.fri Me event that the above rainedinsurance OoMpany doesnot IT1$� tlfYtoili end% l ( - S-%tu xw q Ment of this invoice ac ordinq to!ts:errrs3 £!O!sny a^Capt for such p8V-nent and 7. 2 , t;.l?"XCs rep I,,wa on iS invoice i0 Me 4 ywe :n&Mfid oia"G+'}mpanj wb!en-!n -i-r tb �w a - PF l Qt � t to s a ¢k � � 1 CLAIM / BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTIOct 6, 1998 Claim Against the County, or District Governed by } 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 California Government Codes. y notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), liven pursuant to Government Code Section 913 and S F P 10 1998 915.4. Please note all "Warnings". AMOUNT: $5000 COU NTy COUN8!EL tAARTc"€FEZ CALIF. CLAIMANT: Paul Erias Stelly, Sr. ATTORNEY: DATE RECEIVED: ADDRESS: c/o Janetta Carol Wise BY DELIVERY TO CLERK ON: 313 Lawton Street 48 Antioch CA 94509 BY MAIL POSTMARKED: Sept 5. 1998 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, C Dated: Sept 9 , 1998 By: Deputy H. FROM: County Counsel TO: Clerk of the Board of Sup ery ors ( } 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). Tip. 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 en red in its minutes for this date. Dated: L.� W ,955 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, ad essed to the claimant as shown above. Dated:, ° By: PHIL BATCHELOR By uty Clerk CC: County Counsel County Administrator > . i , PPLL 41 ' / �: ... / . Y:'-...s ..l'' �.•:.rG /G w ` x ..+-:`a^. {'..S C)..i.. .. �.::+.,............ ........................ e , i i f .... .: � L:,. : Y'' k,..:! x �fk{ 5..:.... r2. .7.�! ,,.,�.-o.t� -.... 1 .. �•,• L. � 5.�. ...... F, 5` f ks:f •-'t ry f f` `i a f'.$ "! l3} bf ff f _> __. f 1 i'5!1t .. ,•3.%.f..'�r�ki_�,-'f� .. I��ktL .y.�; ):.. { ..`�✓ f.... ,ZO 3m 3 n,.'j:; £ r L •: S:^ f�.:'�,.f i.:fi 3 <. r},. :y �"r�,...,, kt..'.. 33.,:: sf:?�:Ems/ .r9/�'.+<,i, f��i F:�` ,�., �.:1., `y i f Lr- )h!. i y , iS' f )a ,F L).{4-ri yf,.,,)' :: hr t fir;. ♦ { f F r=•-;E!.�!wy , _ w fS Y PAW ) .......... _ _ _ _ ........ rAW51- OW r AT r._. r1/t° -sh./'�,.�c.,,:.: „�F,,.,f..}f s'•t.. - T t, ::.1�....fr a �.!�'E�� .of It,? m _ .•l r'f�• } 1 ,ti�r .t ,lit.. �- ° ... .. Ej too i Y Al t . { fff tAd .111 Win of , 1(1y� _. _... ..:., s i.;:s. .. bvw .y r. q w.: _. ' ;,,:P•' 7,.y .;-. f fano%"� 3 •. x., j: i F d ! r( ' r t° PAGE r t 9 ;, .................................................................. ...... ......... ................... .......................... Z. What are the names of county or district officors, servants oz� -omplaytes causing the damage or injury? t' M-' N'-f M� iN i.z '14� 4. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto daaago.) T�iv, -T-wL Al-*�'.� P%'.',,<���...>*%..,.,>sr5"...,,�,,,.z. ap- L A-il%/ Lg 7. Sow was thio a*ount claim" abov* computed? (Xncludal the *Wtizated amount of any prospective injury or damage.? AI-M S. Names and addresses of witnesses, doctors and A We- '55 9. List the expenditures you made on account of t1iis .accid*nt or injury. AMOUN-T 3 C A I Gov. 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Ssw .eear �u'�sw• .N+�yr�*yarVmy 6 N Kr.r{ar^+ <or{. w v� .es r\,x s-0a yj r..WST gpav s:: �j*�Jiy�� j f? y i •e , Check On:6: est { { � {�rte�ance { �Appeat { }athe Request, ALO x r }p jjk}vy}may / i#41V `Mi'��• Ti�.'iys5j � i{�, SS.L•,�3{ S J 4,>. Routed Tb: V 1111E { )APPROVED i{ }�����•-{#itt3te�e�SOC1� e; V '711,1 -97 V7 bate, Pink: e�pf by Inmate MT ata: M s�2rs� 4e:To Bookino ....:� F 11.0 RY __ _ E�S+,si:� � N sM ; •t i. -`�.:.a ,-..-._ old ... t .. f Tin JOs � .......... ............. S �f 03/ ar f" t r ~,sem' r `Cl+i M a i CLAIM BOARD OF SUff.RVISORS OF CONTRA COSTA CQUNM CALIFORNIA BOARD ACII'0 Oct 6, 1998 Claim Against the County, or District Governed by ) 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". g` 1998 AMOUNT: $250,000 VIiNSL r :.,,4 .Z CALIF. CLAIMANT: Louisa E. Tapley-Van Pelt ATTORNEY: Richard J. Baskin DATE RECEIVED: Law Offices of Richard J. Baskin ADDRESS: One Kaiser Plaza Ste 1585 BY DELIVERY TO CLERK ON: Oakland CA 94612 BY MAIL POSTMARKED: Sept 3. 1998 L FRONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, C Dated: Sept 8 , 1998 By: Deputy CZ H. FROM: County Counsel TO: Clerk of the Board of SuperN6s6rs ( ) 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: ,�°� C-- ��'' '°" Deputy County Counsel M. 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 enter in its minutes for this date. Dated: ., PHIL BATCHELOR, Clerk, By puty 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 Post 1 Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, dressed to the claimant as shown above. Dated: Ir t22? By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator I RICHARD J. BASKIN, State Bar No. 111008 LAW OFFICES OF RICHARD J. BASKIN +►"""**""""'""` 2 One Kaiser Plaza, Suite 1585 ' IVED Oakland, California 94612 3 Telephone No.: (510)444-1740 - 4 Attorney for Claimant ` Rmwsupk 5 6 7 8 SUPERIOR COURT OF CALIFORNIA, COUNTY OF CONTRA COSTA 9 10 IN THE MATTER OF THE CLAIM OF 11 LOUISA E. TAPLEY-VAN PELT CLAIM 12 against 13 CONTRA COSTA COUNTY I 14 15 TO: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 16 17 Louise E. Tapley-Van Pelt hereby makes this claim against the above-named public entity 18 for the sum of Two Hundred Fifty Thousand Dollars ($250,000.00), and makes the following statements in support of the claim: 19 A. NAME AND POST OFFICE ADDRESS OF CLAIMANT: 20 Louisa E. Tapley-Van Pelt 21 225 Coggins Drive,No. 139 Pleasant Hill, California 94523 22 B. POST OFFICE ADDRESS TO WHICH NOTICES CONCERNING THE CLAIM 23 ARE TO BE SENT: 24 Law Offices of Richard J. Baskin One Kaiser Plaza, Suite 1585 25 Oakland, California 94612 26 C. DATE, TIME AND PLACE OF THE OCCURRENCE OR TRANSACTION GIVING RISE TO THIS CLAIM: 27 28 The events giving rise to this claim occurred on or about March11, 1998, at approximately - 1 - 1 4:45 p.m.on I-680 onralnp from Marina Vista 24 feet South of Marina Nista in the City of Martinez, 2 County of Contra Costa, State of California. 3 D. CIRCUMSTANCES GIVING RISE TO THE CLAIM: 4 The circumstances giving rise to this claim are as follows: 5 Claimant is informed and believes, and thereon alleges, that at all times material hereto, the 6 County of Contra Costa was the employer of defendant,Linda Michele Bulkeley,and was an owner, 7 and in possession and control, of a certain 1990 Chevrolet Cavalier automobile, California license 8 number E333362. 9 Claimant is informed and believes, and thereon alleges, that at all times herein mentioned, 10 Linda Michele Bulkeley,was the duly authorized agent, servant, and/or employee of the County of 11 Contra Costa with respect to the events and transactions herein alleged, and in acting or omitting to 12 act with respect thereto as hereinafter alleged,was within the course, scope and authority of such 13 agency, service,and/or employment,and conducting herself pursuant to, and in accordance with,the 14 consent,permission, authorization and/or ratification of the County of Contra Costa. 15 Claimant is informed and believes, and on such information and belief alleges, that at all 16 times herein mentioned, Linda Michele Bulkeley was driving and operating said 1990 Chevrolet 17 Cavalier vehicle,with the consent,permission and knowledge of the owners thereof, including the 18 County of Contra Costa, in a southbound direction on I-680, in the City of Martinez. 19 On or about March 11, 1998,at approximately 4:45 p.m.,claimant Louisa E.Tapley-Van Pelt 20 was driving and operating her 1985 Buick Century, California licence number 2KIY869 in a 21 southbound direction on the onramp to I-680 from Marina Vista, in the City of Martinez. 22 At said time and place, said public entity, directly, and by and through its agents, servants 23 and employees,including but not limited to Linda Michele Bulkeley, sonegligently,carelessly, and 24 unlawfully entrusted, managed, maintained, serviced, repaired, drove, owned and operated their 25 1990 Chevrolet Cavalier vehicle along and upon said I-680 in a southbound direction on the onramp 26 from Marina Vista so as to cause it to strike the rear of the 1985 Buick Century operated by the 27 claimant, Louisa E. Tapley-Van Pelt in violation of California Vehicle Code section 22350 and to 28 thereby cause claimant to sustain severe personal injuries and damages. 2 - 1 E. NAMES OF PUBLIC EMPLOYEES CAUSING INJURY, DAMAGE OR LOSS: 2 The names of the public employees causing the injuries, damages and losses to claimant 3 include, but are not limited to, Linda Michele Bulkeley. There may be other public employees 4 responsible for the injuries, damages and losses sustained by claimant, but the identities of said 5 persons are not known at this time. 6 F. ITEMIZATION OF CLAIM AS OF DATE OF PRESENTATION: 7 The claim as of the date of its presentation includes the following: 8 Expenses incurred by and on behalf of claimant for the services of health care practitioners 9 and facilities to care for and treat claimant's injuries both to date and in the future; Damage to 10 claimant's earnings and earning capacity both to date and in the future; and General damages. 11 All of the above damages combined are in an amount in excess of the minimum jurisdiction 12 of the Superior Court. 13 LAW OFFICES OF RICHARD J. BASKIN 14 15 Dated: September 3., 1998 CH J. BA- SKIN 16 Attorneys for Claimant 17 18 19 20 21 22 23 24 25 26 27 28 - 3 - 1 PROOF OF SERVICE BV MATT, 2 3 I,Kay Corlett,the undersigned,hereby certify that I am a citizen of the United States, 4 over the age of 18 years and am not a party to the within action. I am employed in the office of a 5 member of the bar of this Court, at whose direction this service was made. My business address is 6 One Kaiser Plaza, Suite 1585, Oakland, California 94612. I am familiar with my employer's mail 7 collection and processing practices; know that said mail is collected and deposited with the United 8 States postal Service on the same day it is deposited in the mail; and know that postage thereon is 9 fully prepaid. Following said practice, on September 3, 1998, I served a true copy of the 10 foregoing Claim on the interested parties by placing a true copy thereof enclosed in a sealed 11 envelope by Certified Mail, Return Receipt Requested, with postage thereon fully prepaid, 12 addressed as follows: 13 Board of Supervisors of Contra Costa County 651 Pine Street 14 Martinez, California 94553 15 I declare under the penalty of perjury that the foregoing is true and correct. 16 Executed on September 3, 1998, at Oakland, California. 17 18 Kay Coyle 19 20 21 22 23 24 25 26 27 28 goat- n � t H r � cr LnL w � 4 � nn F„i t.n G *— 00 CA trn © s 1C� 1� CR C'Y a CLAIM BOARD OF SUPERVISORS OF CONTRA COS-1—A COUNTY, CALIFORNIA 130010 ACTItN1I: OCT 6 , 1908 Claim Against the County, or District Governed by } 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 California Government Codes. I notice of the action] taken on your claim by the Board of Supervisors. (Paragraph IV belovv), given pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings". AMOUNT: $1274.64 R1;- Zmn1WqD CLAIMANT: Eric Thomas SFP # d U?,41 ATTORNEY: DATE RECEIVED: COUNT'COUNSEL MARTINEZ CALIF, ADDRESS: 2400 Rancho Del Lago Road BY DELIVERY TO CLERK ON: Martinez CA 94553 BY MAIL POSTMARKED: Aug 27, 1998 I. FROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerl Dated: Aug 31, 1998 By: Deputy s. H. FROM: County Counsel TO: Clerk of the Board of Superv' :o { ) 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: <_y <._. 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 e erect in its minutes for this date. Dated:_ PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code si6tion 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, a ressed to the claimant as shown above. Dated: � By: PHIL BATCHELOR By uty Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 1.00th 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 tiled with the Cler4c of the Board of Supervisors at its offiee 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.. Cade Sec. 72 at the end of this farm. RE: Claim By _ ) Reserved for Clerk's filing stamp .... r oy Against the County of Contra irosta or ) f District) ' ` s (Filln irmeF7 } _.. The undersigned claimant- hereby makes claim against t�h County of Centra Costa or the above-named District in the stmt of $ ,�. r G`f and 'in support of this claim represents-as fellows: 1. When did the damage..or injury occur? (Give exact date and hour) 2. 'Where did the damage or injury occur? (Include city and minty) .Y��f�sS.,. ._. .�.����. "r""`1 �. � G3f"'£-'.l...ef „/J�'ri�1""t �,a;•:+r.': Ysi. �f.+YI�i`+W.rrMwsratr�arr+.+. r+.rwir 3. How did the damage or injury occur? (Give full details; use extra paper if required) r. r� z- r✓�" 4. What parti.oul.ar acct or omission an the part of county or district officers, servants or,employees caused. the.injury or.damage? r (over) 5, wnat are the names of county or district officers, servants or employees causing the damage or injury? 5. -What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) eA3. Names and addresses of witnesses, doctors and Hospitals. _...........__......_w. .........._.._...r.._.._.._.._._...... ------------ 9. __...._—_...._..— 9. List the expenditures you made on account of this accident or injury: DATE I'T'EM - NT- Gov. Code See. '910;2 provides: "The claim must be signed by the claimant SEND NOTICES TOs (Attorne ) or by some R2tson on his..behalf." Name and Address of Attorney Claimant's Signature), Address Telephone No. Telephone No. TIM IFW 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 imprisoriment in the county Jail`for a period of not more than one-year, by a fine of not exceeding one thousand ($19000), or by,both such imprisonment and fine,°`or'by imprisonment in the state prison, by a fine of not exceeding ten thousand .doll.ars ($10#000, or by. both such imprisonment and fine. ..................................................... ADDENDUM TO THE CLAIM OF (Print your full name) zo (1) Do you use the roadway as part cif a. daily` commute? Yes f ) No f } ( 2) Were you aware that construction would be commencing on the roadway? Yes { } No { 3) Was an alternate route available? Yes f } No ( 4) Did you read about the, impending resurfacing in the local newspaper? Yes { ) No f#:,ry ) ( 5) bid you see warning signs advising of loose gravel and a 25 mile per hour advisory sign? Yes ( ;` ) No f ) (6) Did the damage result from another vehicle exceeding the 25 mile per hour advisory? Yesy ) No { ) (7) bid a vehicle traveling in the same direction and exceeding the 25 mile per hour advisory sign attempt to pass you? Yes f ) No f (8) Lid a vehicle coming from the apposite direction cause gravel to be thrown onto your car? Yes {" �'} No f ) (9) Was the vehicle located directly in front of you exceeding the speed advisory? { } f } Yes Nt3 � �, fix.- ........................ ...... ..... ( 10) Did you travel the roadway more than once during the resurfacing prior to the damage sustained to your car? Yes ( ) No ( 11) Did you obtain the identity of the car relating to questions 6 thru 9'? f Yes ( ) No ( ) If yes, please provide identification below: ( 12) Please describe in your own words how the gravel caused damage to your vehicle and the angle the gravel was thrown onto the car, along with the 'specific damaged parts on your vehicle. +'it .��✓ 1fx�' r'. 3 GJJ'c .32 e 7 J '2 ✓ ' '}, t CF �+�"�«'`;.Ji-� 71�»i� ;�__� L-�r'✓'� /``-%�..,��.f '�'i�l.,.1! :,?fes �L'i0'Y�i� -`�` £��i.c%�, 's{%- f°�-+ti.r �;'F e��.�:SY .. � t�•'S.'��� ��� T!i�!¢i /3�'Z:-ti�� :�f.Z 7'k' /�'t„t��,� fes' ' �r;� t,�.,`� ✓ �. sz f ( 13) Were you aware that using the road during the chip seal process might result in damage to your car? Yes ( ) No : ` } I declare that the above information is true and correct under the penalty of perjury. (Signature) Vnate) r DAMA&E REPORT 'I'HQIe#A 6$11§198 at 16813 r I}.R.. 3761st--€002574 Bot: F. MERCA FREtTS 101.0, PAINT & C0TJ T-S T0N PPA#CA1>9813887' 9****FAX#492516119-94a? 19312 CA, D,D INDUSTRIALPLACE oi Parte 0.00 Body 1 . Labor° -5 3 unity 0 $54 .00 286.20 h.Paii.nt units G-.4 u .ts @ $54 .'tii? 345 .60 :x22.5 tax on $ 591.08 at 8�i•2'50[3.* 48 .76 �rTOTAL -__-_w_Y __ . � 127464 XX� f ? $ 1274 .64 INS7iCESmwrmnu Arm Tim I NNW R3iw 8.1 _ ALVJ Y Q9 Iti f 1G" m ORWO N YA"s A" ozaa4bVmen 1XIC'R w f' afZY mr 00 rx"T ImpaGT- a. its rdWAM WT utasnmt ML a)axs (m 2.,m arca RAY rte ALL � zees A29 stsascx TO lmrotavi !! 6nspMRI M FOR �08T S`t`C3LM 2 mitts. OR CaAL rAlv,6, m THIS ESTIMAT HAS E PREPAR BAS ON THE USE OF CRASH PARTS SUPPLIED BY A SOURCR OT ITM XANMACTOER OF yOUR MOTOR VEHICLE> Al W RA1►!'�"TRS APPLICABLET#� SE RR1? X ,, PARTS ARE PROVIDED BY-''"SSE MAMPACIrMR-OR DrSTRrBLUTTOR F TR s TS r RATURR 'T'HM BY THE ORICIMkL KIANtMACTMR OF YOUR VEHICLE> lll aCirtat� k etL tlL C1k }� an MKOTM 0=2. na-412r3ek{+3 it ear » derived ,t'xOwc rasa Quide LtR2,i3FM8. Datebwrgo bate St39 Double a*f*risk(**; to= indicate t ae Yi �bY 4 0UW1ioX cthoX 4M the gj=Aj equ. int= m�nafej t srorC C•'APA it l don 0e hied ___ C9.ik3 and MAW% by the certified Auto Parto A.0mciativn, 8azt, cow and Lex Tuns r'� vided! fr Xsti l xuto glaze s cific ti=o; z'=. tasst - A jnr�act G$' ocr tiQn Borvices :Irm, ii 4 1 k age: 2 f i I DAMAdE REPORT 'THOMAS 08/19/98 at 16 :13 w D.R. 37616-0002574 BAR4Aj112956 Est: F. MERCADO PRECISION PAINT & COLLISION EPA#CAD981388739****FAX# (925) 609-9407 1932 ARNOLD INDUSTRIAL PLACE CONCORD, CA 94520- (925) 609-8585 Owner: ERIC THOMAS Day Phone: (925) 229-2299- Address : 2400 RANCHO DEL LAGO Other Ph: - MARTINEZ CA 94553 Deductible : $ N/A Insurance Co. : Phone: Claim No. . Adj . : 93 CHEV K3500 4X4 CREW CAB FLEETSIDE 4D P/U GREEN 8-6 .5L-TD Vin: UNK License: SZV494 OR Prod Date: 0/ 0 Odometer: 0 Power steering Power brakes Tinted glass Body side moldings Dual mirrors Anti-lock brakes (2) Clear coat paint Metallic paint -------------------------------------------------------------------------------- PART NO. OP. DESCRIPTION OF DAMAGE QTY COST LABOR PAINT MISC -------------------------------------------------------------------------------- 1 FRONT DOOR 2* Repr LT Outer panel 1 0 . 00 1. 0 2 . 8 3 Add for Clear Coat 1 0 . 00 0 . 0 1 . 1 4* BLEND TIME 1 0 . 00 0 .0 0 . 0 5 REAR DOOR 6* Refin LT Outer panel 1 0 . 00 0 . 0 1 .2 7 FENDER 8* Refin LT Fender 1 0 . 00 0 .0 1 .3 9 WINDSHIELD 10** Repl A/M Windshield GM tinted 1 0 . 00 3 .5 0 . 0 T 433 . 88 11* RESTORE CORROS PROT/PER PANEL 1 0 .00 0 . 1 0 .0 T 5 .00 12* TINT COLOR 1 0 .00 0 .5 0 . 0 13* HAZARDOUS WASTE REMOVAL(UP$3) 1 0 .00 0 . 0 0 .0 X 3 , 00 1.4* COVER CAR 1 0 . 00 0 .2 0 .0 T 5 . 00 -------------------------------------------------------------------------------- Subtotals ===> 0 . 00 5 .3 6 .4 446 . 88 Page: 1 y , Y �i yiY 6� W s7 rip tD r► k . IN i i S CI.,AIM BOARD OF SUPERVISORS OF CON'T'RA COSTA COUNTY CAL MRNLA BOARD ACT] Oct 6, 1998 Claim Against the County, or District Governed by ) 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 California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please noteall "Warnings" AMOUNT: $1,000,000 m im CLAIMANT: Harry Willett $ a lgg8 ATTORNEY: DATE RECEIVED: COUNTY OOUNSEL MARTINU CALF. ADDRESS: 901 Court Street BY DELIVERY TO CLERK ON: Martinez CA 94553 BY MAIL POSTMARKED: Sept 8, 1998 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, erk Dated: Sept 10 , 1998 By: Deputy H. FRONL County Counsel TO: Clerk of the Board of Super ors ( ) 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: 1 tylelm £ rt' 5 Cif ' 1r c e-,vid C° +—I,-r,t, c- Dated: By: ' . / � �� �_ Deputy County Counsel M. FRON1 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 e red in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional 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 Post Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, a ressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By puty Clerk CC: County Counsel County Administrator VICTOR J.WESTMAN /-+/� /r/� /� �^��yi ��i DEPUTIES: COUNTY COUNSEL CONTRA COSTA COUNTY PHILIP S.ALTHOFF /�► JANICE L.AMENTA OFFICE (}F THE COUNTY COUNSEL SHARON L.ANDERSON ANDREA W.CASSIDY ARTHUR W.WALENTA,.JR. COUNTY ADMINISTRATION BUILDING VICKIE L.DAWES ASSISTANT COUNTY COUNSEL 651 PINE STREET,9M,FLOOR A ICHAEL D FARSR MARTINEZ, CALIFORNIA 94553-1229 LILLIAN T.FUJII DENNIS 0. SILVANO B.MARCHESI GREGORYC.HARVEY ASSISTANT COUNTY COUNSEL JANET L.HOLMES KEVIN T.KERR GAYLE MUGGLI BERNARD L.KNAPP EDWARD V.LANE,JR. OFFICE MANAGER MANY ANN MASON PAUL R.MUNz PHONE(925)335-1800 VALERIE J.J. RANO E FAX(925)646-1078 DAVID F SCHMIDT DIANA J.SILVER BARBARA N.SUTLIFFE JACQUELINE Y.WOODS NOTICE ICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM TO: Mr. Harry Willett 901 Court Street Martinez, CA 94553 RE: Claim of Mr. Willett Please Take Notice as Follows: In regards to the claim you submitted on September 8, 1998,portions of your claim are timely and portions are untimely. The portions of your claim prior to March 8. 1998 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2.,because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to Murch 8. 1998 were not presented within the time allowed by law, no action was taken on those portions of your claim. Your only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. VICTOR J. WESTMAN, COUNTY COUNSEL By: I.r Monika L. Cooper Deputy County Counsel H:\C3ROUPS\TOR`P,RISK-MGT\CLAIMS\LATE\W ILLETT2 Page 1 ( j :31 CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) t declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Untimeliness as to a Portion of the Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: September 15, 1998,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management Page 2 ....... ......................__ ........................................................................................ ala BOARD a?` SVPERVIBORB oP CONTRA COSTA COUNTY INSTRUCTIONS !TO CLAIKAi�1T A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the .100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause ' of action. Claims gelating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the board of Supervisors at its office in Room 108, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud, See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk''& filing stamp RE } Against the County of Contra Costa} se or District} �,,�st?or"S€ ' : (Fill in name) } The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of S_ and in support of this claim represents as follows: 1. When did the damage._or injury occur? (Give exact date and hour) < b� 2. where did the damage or injury occur? (Include city and county) f ; 3. Now did the damage or injury occur? (Give full details; use extra paper if r*quired) s j(( s i , r : 3 4. What particular act or omission on the part of coun` y or district officers, servants or..employees caused the injury or damage? 1 (over) What are the names of county or district officers, servants ,.gr , employees causing the damage c�fnj� ? you a k�:,�` r�� £` � •�' '� 'r f X i,J• Q'✓ � t� y�rT, fT k r 6. What damage 6f injuries do you clam resulted? (Give full extent ' of injuries or qes claimed. At ach tw estimates for autoq damage. ) al• >€ %7 .azJ p'' . rc✓dr,fti< r „ ?. How was the amount claimed above computed? (Include the estimated azount7 of,-..terry .progspe t4 yq iniury or damage.} s F r Ery $. Nagos ,, end addresses of witnesses, doctors and hospitals. t ° ' V ,l4/,. `r++• 9. List the expenditures you Stade on account of this accident or injury. AMOUN r <t: Gov. Code Sec. 910.2 provides } "The claim must be signed by the claimant or by some person on his SEND V0110ES O: " Name and Address of Attorney ) b , ( aimantls Signature) (Address) Telephone No. } Telephone No.�_ XOTICZ Section 72 of the Penal Coda 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, authorised to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten ' thousand dollars ($10,000, or by both such imprisonment and fine. "w w.. (� L�j Lo Ln J t l =VAN""J APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA CnUIM, CALIFORNIA MERRITHEW MEMORIAL HOSPITAL BOARD ACTIO ,f3, 1998 Application to File Late Claim ) NOTICE TO APPLICANT +�Ct.',' Against the County, Routing ) The copy of this acumen ma-ileaia—ilea you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section Referenoes are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "tAYSING" Claimants Janet L. Sherbourne Attorneys Michael. S. Klein Address: C.i�# TY vCE»L 18 Crow Canyon Court Ste 390 h4%F T41"E2 CALIF. San Ramon CA 94583 Amounts exceeds $25,000 By delivery to Clerk on Date Received: By mail, postmarked on Aug 25,__1998 I. FROM-. Clerk o the Board of Supery cors 'TO-. County Counsel Attached is a copy of the above noted Applicatic ''to Pile Late' Claim, DATED: Aug 31, 1998 P'H'IL BATCHELOR, Clerk, BY Puty I FROM: county Counsel TO: Jerk of the and of Supervisors ( } The Board should grant this Application to File Late Claim (Section 911.6). ( The Hoard should deny this Application to Pile Late Claim (Section 411.5). 11-DATED i,..., VICTOR id1ESTW, County Counsel, HY (��� Ctu, eputy r II. iiC? FtDER By 57wUmoTs vo e of Supervisors present (Check one only) { ) This Application is granter! (Section 911.6). X) This Application to File Late Claim is denied (Section +911.5). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATES ; % PHIL BATCHELOR, Clerk, By Deputy WARNIM (Gov. Code 1911-8) If you Wish to file a court action on this matter, you must first petition the appropriate court for an oder relieving you frrmm the provisions of Goverment Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court Vithin six (6) mmths from the 'date your application for leave to int a lata claim was denied. You may s"k the advise of any attorney of your choice in mvmtion with this matter. If ng want to consult an attorney, should do so imeediattel . V. FROM: Clerk of the Boar s County Counsel (2) County s rater Attached are copies of the above Application. We notifed the 'applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board's copy of thi Claim in accordance With Section 29703• IL PHBATCHMM, Clerk, By Deputy V. WOR 1 County Counsel (25 County Aftinistrator TO: Clerk o the Burd of Supervisors Received copies of this Application and Hoard Order. DATED: County Counsel, By - County Administrator, By APPLICATION TO FILE LATE CLAIM ..... . __. _.... ....... .. . ... . 1 Michael S. Klein (SB #50910) 18 Crow Canyon Court, Suite 39{} .-, --- : 2 San Ramon, California 94583 (925) 831-0700311 e 4• 3 Attorney for claimant U A 5 6 7 8 In re the Claim of : APPLICATION FOR LEAVE TO PRESENT LATE CLAIM FOR PERSONAL 9 JANET L. SHERBOURNE, INJURIES RESULTING FROM MEDICAL MALPRACTICE 10 Claimant, 11 vs . 12 MERRI`I`HEW MEMORIAL HOSPITAL, COUNTY OF CONTRA COSTA, Michael 13 Alperin, M.D. , Edwin Carlson, M.D. , and others whose 14 identities are unknown to claimant, 15 Respondents . 16 / 17 To: Merrithew Memorial Hospital, the County of Contra Costa, 18 California, Michael Alperin, M.D. , Edwin Carlson, M.D. , and others 19 whose identities are presently unknown to claimant : 20 Pursuant to Government Code § 911 .4, Claimant Janet L. 21 Sherbourne hereby applies for leave to present her claim for 22 personal injuries suffered as a result of medical malpractice after 23 the time limit prescribed by Government Code § 911 .2 has expired. 24 As required by Government Code § 911.4, a copy of the proposed 25 Claim is attached hereto. Claimant's factual declaration is also 25 attached hereto. 271 DATE OF INCiDF=-. 12/27/96 28 1 ev, / 1 PLACE OF INCIDENT: MERRITREW MEMORIAL HOSPITAL 2 1. At all times relevant to this matter, Claimant was 3 inexperienced in legal matters and had not previouslybeen involved 4 in litigation. 5 2 . Claimant' s cause of action accrued in or about early 6 December 1997, when she was informed by an examining and treating 7 physician both the reason for her medical conditions apparently 8 resulting from the procedure performed in December 1996 and that 9 negligence or other tortious conduct or breach of fiduciary duty 10 was the cause of such medical conditions. These facts are set 11 forth in the copy of the Claim attached hereto and incorporated by 12 reference. 13 3 . Pursuant to Government Code § 911 .2 the claim could have 14 been timely presented to Respondents up to and including early June 15 1998 . 16 4 . The reasons for the failure to present the Claim within 17 the time provided by Government Code 911 .2 are as follows: 18 a. As set forth in the attached. Claim, in June 1997, Claimant 19 executed and presented to Respondents a Premature Claim, which was 20 timely rejected by Respondents. The claim was premature because at 21i the time it was presented to Respondents, Claimant had not 22 discovered, or had reason to discover, through her diligent 23 attempts to investigate, that the cause of her medical conditions 24 was negligent or other tortious conduct or breach of fiduciary duty 25 on the part of Respondents or their agents or employees. 26 Therefore, pursuant to Code of Civil Procedure 340 .5, her cause 27 of action had not yet accrued. 28 2 1 b. Within about a month after the surgery, Claimant first 2 contacted an attorney, diligently attempting to properly exercise 3 her legal rights. The attorney later advised her that she did not 4 have a viable cause of action. within a few months, Claimant 5 contacted another attorney, who prepared the Premature Claim and 6 advised her to present it to Respondents by the end of June 1997, 7 which in reliance upon such advice she in fact did. The same 8 attorney prepared Notices of Intent To Initiate Legal Action and 9 advised Claimant to serve them on various possible defendants, 10 which in reliance upon such advice she in fact did. Neither the 11 attorney who advised Claimant to present the Premature Claim nor 12 Claimant had knowledge or reason to know of the cause of Claimant' s 13 medical problems or whether they were the result of negligence or 14 other tortious conduct or breach of fiduciary duty by Respondents, 15 so that Claimant' s cause of action could not possibly have accrued 16 at that time. Nonetheless, Claimant diligentlycontinued to 17 attempt to find an attorney to represent her. From February 1997 18 through October 1997, Claimant telephoned ten or more attorneys 19 whose names she obtained from the telephone directory and was 20 rebuffed by all of them when she attempted to ' secure legal 21 representation. As late as October 1997, Claimant telephoned the 22 Contra Costa County Bar Association Referral Panel and was referred 23 to another attorney, who advised Claimant, after he obtained an 24 opinion from yet another attorney, that she did not have a viable 25 cause of action. Nonetheless, Claimant continued to consult with 26 physicians, most of whom were Respondent' s agents or employees, in 27 her efforts to discover the cause of her medical conditions and 28 3 1 whether such cause came about as a result of culpable conduct. 2 c. As set forth above, the Premature Claim was presented on 3 the advice of counsel who could not, and did not, have sufficient 4 information to determine that Claimant' s cause of action had 5 accrued, due to the continuing lack of information with respect to 6 the factual cause of Claimant' s medical conditions or whether the 7 medical problems were the result of negligence or ether tortious 8 conduct or breach of fiduciary duty by Respondents . 9 d. As set forth in the attached Claim, afterthe December 14 1996 procedure, for an extended period of time Claimant consulted 11 with and continued to be examined and treated by Respondents, or 12 their agents or employees, with respect to the medical conditions 13 which appeared to have resulted from the procedure.' During this 14 time, she continued to question Respondents or their agents or 15 employees in her efforts to discover the cause for her medical 16 conditions . Claimant was repeatedly told by Respondents or their 17 agents or employees that the cause of her medical conditions was 18 not known and none of them informed her they that it related to the 19 surgical procedure performed upon her by Respondents in 1996 . 20 e. After Claimant learned of the nature and character of the 21 causes of her medical conditions in December 1997, she attempted to 22 determine whether she was entitled to take appropriate legal steps 23 to permit her to pursue her cause of action against Respondents. 24 5 . If the facts with respect to Claimant's knowledge of the 25 negligent cause of her medical conditions as alleged in the 261 Premature Claim had been true, Claimant would have been required to 27 file suit by January 1998. 2$ 4 _.._. _....... . ....... ... .............. 1 6 . Claimant did not file legal action on or before the 2 January 1998 deadline. 3 7 . Upon learning of the appropriate legal procedure to follow 4 in order to property present a claim or late claim to Respondents, 5 Claimant has promptly and diligently moved to present this 6 Application and the attached Claim. 7 8 . Claimant did not timely present the attached Claim because 8 she was excusably and understandably mistaken in her belief that 9 the time had passed within which she could have timely presented 10 it. Claimant mistakenly believed that because the Premature Claim 11 had been presented and she had failed to file suit within six 12 months of its denial, she could not present the attached Claim 13 based upon the correct date her cause of actionaccrued. 14 Claimant' s failure to timely present the attached Claim was a 15 result of excusable inadvertence for essentially the same reasons . 16 9 . If there was any neglect on Claimant' s part in presenting 17 the attached Claim, it was excusable, in that she has diligently 18 sought to discover the cause of her medical conditions and whether 19 they were the result of negligence or other tortious conduct or 20 breach of fiduciary duty, diligently sought to secure the services 21 of legal counsel to assist her in presenting her claim and 22 diligently attempted to comply with the applicable Government Code 23 sections. It is such diligence, and reliance on legal counsel, 24 that led Claimant to present the Premature Claim as advised by 25 earlier counsel, even though at the time of presentation her cause 26 of action had not yet accrued. 27 10 . The delay in presenting the attached Claim will not 28 5 1 prejudice Respondents since by virtue of the Premature Claim they 2 have previously received notice that an incident, involving a 3 surgical procedure performed upon Claimant occurred at Merrithew 4 Memorial Hospital on December 27, 1996 and that Claimant suffered 5 injuries as a result of the procedure. Moreover, as set forth 6 above, Respondents or their employees or agents continued to 7 examine, treat and order tests for Claimant in what they 8 represented to be efforts to determine the cause of Claimant' s 9 medical conditions, which gave them as much or more information 10 than they would have acquired had Claimant timely 'presented the 11 attached Claim, based upon the true date her cause of action 12 accrued. Respondents performed any factualor medical 13 investigation they believed would be required after their receipt 14 of the Premature Claim, in addition to the information they 15 obtained before it was presented. 16 11. The reason for the delay in presenting the attached Claim 17 was a result of correct application of the legal requirements for 181 accrual of a cause of action, so there can be no prejudice to 19 Respondents on account of the appropriate legal treatment of her 20 cause of action Claimant now seeks . 21 DATE. August 27, 1998 22 'Mic 41 . leer 24 Attorney for Claimant 25 26 27 28 6 f 1 Michael S. Klein (SB #50910) 18 Crow Canyon Court, Suite 390 2 San Ramon, California 94583 (925) 831-0700 3 Attorney for Claimant 4 5 6 7 8 In re the Claim of : DECLARATION OF JANET L. SHERBOURNE IN SUPPORT OF 9 JANET L. SHERBOURNE, APPLICATION FOR LEAVE TO PRESENT LA'Z'E CLAIM FOR PERSONAL 10 Claimant, INJURIES RESULTING FROM MEDICAL MALPRACTICE 11 vs . 12 MERRITHEW MEMORIAL HOSPITAL, COUNTY OF CONTRA COSTA, Michael 13 Alperin, M.D. , Edwin Carlson, M.D. , and others whose 14 identities are unknown to Claimant, 15 Respondents . 16 17 I, Janet L. Sherbourne, declare: 18 1 . I am the Claimant making the within Application For Leave 19 To Present Late Claim For Personal Injuries . I am 45 years old and 20 have four children. 21 2 . Before I became involved in this matter, I was 22 inexperienced in legal matters. I was not previously involved in 23 any litigation. 24 3 . I underwent a hysterectomy at Merrithew Memorial Hospital 25 on December 27, 1996. The primary surgeon was Michael Alperin, 26 M.D. , who was assisted by E=dwin Carlson, M.D. I do not know the 27 identities of other physicians, registered nurses and assistants 28 1 1 who were present at the surgery. The hospital and its personnel 2 will sometimes be referred to as "Respondents" . 3 4 . After the hysterectomy, I began to have problems with my 4 back and my legs . I had never had those kinds of problems before. 5 1 have had terrible pain. I have a limp and have to walk with the 6 aid of a cane. I have had pain so bad in my back and legs that I 7 could not walk or sit. I have had awful pain in my lower back. 8 1 have followed the instructions the doctors have given me and 9 tried to help myself as much as I can. 10 S . Within about a month after the surgery, I first contacted 11 an attorney, Gerald Turner, because I did not know', if I had any 12 legal rights as a result of my medical condition at that time. 13 Later, Mr. Turner, advised me that I would not have a' lawsuit worth 14 filing unless I could get another neurologist to say what the cause 15 of my problems was. 16 6 . A few months later, I contacted another attorney, Barry 171 Balamuth. Although I dial not speak directly to him, I did speak to 18 his paralegal, Marg Beth, who told me that she would relay my 1.9 information to him. After taking my information, the paralegal got 20 back to me and told me that I should mail a Claim to the County of 21 Contra Costa and a Notice Of Intention To Initiate Legal Action to 22 Merrithew Memorial Hospital and various doctors. Mr. Balamuth' s 23 office had prepared the documents, but with my name on them, since 24 he did not want to take my case. The only reason I sent the Claim 25 to the County and the Notices was because I was told to do so. As 26 1 will explain, at the time I dealt with Mr. Balamuth and sent the 27 documents, I did not know what was causing my medicalcondition and 28 2 __ _... _....._.. _........ _........ ......_ ...... ... ..._.. .. ................... ......... 1 I did not know if anyone at Merrithew had done anything wrong 2 during my surgery so that I would be able to sue theist. Mr. 3 Balamuth could not have known either, since I could not possibly 4 have given him this information and he did not spear to any of my 5 doctors . 6 7 . From February 1997 through October 1997, I telephoned ten 7 or more attorneys whose names I obtained from the telephone 8 directory. None of them wanted to take my case. None of them 9 would give me any legal advice. 10 8 . In August 1997, I telephoned the Contra Costa County Bar 11 .Association Referral Panel and was referred to another attorney, 12 Harold W. Tobin, who advised me, after he obtained an opinion from 13 yet another attorney, Daniel Dell'Osso at the firm of Walkup, 14 Melodia, Kelley & Echeverria, that I did not have a good lawsuit 15 against Respondents . 16 9 . Since I had been told for about a year that the surgery 17 did not cause my problems, I had no idea of the cause of my medical 18 conditions that came on after the December 1996 hysterectomy until 19 December 1997, when Dr. Jacob Rosenberg informed me that based on 20 tests he had examined it appeared my problems had been caused by 21 something that must have gone wrong during the surgery. He also 22 told me that it was something that was not supposed to happen and 23 that it was not a normal thing to happen in that kind of surgery. 24 10. Before Dr. Rosenberg told me about the reason for my 25 problems and that something had gone wrong during the hysterectomy 26 surgery, I spent most of the year being examined and tested and 27 then told by various doctors that they did not know what was 28 3 11 _...... ......_.. _........ . ..__. ....... .......... .......... 1 causing my problems: 2 a. On January 3, 1997 1 had to go to the Merrithew Emergency 3 Room, where after examining me and evaluating test', results, Dr. 4 Stinson told me that my problems probably happened because I had 5 been resting in bed so long after the surgery. He told me 6 "everything is fine" , prescribed pain medication for me and told me 7 I should "follow up with neurology" when I asked him ghat was wrong 8 with me. He also told me I should go back to Dr. Burt . 9 b. On January 14, 1997 1 was taken by ambulance to the 10 Emergency Room of Delta Memorial Hospital . The doctor who examined 11 and treated me there could not tell me the cause of my medical 12 problems. 13 c. On January 17, 1997 I visited my regular doctor, Dr. Burt, 14 who examined me. I had told her all about the problems I was 15 suffering but she could not tell me the cause of my medical 16 problems . She ordered Merrithew to try to discover the cause of my 17 medical problems. 18 d. On January 21, 1997 1 had to go to the Merrithew Emergency 19 Room again. Dr. Liu and another doctor there examined me. The 20 other doctor told me that my condition "could be" multiple 21 sclerosis . Both doctors recommended further testing and 22 recommended that I come back to Merrithew for that testing. 23 e. I had further tests done at Merrithew on January 31, 1997 24 as the doctors had told me to. Further tests were done but nobody 25 told me anything about the results of the tests and 'I did not see 26 a doctor at all . 27 f . Can March 11, 1997, I went back to Merrithew and was 28 4 1 examined and tested. Dr. Rafanov (I am not sure how to spell his 2 name) , a neurologist, examined me and then told me j the multiple 3 sclerosis test results were not yet complete. He also said that my 4 condition would get better as time went on. There was another 5 doctor there, Dr. Knight (I think) , who told me that "nobody really 6 knows" what had caused my problems. The doctors ordered more tests . 7 g. On April 4, 1997, I again went to Merrithew, where I was 8 again examined and received more tests . A female neurologist whose 9 name I do not recall did further tests, then told me to rest and to 10 go back to Dr. Burt . 11 h. I went back to Dr. Burt, who examined me again. Then she 12 told me that "we still don' t know what' s causing the problems; all 13 the tests are normal" . 14 i . On May 13, 1997 I was again examined and tested at 15 Merrithew. They did another test. I believe Dr. Knight was the 16 doctor who told me that my conditions could be the beginning of 17 multiple sclerosis but "could go away" . When I asked him the 18 direct question of what was wrong with me, he would not answer me. 19 j . Then I went back to Dr. Burt . She examined me again. She 20 told me that "they still don' t knew what' s causing the problems" . 21 k. within a couple months, Dr. Burt agreed with me that I 22 should visit the Pain Clinic because I continued to have very 23 serious pain all the time. 24 11 . After December 1997, when Dr. Rosenberg told me about 25 what he thought had happened I tried to find another lawyer to take 26 my case. I did not find a lawyer who was willing to discuss my 27 case with me until April 1998 . 28 5 el 1 12 . All during 1997, and continuing to the present, I have 2 had a very difficult time emotionally. I have been seeing a 3 psychiatrist about these emotional problems for sometime and have 4 been taking the medications he has prescribed. During 1997 I 5 became very depressed about my condition and the fact that nobody 6 could tell me why I was having the problems I was having and no 7 lawyers seemed to want to help me in any way to find out or to take 8 legal action. Although I tried as hard as I could to find out what 9 was wrong with me, all through 1997 the doctors told me over and 10 over that they did not know. I did not know that Respondents had 11 done anything that I could sue them for. 12 13 . Finally, Dr. Rosenberg gave me the information about the 131 reasons for my condition. I was still very depressed and it was 14 very difficult for me to do things . It was not until April 1998 15 that I was referred to my present attorney. Since' then, I have 16 continued to have the severe pain and difficulty moving and it took 17 some time to get all the information to my attorney. ' In addition, 18 Dr. Rosenberg is difficult to get hold of and talk to. 19 14 . I was very discouraged because I thought that when I did 20 not file a lawsuit in January 1998 that I would never be able to 21 file one. Now, I hope that I will be allowed to file a lawsuit 22 because nobody could help me with the reason for mfr condition or 23 tell me of the fact that Respondents had not acted properly until 24 Dr. Rosenberg first told me about it . Since then, I 'have tried to 25 move as fast as I could to do whatever is necessary for me to get 26 fair treatment and be able to file my lawsuit . However, because of 27 the continuing problems I have been having it has taken quite 28 6 _... ..... ......... ......... .__.._. .. _.._.__.. .._..._........__. _ _ ..... ........ .......... ......... 11 while to provide all the information necessary to get to this i 2 point . i 3 DATE: August ,0 1998 4 I declare under penalty of perjury under the laws of the State i 5 of California that the foregoing is true and correct . 6 t Janet 8 s r e I 9I 101 12 13 14 15 16 17 i 18 191 E 20 ! i 21 � 22 23 24 i 25 261 27 28 7 ................. . ..... ......... 1 Michael S. Klein (SB #50910) Attorney at Law 2 18 Crow Canyon Court, Suite 390 San Ramon, California 94583 3 (925) 8310700 4 Attorney for Claimant 5 6 7 8 91 In re the Claim of: CLAIM FOR PERSONAL INJURIES RESULTING FROM MEDICAL JANET L. SHERBOURNE, MALPRACTICE 10 Claimant, 11 VS . 12 MERRITHEW MEMORIAL HOSPITAL, 131 COUNTY OF CONTRA COSTA, Michael Alperin, M.D. , Edwin Carlson, 14 M.D. , and others whose identities are unknown to 15 claimant, 16 Respondents . 17 18 To: Merrithew Memorial Hospital, the County of Contra Costa, 19 California, Michael Alperin, M.D. , Edwin Carlson, M.D. , and others 20 whose identities are presently unknown to Claimant : 21 CLAIMANT'S NAME AND ADDRESS: Janet L. Sherbourne, 8510 Brentwood 22 Blvd. , Apt . 212, Brentwood, California 94513 . 23 NOTICES SHOULD BE SENT TO: Michael S . Klein, Attorney at Law, 18 24 Crow Canyon Court, Suite 390, San Ramon, California 94583 25 Claimant Janet L. Sherbourne claims damages from Merrithew 26 Memorial Hospital, the County of Contra Costa, California, Dr. ' s 27 Michael Alperin and Edwin Carlson, and others whose identities are 28 1 _........ ......... ......... ._....... ......... ....._.._._...._.. ...... .......... .................................................... 1 presently unknown to Claimant as a result of the following: 2 THE INITIAL SURGERY 3 1 . Claimant underwent a surgical procedure, specifically a 4 hysterectomy, at Merrithew Memorial Hospital (Merrithew) on 5 December 27, 1996 . The primary surgeon was Michael Alperin, M.D. , 6 who was assisted by Edwin Carlson, M.D. Other physicians, 7 registered nurses and assistants whose identities are presently 8 unknown to Claimant, were present at and participated in some 9 manner in the surgery; Merrithew and such health care professionals 10 will sometimes be referred to as Respondents. 11 2 . Claimant believes Dr. ° s Alperin, Carlson and the other 12 physicians, registered nurses and assistants whose identities are 13 presently unknown to Claimant, were at the time of the surgery 14 employees of Merrithew or were in some manner acting as agents of 15 Merrithew acting within the scope of their agency. 16 INJURIES/DAMAGES 17 3 . As a result of the surgery, Claimant has suffered severe 18 and permanent injuries to her nervous, neuro-skeletal and neuro- 19 euro19 muscular systems, suffered continuing severe pain and suffering, 20 and emotional and mental trauma, all of which have seriously 21 interfered with Claimant' s mobility and her ability to lead a 22 functional, normal life reasonably free of pain and suffering and 23 emotional and meatal trauma. The consequences of the Respondents' 24 conduct just enumerated are reasonably certain to continue in the 25 foreseeable future. 26 4 . The damages and injuries suffered by Claimant were the 27 result of negligence or other tortious conduct or breach of 28 2 _....... ........... ....__. ........ ....... .. .... ........ ........_. ..__. . .._..... ._....... _ ........... .... . ............_...._.. 1 fiduciary duty by Respondents. 2 COURSE OF EXAMINATION AND TREATMENT 3 5 . Beginning shortly after the surgery, Claimant sought to 4 determine the cause or reason for her pain and mobility problems 5 from the health care professionals who examined and treated her but 6 did not receive any coherent explanation from the physicians with 7 whom she consulted. Many of these health care professionals were 8 employees or agents of Merrithew. 9 6 . On or about January 3 , 1997 Claimant' s medical conditions 10 required her to seek care and treatment from Merrithew in its 11 Emergency Room. A physician who was an employee or agent of 12 Merrithew informed Claimant after examining her and evaluating 13 tests ordered for Claimant, that her problems probably resulted 14 from prolonged bed rest after the surgery, that "'everything is 15 fine" , that she should "follow up with neurology" and prescribed 16 her pain medication. 17 7 . On or about January 14, 1997 Claimant was required to seek 18 care and treatment at the Emergency Room of Delta Memorial 19 Hospital . The physician who examined and treated her at that time 20 was unable to inform her of the cause of her medical conditions. 21 8 . On or about January 17, 1997 Claimant consulted her 22 regular physician, Dr. Burt, who examined Claimant. Dr. Burt could 23 not determine the cause of Claimant' s medical conditions and 24 directed a communication to Merrithew urging it to !determine the 25 cause of Claimant's medical conditions . 26 9 . On or about January 21, 1997 Claimant was again required 27 to seek care and treatment from Merrithew in its Emergency Room. 281 3 ......... ..._.._... ......... ......... ._.._.... ._............. .. ....... ...... .... . .... ......... ....... ........ ............................ ......... 1 Claimant was again examined and was told by physicians who were 2 employed by or agents of Merrithew that her condition "could bell 3 multiple sclerosis, recommended further testing and recommended 4 that she return to Merrithew for further testing. 5 10 . Claimant underwent further testing at Merrithew on or 6 about January 31, 1997 as the physicians had directed. At that 7 time further testing was done but Claimant was not informed of the 8 outcome. 9 11 . Claimant was next examined and tested by 'Merrithew and 10 its personnel on or about March 11, 1997, at whichtime she was 11 told by a physician who was employed by or an agent of Merrithew 12 that the multiple sclerosis test results were not yet complete and 13 that further passage of time was required before Claimant could 14 expect any improvement in her condition. During the same visit, a 15 physician informed Claimant that "nobody really knows" what caused 16 her medical conditions and ordered further tests . 17 12 . Claimant was next examined and tested by Merrithew and 1$ its personnel, on or about April 4, 1997 . At that time, a 19 neurologist employed by or an agent of Merrithew did further tests, 20 directed Claimant to rest and follow up with Dr. Burt. 21 13 . Upon further examination by Dr. Burt a short time later, 22 Dr. Burt told Claimant "we still don' t know what's causing the 23 problems; all the tests are normal" . 24 14 . On or about May 13, 1997 Claimant was again examined and 25 tested by a physician who was employed by or an agent of Merrithew. 26 The physician informed Claimant that her medical conditions could 27 be the beginning of multiple sclerosis but "could go away" and did 28 4 ......... ......... ......... ... ........ ............... _.. .11.11 _... _ ........ ....... ....... ........ .........-_.........._...__... 1 not, or could not, respond to Claimant' s direct questions about the 2 cause of her medical conditions . 3 15 . A short time later, Claimant again consulted and was 4 examined by Dr. Burt. After the examination, Dr. Burt informed 5 Claimant that "they still don' t know what' s causing the problems" . 6 16 . Within a couple months, Dr. Burt agreed with Claimant 7 that she should consult with a Pain Clinic on account of the 8 unresolved serious pain Claimant had been suffering.. 9 17 . Despite the numerous occasions when Claimant was 10 examined, treated and tested by health care professionals, many of 11 whom were agents or employees of Merrithew, and despite Claimant' s 12 consistent diligent efforts to secure an explanation of the cause 13 of her medical conditions, none of such health care professionals 14 was able to provide an answer to the question of the cause of the 15 medical conditions until almost the end of 1997, as set forth 16 below. 17 DELAYED ACCRUAL OF CAUSE OF ACTION 18 18 . At or about the time Dr. Burt informed Claimant "we still 19 don' t know what' s causing the problems; all the tests are normal", 20 an attorney Claimant had consulted prepared a claim for Claimant to 21 present to Respondents pursuant to Government Code 9 910, despite 22 the facts that the cause of Claimant' s injuries and continuing 23 medical conditions remained unknown, as did the question of whether 24 the cause was the result of Respondents' negligence, or other 25 tortious conduct, so that a cause of action could not have accrued 26 at such time pursuant to Government Code § 901 and Code of Civil 27 Procedure 9 340.5, which provides, in pertinent part: 281 5 1 In an action for injury or death against a health care provider based upon such person' s allegedprofessional 2 negligence, the time for the commencement of action shall be three years after the date of injury or one year after the 3 plaintiff discovers, or through the use of reasonable diligence should have discovered, the injury, whichever occurs 4 first. 5 It is well established under California law that the term "injury" , 6 as used in Code of Civil Procedure § 340.5 means both the injured 7 party' s physical condition and its negligent cause. Claimant 8 signed and presented the claim, hereinafter referred to as the 9 "Premature Claims' based solely on the advice of the attorney who 10 prepared it . Claimant sent notices of Intention To Commence Legal 11 Action pursuant to Code of Civil Procedure § 364 based solely upon 12 the advice of the attorney, who had prepared the Notices. 13 19 . At the time such the Premature Claim was presented to 14 Respondents by Claimant and the notices were sent, solely at the 15 attorney' s direction, neither Claimant nor the attorney who 16 prepared the documents for her knew or had any reason to know that 17 her medical conditions and injuries were caused by the negligence, 18 or other tortious conduct of Respondents or their agents or 19 employees . 20 20 . Despite Claimant' s far more than reasonably diligent 21 search for the cause of her medical conditions, she dick not, and 22 could not, discover the relationship of whatever was th cause of 23 her medical conditions to the conduct of those responsible for the 24 surgery until she was informed by Jacob Rosenberg, M.D. in early 25 December 1997 that her medical conditions were caused by something 26 that must have gone wrong during the surgery, that it was not 271 supposed to happen and that it was not a normal thing to happen in 28 6 1 that kind of surgery. 2 AMOUNT OF DAMAGES 3 21 . Claimant claims damages in excess of the $25, 000 .00 4 minimum jurisdictional amount of the Superior Court. Subject 5 matter jurisdiction of her prospective action is therefore in the 6 Contra Costa County Superior Court . 7 DATE. August 27, 19984 r $ - - r 4 i 9 i. r -V MIchaei le'n 10 Attorney for Claimant 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 7 p D b EQ w 4.) 0)-H ,u° 41u cn 44Q- 0 (y{ y a a kD zz it 4) e• 4.) �7D -A Ln t1! C91 = Id �--'' . .0 Ott