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HomeMy WebLinkAboutMINUTES - 12141999 - C19-C20 CLAIM BOA`Rp OF SUPERVISORS OF CONMA COSTA COLTISM. CALIFORI�'iA BOARD ACTlOU DECEMBER 14, 1999 Claim Against the County, or District Governed by 1 ft Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT 1\1� The co of ttis document tailed to you is your end Board Action. All Section referent �. �. PY Y CWiforria Government Codes. 9 notice of the action taken on Your claim by the 199 Board of Supervisors. (Paragraph IV belov4, given S��. no pursuant to Goverrrrent Code Section 913 and 00GR``F 915.4. Pleasete all "Warnings". MA�CINEZ' AMOUNT: $200,000-00 CLAIMANT: DOLORES RECIO ATTORNEY: F. Anthony Edwards, Esq. DATE November 24, 1999 SEIBEL, FINTA & EDWARDS November 24 1999 ADDRESS: 1850 Mt. Diablo Blvd. , Ste 650BY DELIVERY TO CLERK ON: Walnut Creek CA 94596 BY MAIL POS Tn _Prof f i cc, Transmittal L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted elaua. Dated: November 24, 1999 B PHIL B R. Cler y Deputy � II. FROM County Copnsel TO. Clerk of the Board of Supe ors This claim mplies substantially with Sections A. 10 _-�Ad 230.2. ) 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 read warning of claimant's right 3o apply for leave to present a late claim (Section 911.3). (Vf Other. &C e Or! /1-1 T-q j IS ©/) cr w 1! 4-i/v�ly -T i e f-af-i OCeOrr ©n ©r cls et— 144` 1.5' vr� as Sv c ©c��rr'ih r ©r _hD /ga, . See �4j. ' Dated:_ By: Deputy County Counsel IIL PROM Clerk of the Board IrQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHLOR, Clerk, By Deputy Clerk WARNING (Gov. code sectio 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. AFMAVTT OF MAILING I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By - Deputy Clerk CC: Comity r, .1sel C:-unty Administrator a Y I L. This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. NICTOR J;-WESTMAN DEPUTIES: COUNTY COUNSEL PHILLIPS.ALTHOFF JANICE L.AMENTA NORA G.BARLOW B.REBECCA BYRNES SILVANO B.MARCHESIANDREA W.CASSIDY CONTRA COSTA l NTY MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL �, ;� VICKIE L.DAWES OFFICE OF MARKES.ESTIS SHARON L.ANDERSON "` MICHAEL D.FARR .4 INISTRAT1OM$U `",. LILLIANT.FUJII ASSISTANT COUNTY COUNSELDENNIS C.GRAVES , -6 .PI E STREET 'MO, JANET L.HOLMES MAq%ERZ, .IF 229 KEVIN T.KERR GREGORY C.HARVEYa�. BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUNIZ OFFICE MANAGER VALERIE J.RANCHE STEVEN P RETTIG DAVID F SCHMIDT PHONE(925)335-1800NOTICE OF UNTIMELINESS BARBARA NN.ER BAR .SUTLIFFE FAX(925)646-1478 JACOUELINEYWOODS AS TO A PORTION OF THE CLAIM TO: F. Anthony Edwards,Esq. Seibel, Finta&Edwards 1850 Mt. Diablo Blvd., Ste 650 Walnut Creek, CA 94596 Re: Claim of Delores Recio Please Take Notice as Follows: In regards to the claim submitted on November 24, 1999,but mailed on November 17, 1999, portions of your claim are timely and portions are untimely. The portions of your claim prior to May 17, 1999,that you presented to the Board of Supervisors as the governing body of the Housing Authority, 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 May 17, 1999 were not presented within the time allowed by law, no action was taken on those portions of your claim. The claim was forwarded to the Board for action only on the timely portions of the claims. Your only recourse at this time, in regards to any untimely claims, is to apply without delay to the Board of Supervisors as the governing body of the Housing Authority for leave to present a late claim as to the claims which are untimely, 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 B �--"r - Y Monika L. Cooper Deputy County Counsel Page 1 CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;1 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. Executed in Martinez,California. Dated: November 30, 1999 cc: Clerk of the Board of Supervisors(original) Risk Management Page 2 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk o-.11'the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity; separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Dolores Recio Against the County of Contra Costa or The Housing Authority of Contra Costa (District) (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of$200,000.00 and in support of this claim represents as follows: SEE ATTACHED CLAIM 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? c1mform 5? What are the names of county or district officers, servants or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses,doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney (Claimant's Signature) (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, 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." cImform I F. Anthony Edwards, Esq. SBN: 181606 SEEBEL9 FINTA& EDWARDS 2 1850 Mt. Diablo Boulevard, Suite 650 Walnut Creek, CA 94596 3 Telephone: 925-947-1600 Facsimile: 925-947-1990 4 5 Attorneys for Petitioner 6 7 8 ADMINISTRATIVE PROCEEDINGS UNDER THE STATE BOARD OF CONTROL GOVERNMENT CLAIMS DIVISION 10 11 DOLORES RECIO, CASE NO. 12 Petitioner, CLAIM FOR PERSONAL INJURY SUFFERED BY PETITIONER DOLORES 13 v. RECIO 14 THE HOUSING AUTHORITY OF CONTRA COSTA COUNTY, 15 Respondent. 16 17 INTRODUCTION 18 This is a claim for the injuries suffered by Ms. Dolores Recio ["RECIO"] who at the time was a 19 resident at Elder Winds Housing Complex, 2100 Buchanan Road, Apt. B-307, in Antioch, CA. Ms. 20 Recio was the guardian of her mother, Alii Recio who also lived at the complex. Beginning in June, 21 1998, Hardy Woods, another resident at the complex, began a campaign of harassment against Ms. 22 Recio. She reported these incidents to the local manager, yet nothing was done. The events escalated 23 to the point where Mr. Woods felt unrestricted to assault Ms. Recio by going to her residence, waiting 24 for her to approach the doorway and then shooting her in the face twice with a starter pistol after 25 spraying dog repellent on her. As a result of Mr. Woods' conduct and the manager of the Housing 26 Authority inaction, Ms. Recio suffered severe damage to her left eye and bums and injury to her face. 27 This claim is presented on behalf of Ms. Recio for the personal injuries suffered, the medical expenses 28 I incurred now and in the future, and for her mental distress. 2 H 3 SUMMARY OF FACTS 4 Ms. Recio began having problems with Mr. Woods as far back as early 1998. At that time she 5 complained to the local manager of the Housing Authority about the harassment and intimidation by Mr. 6 Woods. She reported the following: 7 1. Mr. Woods found out that her daughter was multi-racial. He then continuously referred to 8 her daughter as a half-nigger. 9 2. Mr. Woods instigated other tenants in the complex to complain about Ms. Recio with the 10 intent to remove her. These incidents were also reported to the local Housing Authority manager. 11 3. Ms. Recio reported to the local Housing Authority manger that Mr. Woods was stalking her, 12 and telling other tenants that she was doing narcotics, that she was neglecting her mother and that she 13 was a prostitute. All these were lies and they were also reported to the local Housing Authority manager. 14 15 4. In June 19981 Mr. Woods came into the laundry room while Ms.Recio was doing the laundry. 16 He proceeded to threaten and intimidate her, calling her a white bitch,grabbing his crotch in front of her 17 and saying "suck my dick", and telling a passerby that she gave him "head" for five dollars. A neighbor 18 came in and pulled him out. Ms. Recio then left the laundry room. 19 5. On June 26, 1999)another tenant,Ms. Alice Navarro told Detective Rogers that in December 20 1998, she saw Mr. Woods sitting on a bench not far from Ms. Recio's apartment and that he told her "I 21 am waiting for that bitch to come out so I can kill her," Mr. Woods also said that he told the Housing 22 Authority that if they did not evict Ms.Recio from the premises, he would going to kill her. Mr. Woods 23 waited for approximately four and one-half hours (4 1/2) outside Ms. Recio's apartment for her to exit. 24 When she did not, he left the area. Ms. Navarro reported the incident to Patrick O'Connor the local 25 Housing Authority manager. Mr. O'Connor recalls the report but he did nothing to follow-up and did 26 not maintain any written documentation about the incident. 27 28 2 I On May 18, 1999,while returning from a trip, and walking towards her apartment, Mr. Woods 2 sprayed Ms. Recio with dog repellent and shot her twice in the face with a modified starter pistol, 3 modified to fire projectiles. As a consequence of Mr. Woods' conduct and the Housing Authority's 4 inaction,Ms. Recio suffered physical damage to her left eye, burning and trauma to her face and severe 5 emotional distress. The incident was witnessed by Mr. Perry Castro, a tenant within the complex. 6 111 7 APPLICABLE LAW 8 The Housing Authority is responsible for assuring that the actions of its employees and agents 9 complies with the law of the state of California and to assure that they comply with the Housing 10 Authority legal obligation as a landlord. The Housing Authority and its employees and agents owes a 11 duty of ordinary care towards its residence. This duty was violated by Mr. O'Connor when he neglected 12 to follow through on the troubling information provided to him by Ms. Alice Navarro. Had he complied 13 with his required duty, Mr. O'Connor would have discovered Mr. Woods violent history and his 14 propensity for violence. The risk of harm to Ms. Recio was increased because of the propensity for 15 violence exhibited by Mr. Woods. Had Mr. O'Connor followed through with the information received, 16 measures could have been taken to provide a safer environment for Ms. Recio. However, nothing was 17 done. 18 Under the Doctrine ofRespondeat superior,the Department of Housing is liable for the omission 19 of Mr. O'Connor, the resident manager of the housing complex. 20 IV 21 DAMAGES 22 On behalf of Mr. Recio, I hereby submit this claim for damages for personal injury, emotional 23 distress and medical cost in the amount of$200,000.00 24 Date: November 17, 1999 SE11BEL7 FINTA&EDWARDS pi e mitte . 25 Res. 711y sub 26 vk-4I ANTHONYADWARDS 27 28 3 PROOF OF SERVICE B Y MAIL (C.C P. §§ 1013(a) 201 S.S) 2 3 1 declare that I am employed in the County of Contra Costa, State of California. I am over the 4 age of 18 years and not a party to the within action. My business address is 1850 Mt. Diablo 5 Boulevard., Suite 650, Walnut Creek, California 94596. 6 On November 17, 1999) 1 served the foregoing document(s) described as: 7 CLAIM FOR PERSONAL INJURY SUFFERED BY PETITIONER DOLORES REGIO 8 on the interested parties in this action by as follows: 9 X BY MAIL. I caused such envelope with postage thereon fully prepaid to be placed in the United States mail at Walnut Creek, California. 10 BY PERSONAL SERVICE. I personally hand delivered the foregoing 11 documents. 12 BY FACSIMILE. I caused the foregoing documents to be transmitted by facsimile to addressee and thereafter mailed to addressee. 13 Parties served are as follows: 14 STATE BOARD OF CONTROL 15 GOVERNMENT CLAIMS DIVISION 630 "Ktl STREET, 4TH FLOOR 16 SACRAMENTO, CA 95814 17 STATE BOARD OF CONTROL GOVERNMENT CLAIMS DIVISION 18 P.O. BOX 3035 SACRAMENTO, CA 94812-3035 19 ATTN: ROBERT McEWAN, Director 20 HOUSING AUTHORITY OF CONTRA COSTA COUNTY 3133 ESTUDIO STREET 21 P.O. BOX 2759 MARTrNEZ, CA 94553 22 1 declare under penalty of perjury under the laws of the State of California that the above 23 is true and correct. Executed this 17th day of NQvember, 1999, at Walnut Creek, California. 24 25 26 -,Neefda L. Bass 27 28 CLAIM BOARD QE SIMERN15ORS OF CONURA COSTA COU-NMI CTEORNIA IMAgD AMOIJ DECEMBER 14, 1999 Claim Against the Cvinty, or District Governed by NOTICE TO CLAIMANT the Board of Supervisors, Routing Endoromnts,and Board Action. AJI Section references are to The copy of this document mailed to you is your California Goarnment Codes. l Mice of the action taken on your dairn by the Board of Supervisors. (Paragraph IV below}, Oven pursuant to Government Code Section 913 and 915.4. Please note III "Warnings". AMOUNT: $200,000-00 CLAIMANT: Dolores Recio ATTORNEY: DATE RECEIVED: Novernber 29, 1999 ADDRESS: c/o F. Anthony Edwards, Esq. BY DELIVERY TO CLERK ON: November 29.1999 Siebel, Finta & Edwards 1850 Mt. Diablo Blvd. , Ste 650 BY MAIL POSTMARJW:—Transmittal Walnut Creek CA 94596 L FROM: Clerk of the Board of Supervisors 7Xk. County Counsel Attached is a copy of the above-noted cl PML BA R, Clerk Dated: Novernber 29, 1999an ....By: Deputy IL FRONL- 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 Tight to apply for leave to present a late claim (Section 911.3). ) Other: Dated: Deputy County Counsel M. IpRox Clerk of the Board TO. county Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant (S=600 911-3). IV. BOARD ORDEIL By unanimous vote of the Supervisors present This Claim is rejected in full. Other:— I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PML 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. Ste 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 HAIUNG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been & citizen of the United Sates, over age IS; and that today I deposited in the United States Postal Service in Martinez, California, postage full. prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PH11, BATCHELOR By Deputy Clerk CC: County Counsel County Administmtw This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: 335-1800 Martinez, CA 94553 Fax: 646-1078 Date: November 24, 1999November 24, 1999 RECEIVED To: ANN M. CERVELLI, CLERK OF THE YOARD NOV 2 9 1999 From: Victor J. Westman, County Counsel By Gregory C. Harvey, Assistant County Counsel CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. Subj: Claim of Dolores Recio ------------------- ------------------ Please treat this as a claim in your normal course. CONFIDENTIAL ATTORNEY CLIENT COMMUNICATION Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987,must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity; separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Dolores Recio, Against the County of Contra Costa or The Housing Authority of Contra Costa (District) (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of$200.000.00 -----And in support of this claim represents as follows: SEE ATTACHED CLAIM 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? c1mform 3: What are the names of county or district officers, servants or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney (Claimant's Signature) (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, 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." Omform I incurred now and in the future, and for her mental distress. 2 11 3 SUMMARY OF FACTS 4 Ms. Recio began having problems with Mr. Woods as far back as early 1998. At that time she 5 complained to the local manager of the Housing Authority about the harassment and intimidation by Mr. 6 Woods. She reported the following: 7 1. Mr. Woods found out that her daughter was multi-racial. He then continuously referred to 8 her daughter as a half-nigger. 9 2. Mr. Woods instigated other tenants in the complex to complain about Ms. Recio with the 10 intent to remove her. These incidents were also reported to the local Housing Authority manager. 11 3. Ms. Recio reported to the local Housing Authority manger that Mr. Woods was stalking her, 12 and telling other tenants that she was doing narcotics, that she was neglecting her mother and that she 13 was a prostitute. All these were lies and they were also reported to the local Housing Authority manager. 14 15 4. In June 1998,Mr.Woods came into the laundry room while Ms.Recio was doing the laundry. 16 He proceeded to threaten and intimidate her,calling her a white bitch,grabbing his crotch in front of her 17 and saying "suck my dick", and telling a passerby that she gave him "head" for five dollars. A neighbor 18 came in and pulled him out. Ms. Recio then left the laundry room. 19 5. On June 26, 1999,another tenant,Ms. Alice Navarro told Detective Rogers that in December 20 1998, she saw Mr. Woods sitting on a bench not far from Ms. Recio's apartment and that he told her"I 21 am waiting for that bitch to come out so I can kill her." Mr. Woods also said that he told the Housing 22 Authority that if they did not evict Ms.Recio from the premises, he would going to kill her. Mr.Woods 23 waited for approximately four and one-half hours (4 1/2) outside Ms. Recio's apartment for her to exit. 24 When she did not, he left the area. Ms. Navarro reported the incident to Patrick O'Connor the local 25 Housing Authority manager. Mr. O'Connor recalls the report but he did nothing to follow-up and did 26 not maintain any written documentation about the incident. 27 28 2 ^ ` ~ - ~ ~ . . ^ . ' . 28 3 � CLAIM BoAgp OF SUpEgN14 qORS OF CONTRA COSTA COUN"XY- r-ALMORNIA BOARD WnOlt December 14, 19119C, Cbfim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Acton. All Section references we to The copy of this document nifled to you is your California Government Codes. 1 notice of the action taken on your dairn by the Board of Supervisors. (Paragraph IV bell)%M, oven DD pursuant to Governme nt Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: `1345.00 Cou'.,,,,jy COUNSEL willie Earl E�aker MARTI NE-Z CALIF. ATTORNEY: DATE RECEMED: ADDRESS: San Quentin State Prison BY DELIVERY TO CLERK ON: i'lovember 15, 19119 Sari Quentin, CA X4974 BY MAIL POSTMARKED: i4over,TDer 12, 19�9 1 FROM. Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PM R9 * I 11 240, _ Novelliber IL�, 1C-)99 By: Deputy Dated: ��.Tim It. FROM County Counsel TO: Clerk of the Board of Supervisors %4 This %;,lairn complies substantially with Sections 910 and 910.2. Ws 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 —...Ay: L_111)yb_7t�67ej*,__��puty County Counsel EL PROM Clerk of the Board TO.- County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. COY Other' I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: Own ��V� . PWL BATCHEWR, Clerk, By Deputy Clerk WARNING (Gov. code sectio 13) Subject to certain exceptions, you have only six (6) months from tl,.,e 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. AFMAVIT 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 full) prepaid a certified copy of this Board Order and Notice to Claimant addressed ed to the claimant as shown above. Dated: By: PML BATCHELOR By. Deputy Clerk J V CC: County Counsel County.Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 'day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp ) RECEIVED Against the County of Contra Costa or ) NOV 15 1999 -1 J"NJ C* rr '"V"� vl ti District) CLERK BOARD OF SUPERVISORS (Fill in name) ) CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ �1 . and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) AM 2. Where did the damage or injury occur? (Include city and county) _ $. C�0 to tA e T *7 T 3. How did the damage or injury occur? (Give full details; use extra paper if required) . s r 4. What particular act o'r omission on the part of county or district officers, servants, or employees caused the injury or damage? „fir _ e � l d ' C C� r 1 1, sI "l, f,-l *rv7 �«�� iA .,..!f,..• i t R 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. 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.) .A 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TMM AMOUNT ****************************************************************************************** Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) T,, (Claimant's Signature) (Address) Telephone No. )Telephone No. ************************************************************** *************************** NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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. This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. CLAIM BOARD OF SUPERVISORS OF CONMEA COSTA COUN"IYI CALEFORNTiA BOARD AMOU December 14, 1999 Chiirn Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, j NOTICE TO CLAIMANT Ind Board Acton. All Section preferences `v av The copy of this documentffailed to you is your California Govermmrit Codes. retire of the action taken on your dairn by the NO V 2 3 Board of Supervisors. (Paragraph IV belov4, Oven pursuant to Government Code Section 913 and COUNTY COUNSI�L MARTINEZ CALIF. 915.4. Rease note all "Warnings AMOUNT: Exceeds Jurisdiction of the Superior Court CLAIMANT: Debra Goulart ATTORNEY: Thomas N. Stewart, III DATE RECEIVED: November 22, 1999 Bold, Polisner, Maddow, Nelson & Judson ADDRESS: 500 Yganacio Valley Rd. , Ste325 BY DELIVERY TO CLERK ON: Nnyaujaer 22. -1 gog Walnut Creek CA 94596 BY MAIL POSTMARKED: Noutzmbpr 20 1999 L FROM: Clerk of the Board of Supervisors TQ. County Counsel Attached is a copy of the above-noted claim. PHIL B44PMOR, November 23, 1999 k-- Dated: Deputy _Ay: Depu IL FROM County Counsel TO: Clerk of the Board of Supervl(sors ?bis 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: 7 Dated: _ f j'" ',_„ �.,.____�y Deputy County Counsel IM FROM: Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV, BOARD ORDER By unanimous vote of the Supervisors present: ?bis Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 00(, 4, P191.BATCHEWP, Clerk, By ALK-L6 Deputy Clerk WARNING (Gov. code sectio 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. Ste 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 itamediately. OFor Additional Warning Ste 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 full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above- :: Dated:_&J�,- (-5 1 q '1 1) By: PHIL BATCHELOR Byputt' Clerk CC: County Counsel County Adninistmtor RECEIVED NOV-2.2 1999 Claim of Debra Goulart CLAIM FOR PERSONAL IN BOARDoSUUA VISORS INJUNCTION AND ATTO V. Contra Costa County l To the Clerk of the Board of Supervisors of Contra Costa County: You are hereby notified that Debra Goulart,who may be reached through her attorney at the address stated below, claims damages from Contra Costa County in an unknown amount . which exceeds the limited jurisdiction of the Superior Court. This claim is based on personal injuries sustained by claimant in September 1999 and continuing at 1240 Danzig Plaza, Concord. At that time, claimant,who is disabled., suffered inconvenience, embarrassment and humiliation when she attempted 10 gain access to the County's"Concord Mental Health"facility and encountered an inaccessible front door,elevator and interior door to the facility, each of which prevented her from graining access without the help of able-bodied people, and which failed to meet the standards of the California Building Code and Title H of the Americans with Disabilities Act of 1990 and.the federal regulations adopted pursuant thereto. Claimant's damages consist of emotional distress in an unspecified amount-which would exceed the limited jurisdiction of the Superior Court. Claimant also seeks an injunction making "Concord dental Health"accessible to her and attorneys' fees. All notices or other communications regarding this claim are to be sent to claimant's attorney as follows: Thomas N. Stewart,III Bold, Polisner,Maddow,Nelson&Judson 500 Ygnacio Valley Road, Suite 3.25 Walnut Creek, CA 94596 Telephone: (925)933-7777 Fax: (925) 933-7804 Date: Thomas N. Stewart, in, attorney for Debra Goulart 1 PROOF OF SERVICE 2 I am a citizen of the United. States, over the age of 18 years, 3 employed in the County of Contra Costa, and not a party to the 4 within action; my business address is 500 Ygnacio Valley Road, Suite 325, Walnut Creek, California. 6 On November 19, 1999, I served the within CLAIM FOR PERSONAL 7 INJURIES, INJUNCTION AND ATTORNEYS' FEES {Debra Goulart} on the 8 parties in said action, by placing a true copy thereof enclosed in 9 a sealed envelope, with postage thereon fully prepaid, in the 10 United States mail at Walnut Creek, California addressed as 11 follows: 12 Clerk, Board of Supervisors 13 Contra Costa County Administration Building 14 551 Pine Street - Room 105 Martinez, Ca. 94553 15 I declare, underenalt p y of perjury, under the laws of the 16 State of California that the foregoing is true and correct. 17 Executed on November 19, 1999, at Walnut Creek, California. 18 19 20 James H. Job 21 7 22 23 24 25 OLD,POLISNER,MADDOW, NELSON&JUDSON ATTORNEYS AT LAW SUITE 325 500 YGNACIO VALLEY ROAD WALNUT CREEK,CA 94596 PHONE: 925-933-7777 FAX:925-933-7804 CA O r O 'D O - r f rn o 0 76 Z 70 < 7 µ D C o a m w n -n 0v A q ZZ D R, o i (P ° O W rA 9r) a D . G p i y V O Z o S t^ N@ ti0 O :..- 0'-Q N 0 ti �- N r r r w r w ✓ t C 1 I' a S F r 1 * ti S t �i t 4 S' g; A. C' d CLAIM BOARD OF SUPERVISORS OF COSH COSTA COUTSty-W. CA I 31-0-RNTIA BOARD AG Olk DECEMBER 14, 1999 Daim Against the County, or Distract Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Acton. AI! Section references are to N copy of this document nailed to you is your California Govermnerit Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belov4, Oven N 0 V 2 3 i999 pursuant to Government Code Section 913 and COUNTY COUNSEL 915.4. Please note oil 'Warnings AMOUNT: $1001000.00 MARTIiNEZ CALIF, CLAIMANT: Monique Kirkland ATTORNEY: Craig L. Judson - 114926 DATE RECUVED: November 19, 1999 Bold, Polisner, Maddow, Nelson & Judson ADDRESS: A Professional Corporation BY DE 1MY TO CLM ON:November,,,19A 1999 500 Ygnacio Valley Rd. , #325 November 18, 1999 Walnut Creek CA 94596 BY MAIL POS L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA R, Cler,4 November 23, 1999 Dated: By: Deputy IL FROM County Counsel TO: Clerk of the Board of Supervisi*s ) 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: A Dated: Deputy County Counsel IML PROM Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). N. BOARD ORDER: By unanimous vote of the Supervisors present: ?his Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: /-'I- PML BATCHEWR, Clerk, By 470� X1Wa?Z-i. Deputy Clerk WARNING (Gov. code secti6fi 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 Goverment Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of 'his 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 full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: _4� � K ��1, BY: PHIL BATCHELOR By (1>2.4_��2��Deputy Clerk V CC: County Counsel County Administrator M This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i i MI:34 CONTRA WSTR CTY RISK MGT P-01/02 claivfs-to: BOARD OF SUPERVISORS OF OMTRA COSTA COUNTY INSTRUCTIONS 70 CLkIKWr A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims- relating to causes of.action fordeath 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. "Claim must be filed With the Clerk of the Board of Supervisors at its ,office in Room 106, County Administration Building,, 651 Pim 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 See. 72 at the end of this form. A RE! Claim BY Reserved for Clerk's filing stamp MONIQUE KIRKLAND RECE Against the County of Contra. Costa NOVV 191999 COUNTY _ 7 CONTRA, COSTA COUNTY SHERIFF's DEPT. CAROL LOU-ISE MISSAGPIA District) CLERKCONTRA C STA CO.BOARD OF SUPFRvgqORS :--(Fill In name) The undersigned claimant hereby rakes claim against the County of Contra Costa or the above-named District in the sum of $ 10 0 0 0 0. 0 0 and in support of this claim represents -as follows: 1. When -did the damage or injury occur? (Give exact date and hour) July 2, 1999, 6 : 45 p.m. 2. Where did the damage or injury occur? (Include city and county) Eastbound Hwy 4 at Cypress Road, Oakley, California 3. How did the damage or injury occur? (Give full details- use extra paper if required) See attachment 3 . 4. what particular act or omission on the part of county or district officers* servants or.employees caused. the.injury or.damage? Officer Massaggia entered the intersection against a red light, was traveling at a fast speed, did not have the siren operating, and failed to yield to cross traffic who had the right-of-way. " (over) SEP-01-1998 0534 99% P.01 Wnat are tne names Of county or district officers: servants or employees causirtg the damage or injw-y? Sheriff officer Carol Louise Missaggia What damage or .injuries-do you claim resulted? (Give full extent Of injuries or damages claimed. Attach two estimates for auto damage. Claimant sustained a severe back, neck and leg injury. She had to be airlifted to John Muir Hospital, and is still being actively treated at Kaiser Hospital. it Baas the amount claimed above c=pUted? (Include the estimated amount of any 7. Haw pros.nective inJury or damage.) Claimants medical expenses to date are $24 , 750. 64 -Nam aad cV�ggses 0,f witnesses, %s a? 1r � edhO John Muir Tr,,,.,,� 1� Ai-r Rescue 1601 Ygnacio Vly.Rd. f 1601 Ygnacio Vjy.Rd. 20876 Corsau Blvdo,#B Walnut Creek, CA 94596 walnut Creek, CA 94596 Hayward, CA 94545 ;raiser Antioch 3400 Delta Fair Blvd. ,Antioch, CA 94509 9. List the. expenditures you madeon account of this accident or Injuryt DATE ITEM AMOUNT • BOLD, POLISN ER, MADDOw, NELSON & JUDSON A PROFESSIONAL CORPORATION ROBERT B. MADDOW SOO YGNACIO VALLEY ROAD, SUITE 32S JEFFREY D. POLISNER CARL P A. NELSON OF COUNSEL CRAIG L. JUDSON WALNUT CREEK, CALIFORNIA 94596-3840 FREDERICK BOLD, JR. THOMAS N. STEWART, III TELEPHONE (925) 933-7777 (RETIRED) TELEFAX (925) 93.3-7804 November 17, 1999 CERTIFIED MAILED Board Supervisors Contra Costa County Uo, Administration Building, Rm.#106 651 Pine Street NOV 19 1999 Martinez, California 94553 CLERI WAfjr)OF,511PERV CONTRA Co' Go.ISOR S RE: IAONA 1-8 TQUP KIRKLAND DATE OF ACCIDENT: TULY 2, 1999 Dear Sir/Madam: This firm has been retained by Monique Kirkland for her claim against the CONTRA COSTA COUNTY SHERIFF'S OFFICE and Officer, CAROL LOUISE MISSAGGIA. Enclosed please find the County Claim form for Ms. Kirkland's claim. Please have the risk manager contact me. If you have any questions do not hesitate to call me- MONIQUE KIRKLAND CLAIM ATTACHMENT 3 Claimant Monique Kirkland was driving eastbound on Hwy 4 in Oakley at approximately 6:45 p.m. She entered the intersection at Cypress Road on a green light. Defendant Carol Missaggia, an on-duty Contra Cosa County Sheriff's Officer who was acting within the course and scope of her employment, entered the intersection against a red light at a fast speed. Defendant entered the path of travel of claimant and was broadsided by claimant who had no opportunity to take any evasive action. CP 0 f 0. T r Z ,rn o � + A Z 70 t / y N N 4 n c i 4 a � Z A Z v� rn Q• ➢Z to 0 0 cr N .D t N �r P tA o m Ln �3 N 0 .. .r to /fit e• C W . CP = e C( ( q CLAIM BOARD OF SUPERVISORS OF CQMMA COSTA CO=. CALEFORNIA BOARD AM Deceriiber 14, 1c•)99 C161M Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Acton. All Section references are to The copy of this docurnent mailed to you is your California Government Codes. retire of the action taken on your dairn by the Board of Supervisors. (Paragraph IV belovO, Oven pursuant to Government Code Section 913 and 7z��T-0 2w[EM) 915.4. Please note all 'Warnings N10114 19 bij AMOLNT: U-nspecif led COUNTY COUNSEL 4 MARTINEZ CALIF. CLAIMANT: Li-eai Le ATTORNEY: DATE RECEIVED: ADDRESS: 713" Cis fey Street BY DEI rVERY TO CLERK ON: Eay IjPoint, CA 1-4-565, BY MAIL POS714ARIUM: L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL OR, Dated: NnyPn1h(­r 11;,4 jc,,�i( By: Deputy ?1 TAAAAf IL FROM County Counsel M, Clerk of the Board of Supervisors Ca 11 I Vf This claim complies su stantia�y 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 Cl-erk should return claim on ground that it was filed late and send warning of claimant's Tight to apply for leave to present a late claim (Section 911.3). (Other: �fl CA!J'(M 6AIQ Oar-hcj1tq Como[le_s ci 1 Oand 9 m_2 ; qclr� %J Ana e? Ipr© 14 q 96-, 0/1 7 777 4 /1'64,z,1rJ-7W 1'c4e-A�V let�e_41/"r-for 017rlilne y 8�_n County Coufisel Dated: BY: M. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant (Section 9113). IV. ROAM ORDER: By unanimous vote of the Supervisors present This Claim is rejected in full. Otber:___ I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: Jl :2 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 13) 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 7bis Notice. AFMAM OF MA UNG 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 full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above, Dated:_Dp&,_ l2By: PHIL BATCHELOR By ()dJ/_CkDeputy Clerk CC: County Counsel County Administrator a This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i RECEIVED NOV 91999 Novemver 5, 1999. CLERK O A RA OF CO;O COSTA TO: BOARD OF SUPERVISORS AND COUNTY COUNSEL. CONTRA COSTA COUNTY. (Ref: Second Answer To Notice To Claimant Of Late-Filed Claim dated October 21, 1999 and November 3, 1999) I WOULD LIKE TO INFORM YOU THAT YOUR EMPLOYEE DEMOLISHED MY FOUR HOUSES AT 68-70 MOUNTAIN VIEW AVE IN BAY POINT IN DECEMBER 1998. I FILED CLAIM IN OCTOBER 1999, WITHIN ONE YEAR TIME LIMIT FOR REAL PROPERTY. IN SEPTEMBER 1998, YOUR EMPLOYEE DEMOLISHED OUR FOUR HOUSES AT 151 AMBROSE AVE IN BAY POINT. WE ALREADY FILED CLAIM AND LAWSUITS LONG TIME AGO FOR THESE CASES. IN DECEMBER 1998, HE DEMOLISHED FOUR OTHER HOUSES AT 68-70 MOUNTAIN VIEW AVE IN BAY POINT (TOTAL OUR 8 HOUSES WAS DEMOLISHED BY TIM GRIFFITH). THIS CLAIM IS... FOR FOUR HOUSES HE DEMOLISHED IN DECEMBER 1998. TRULY YOURS, LIEM LE 713 CASKEY ST IJAY VOINT, CA 94565. 709-1063, RECEIVED NoCLERK�ry RVISORS AniaOV s°g999 � s� LIEM LE Claimant Vs. CONTRA COSTA COUNTY,AND ITS EMPLOYEE, TIM GRIFFITH. FIRST CLAIM FOR DAMAGES O F © U R P Q U SS 1- © CA -TA�P- -7— 70 .M 0 N—rA I" V/i= k/ y41f le 1 N R A Y P*!A x`7;. CA TO THE CONTRA COSTA COUNTY BOARD OF SUPERVISORS AND THEIR ATTORNEYS, THE CONTRA COATA COUNTY COUNSEL. I am the owner of a real property consisting of four(4)single family residences commonly known as 68-70 Mountain View Ave in Bay Point, Contra Costa County. I has been damaged by the discrimination and the illegal conduct and wrongdoings of Mr Tim Griffith, an employee of the County of Contra Costa, and has suffered damages as a result of such conduct and law violations. On the 25th of June, 1998, 1 received a notice of violation required the corrective actions that I promptly performed. I immediately came to County Building Inspection Dept,and I was given two weeks to clean up junkyard ans remove two trailers. All these works was done before the two week deadline. I also applied for demolition permit to demolisdha room added without permit to the house located at 68 Mountain View,but Mr Tim told me I can do it without permit, and I demolished that room on the 2nd of August, 1998. The refusal to issue permit upon owner's request of County employee is an illegal conduct and a discrimination against me,because other owners are allowed to pull these permits. The sande thing happened to the house located at 68A Mountain View Ave:tenant had failed to pay PGE bill, and PGE removed the meter. It requires aii restoration permit issued so that PGE put back the meter. I applied for that permit,but my application rejected by Building Inspection Dept whose obligations are to issue permits and do the inspection to make sure the deficiencies was properly done. Despite all my corrective works required by inspector Tim Griffith had been done on the 2nd of August and 1I sent him a report to inform the progress of corrective works,but two weeks later, on the 13th of August,he still sent a recommendation for abatement of these four(4)houses on the gound of"improper land use,trailer park land use permit required,illegal junkyard". These condemnation was no longer existed when this abatement decision was made,because I had already performed these corrective actions and he knew it. The justifications and reasons of batement was no more existed,but he still wanted to demolish these four houses. Only his discrimination against me can explain his conduct,violating the abatement code itself. And strangely,by that time,he only inspected one house(70 Mountain View)and only found two minor deficiencies: a loose light fixture and moinsture above bath tub. He didn't inspect three other houses and he didn't let me know what was the code violations and whartwas the corrective works required. Can you condemn to death a person without let him know what crime he committed?. Your employee tried to knock down my four houses after I performed the corrective works he imposed and he didn't let me know what else wrong so that I could fix it,because he only entered one house and found two tiny things that can be fixed without any permit required, and he failed to inspect the three other houses. In his letter sent to me as well as in his recommendation,he mentioned the"substandard dwellings"but I asked him mansy times about the code violation, "please specify them,please let me know what `s wrong" besides the one I already fixed,but he refused to disclose them. Do you believe in this age of information, a County employee tried to hide me something concerning my own property, especially the ones that he could use as the justifications to demolish my four single family buildings?He was hired to inspect people's real property and to inform them the code violations and the corrective works. He has always done these obligations to other owners,but he refused to let me know the specific code violations of my property. Only his discrimination against me can explain this illegal conduct: he wanted to demolish my four houses, without let me know what was wrong and despite my corrective works,because I am an Asian. Oxford dictionary defines that discrimination is"treating a person or a group differently(usu worse)than others". The above facts and the following conduct of your employee will show you I was treated differently, always worse,than others. I applied for permits to comply to code, if there're any violations,but my application was repeatedly rejected. He told me I need to hire a licensed contractor to apply for permits. This is a discrimination against me,because other owners are always allowed to pull permits as owner-builder. My next door neighbor,Mr Bartlett Kenneth, a white man who owns six houses located at 80-88 Mountain View Ave, was allowed many times,to pull permits as owner-buider. I told him about my permit application rejected, he said it's definitely wrong. After my application for permit as owner-builder was rejected,I hired a licensed contractor,Mr Tony Azores, to do this job. He went to Building Inspection Dept to apply for permits,but his applicaytion was rejected too, on the ground his list was not complete. He tried with a second list,but it was also rejected. I told Mr Tim Griffith please let us know what violations and what permits required,we will do exactly everything you want to resolve this matter. But he refused to specify what violation was missing in my contractor's list. And my contractor gave up due to inspector's rejection of permit application. Then I hired the second contractor,Fuller Construction Co,who gave me a list and a proposal to repair the"substandard dwellings". But due to no permit issued on the same ground(incomplete list),he was unable to do the corrective works. And again, Mr Tim Griffith refused to let me know the specific code violations of my four houses. After trying many time unsuccessfully to pull permits and meet many contractors, I was informed that some repair works can be done without any permits, such as replace light fixture,replace regular receptacles with GFCI receptacles, caulk and paint, disconnect the electric cords etc... I performed the following works to fix the deficiencies that I thought what inspector called"substandard dwellings",because,by that time,he didn't specify them. - 70 Mountain View: I replaced the light fixture and caulked and painted the sheet rock above bath tub, the only two defects that inspector found when he came there to inspect. - 68 Mountain View:removed the motion detective light,replace two light fixtures,and installed one GFCI receptacle, and removed sewer pipe connection. - 70A Mountain View: I disconnected the extension cord,replaced one light fixture and covered the main electric panel. - 68A Mountain View: Fixed the broken windows, cauked the bath tub. - These last three houses,no inspector came there of inspection. I did my best to comply with the requirements of inspector. But he repeatedly blocked the permit issuance. In other word,he ordered me to pull permits to repair something that he didn't specify within a two week deadline,and he repeatedly rejected my permit applications until the deadline expired and he put the abatement notice: these four houses was condemned to death and will be demolished and I had not received any specific building code violations, except some minor defects(extension cords,light fixtures...) that inspector took pictures and shown to me and I already fixed all of them. These four houses was in average condition, as good as many others in the neighborhood and better than hundreds of others in Bay Point area.. All four tenants strongly protested the abatement. They wrote four letters presenting to board of supervisors stated their dwelling is in good condition,everything is working and no code violation exists. Dispite all these facts,board of supervisors,without questions and debate,approuved the recommendation of abatement after allowing me presenting my case in three minutes and one of my tenants,representing others,reading, in two minutes, fours letters confirming my corrective works done,their dwelling is not substandard and protesting against the abatement. And I had not received any notice specifying the code violation and I hat not known the reason of abatement. After abatement decision was made, Mr Tim Griffith told me I had to pay$800 to have the comply to code inspection in order to have a list of items be repaired in lieu of demolition. I agreed to pay and only made a small request,because this inspector was biased against me due to my Asian nationality: I informe the County of that belief and asked a different building inspector be assigned, any inspector other than Tim Griffith. The County,without case, and in furtherance of the discrimination against my rights, denied my request of another building inspector. Mr Tim Griffith did the inspection and gave me a list with many false accusations. He declared the two hoses located at 68A and 70A Mountain View had no foundations. This allegation was false. He also stated the front house,68 Mountain View,the roof was leaking. My tenant told me his dwelling wasn't leaking despite it was raining a lot in 1998. I wrote him a letter to protest against these false allegations and asked him to remove them. He didn't answer my letter and didn't correct blatant errors in the report. Mrs Bentley Florence,a white woman, who worked for County Counsel and owns the house located at 139 Ambrose Ave in Bay Point,received a list of repair with the item"no foundation" from Mr Tim Griffith. She protested again this false allegation and Mr Tim agreed to removed it and Mrs Florence saved her house. I had the same false allegation, and, did the same protest, but Mr Tim refused to do the same thing he had done for a white woman, and all my four houses was demolished by him;t4 „DQce-ry� 1998 Besides,I submitted to him my plan for rehabilitation that he could accept or reject within hours.He didn't answer it until 29 days later,he informed me he rejected it. He delayed to answer an important report concerning the fate of four houses worth$250.000 until the time gone and demolition date was too close to do anything else. And he knew time was crucial in this abatement case. He also rejected my request to be allowed reasonable time to repair. He blocked every door and carried out the wrongful conduct with malicious intent to demolish my four houses. He violated abatement code and procedure,abused the power,violated the law against discrimination. In demolishing my four houses,he also violated Amendment L"The right of the people to petition the government for a redress of grievances...",Amendment 4:" The right of the people to be secure in their person,houses...against unreasonable searches and seizures shall not be violated," and Amendment 5:"No person...be deprived of life, liberty or property without due process of law". I believe I am entitled to compensation based on the failure of the County to follow statutory law,because of the negligent conduct in the assessing of defects of the property,because of the abuse of power of its employee,because of discrimination based on race, and because of the failure to properly investigate the facts, issues and law involved in this matter. As a result of the discrimination and the wrongful conduct of the Country of Contra Coata and its employees, and specifically Tim Griffith, I had been damaged as follows: 1. The sum of$250,000, the fair market value of the property, 2. The sum of$100,000,the rents lost for the four houses in three years. 3. The sum of$21,000 for the demolition costs. 4. The sum of$500,000 for pain and suffering and emotional distress. 5. The sum of$10,000 for attorney and court fees. TOTAL DAMAGES: $881,000. This demolition was a wrongful taking and violated State and Federal Law, County of Contra Costa,due to the discrimination and violation of Constitution and Law of its employees, is fully responsible,and has to pay for these damages. Date:, ugust 18,19 Li em Le, Claimant. 713 Caskey St, Bay Point, CA 94565. (925)709-1063. CLAIM BOAR OF STTpE V1S0gS OF Co] 'T COSTA COLTN"TY, CALIFORNIA BOARD ACTIOU DECEMBER 14, 1999 Claim Against the County, or District Governed by 1 the Board of Supervisors, Routine Endor NOTICE TO CLAIMANT and Board Action. All Section references The copy of this doc�mnt railed to you is your California Government Codes. 1 notice of the action taken on your daim by the NOV 2 4 1999 Board of Supervisors. (Paragraph !U belov4, Oven pursuant to Government Code Section 913 and COUNTY COUN,,-:_L 915.4. Please rote all Wrings". MARTINEZ,CALIF, AMOUNT: Approximately $50,000.00 CLAIMANT: James A. Reeves ATTORNEY: DATE November 23, 1999 ADDRESS: 41 Kirkwood Court BY DELIVERY TO CLERK ON: November 23, 1999 Concord CA 94521-1427 BY MAIL POSTMARKED: November 19. 1999 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. HIL B R. C1erJ November 24, 1999 B nDated: pu ILFRO - O.County Counsel TClerk of the Board of Supervi 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: (''a __q I BY: Deputy County Counsel III. PROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOMW ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: D "1 C1 PHIL BATCHELOR, Clerk, By, w Deputy Clerk WARNING (Gov. code sectiW 91?) 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 MAIMG 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 full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By_ ��JJJZ�LDeputy Clerk CC: ro may rounsel County Administrator w i This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. SHARON HYMES-OFFORD 4 N O V 2 3 1999 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 " 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. (Covt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. if the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim by } Reserved for Clerk's Filing Stamp t� /4, 2t C Against the County of Contra Costa NOV 2 3 1999 or CLER CONTRA COSTACo ISORS District (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S and in support of this claim represents as follows: 1. When did the dannage or injur- y Deco.-' (vtzr 4:=-s ate and Hou:; z}-----------------------sr- --------------------------------------------- 2. Where did the damage or injury occur:' (Include City and County) _ 1/2/ .q--d-_ -tve _ -_U'_ !A fir_ qai<s S�h�a , ►gin Ce_nTer-- rT'nC' C�nTe�_ sT�t } �- 3. How did the damage or injury occur? (Give foil details;use extra paper if required> See aTF�.ck rv\-e-e.-r Crf w't 3 ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage' (Over) a s 1► •aul}puE;uawuosudail pas q;oq Sq Jo I(400`pI$) sJEllop puusnog; ua;gulpaaaxa;ou,lo auljE Sq l-uosud a;E;s ay;ul ;uawuosudwl Sq Jo iaal}- pus ;uowuosudwl Bans q;oq �Cq Jo t( 0006 IS ) ssulloP puusnoy; auo gulpaaaxa ;ou,lo aug is Sq 1-nmi auo aug; aJow ;ou;o pouad u Jo; jluf S;unoa aq; ut ;uowuosudwl Sq Jay;la algeyslund sl luppm Jo `JaganoA °;unoaaE `ll!q `mmla ;ualnprmj j Jo asle;Suu•aumuag.l!aums ay;SEd Jo .s►olle o; pazuoq;nE 6Ja3Wo io pJEoq iau;slp Jo 0:)'S;u= Sac o;Jo I imWo Jo pJEoq a;Eu Suv o;;uawSud Jol Jo aauEAiollu Jo;s;uaswd"Pneijap o;;ua;ui q;lai•oqm uosJad SJaA3„ :sop!Aoad apoj IEuad aq;,lo ZL uoi;aaS I10NI by c�'Q� -S Z� •oH auogdalas •off auogdalas L 11,71 2.5 t7�) p �U (ssaJPPv) Q� DOM (aJiuEiL`�iS S�;uELUtEI�} Sauaoud;o ssalppv Pug awgki µ•jlegoq s:q uo uosJad awos.iq Jo (.CauJOUV) :py S33IJLON (INI3S ;ueuscula ay;.tq pawls aq ;snw wmp ayy„ :sapl,toJd Z•Oib 'aaS V03 '.t00 - COmS Gw -o6 --L1 _�r��_9 (91- -� rcz-5 '.�L.S zdp � 'S�� s�'p�c�l '01,�^�r f•v as'r'�.o sso7 ��-��-$ �-LZ-.S I.ti�lOW� W311 31dQ :SJnfu!Jo;uaplaau slq;jo;unoaau uo apuw no�C saan;!puadxa ay;is!'I •b ----_-------------------------------------------_____________________________________ r r Q IM ;v-n?-7 ' 5 1-���do�,,7 ' ' Z av �-LJVUA ' uE�soaop�sasu;lt , asaweH •gslcl!dsoq p 0$V� SaSadkr7 �v�J�� (vgeuisp ao. nfut amadsosd Sus jo;unouis pa3au:gsa age apnlaul) Lpaindwoa;unowL pawlEla aAogv aq;sL,.tt<tton 'G - ------------------------------------------------------------------------------------ •assump osns so;sa;eua.1"oey gasuV -paunsga saSsuusp io saunfui}o fua;xa nni am Lpa;lnsw wrela noS op saunful Jo sagewup iEgA '9 --------------------------- _ --�-\ ---NA 4?-NA-1 It 9- 'jljLVO j-V1 y,CJnfu!Jo a�8wup ay;�ulsnea saaSoldwa Jo's;uu.tJas'saaa�o�u;slp Jo.0;unoa,lo saun'u ay;aJ�;uq� •S 3.How did the damage occur? County owned/operated vehicle drove into the path of my vehicle. The right front of my car collided with the left front tire area of the county vehicle. 4. What particular act or omission on the part of county or district officers,servants or employees caused the injury or damage? The operator of the county vehicle saw my vehicle,made eye contact,looked straight ahead and continued across the roadway making no attempt to stop or avoid the collision.After the vehicles came to rest the county vehicle then proceeded. It occurred to me that the driver was trying to leave or alter the accident scene however he didn't get far due to the damage to his vehicle. I felt that that Mr. Galvin believed he had the right-of-way because he was driving a marked official vehicle and that his supervisors failed to ascertain his ability or attitude before entrusting him with a county vehicle. 6. What damages or injuries do you claim resulted? My auto was totaled,property damage was settled to the satisfaction of the county on August 19, 1999. The shoulder belt caused pain and a bruise in that area. My head snapped forward with enough force to cause my lightweight plastic/titanium glasses to fly off and resulting in a whiplash injury. The injury was painful for 6 weeks and still causes some discomfort most noticeable when trying to sleep and get comfortable on a pillow.Responding paramedics informed me that I was in danger of dying from my injuries and that my blood pressure was 200/100. I am requesting damages in the amount of fifty thousand dollars be awarded. q ' CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY. CALIFO N A BOARD ACTIOM December 14, Claim Against the County, or District Governed by 1 the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to 1 The copy of this docunent tailed to You is Your California Government Codes. _ notice of the action taken on your daim by the jJ (7, w D Board of Supervisors. (Paragraph IV below!, given pursuant to Govertment Code Section 913 and NOV 1 ' -': 915.4. Please tate all *Warnings COUNTY COUNSEL AMOUNT: $150,000.0v (MARTINEZ CALIF. CLAIMANT: Javier siva z Monreal, aka Javier Rivas ATTORNEY: John '. Gonzales--Madrid DATE . ADDRESS: Duran, Gonzales, .%Icnca & 'l�afoy BY D]:LIVERY ?�0 CLERK ON: iyovern►�er 501 Nit. Diablououlevarc 1!, 1�� .c-.te. L MAIL POSTMARKED: ;,;:� T� Lafayette, CaCaliforniac,454�--.i8i�iY L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHI R, 1 Dated: 1c�.c, By: Depu II. FROM County Counsel TSO: Clerk of the Board of Supervisors ( 4--fiis 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:_ �/ / I%��7 By: - Deputy County Counsel 13L FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV BOARD ORDER: By unanimous vote of the Supervisors present: - This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: c c PHIL BATCHELOR, Clerk, Bygt�71'�XJ *AA,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. AFMAVIT OF MAEU NG I declare under penalty of perjury that] 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 full prepaid a certified copy of this Board Order and Notice to Claimant, dressed to a claimant as shown above. Dated. 1 r 1` By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County AdministmtOT r t This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 ' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ****************************************************************************************** RE: Claim By Reserved for Clerk's filing stamp JAVIER RIVAS MONREAL, aka JAVIER ) RECEIVED RIVAS ) - - Against the County of Contra Costa dtX (FAMILY ) NOV 1 7 1999 SUPPORT DIVISION, OFFICE OF DISTRICT �� '` ATTORNEY, CONTRA COSTA COUNTY) X CLERK BOARD OF SUPERVI ORS ����) CONTRA COSTA CO. (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$150,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Claimant was not aware of the Complaint filed by District Attorney' s Office (No. F98-00755) until on or after May 18 , 1999 . Such Complaint was filed on February 17 , 1998 . 2. Where did the damage or injury occur? (Include city and county) Contra Costa County (wages of Claimant were garnished from his employment in Richmond, California) . 3. How did the damage or injury occur? (Give full details; use extra paper if required) See and incorporate Motion of Claimant to Set Aside Default Judgment and for Attorneys Fees and Costs with Points and Authorities and Declarations in Support (attached as Exhibit A) . CONTRA COSTA COUNTY did not have suf- ficient reason, probable cause or sufficient or reasonable basis upon which to file a Complaint in this matter against Claimant. In doing so, CONTRA COSTA COUNTY exceeded its authority and caused Claimant injury and damages . JAVIER RIVAS MONREAL, aka JAVIER RIVAS, is not the father of JONATAN MOSCOSO. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See and incorporate Exhibit A, attached. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown employees of Family Support Division, Office of District Attorney, Contra Costa County, including, but limited to case worker (s) , J.A. Davi and others. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Special damages: Wage garnishment, loss of income, attorneys fees and costs, medical expenses; Other damages: embarassment, emotional distress, physical manifestations of emotional distress, loss of consortium, defamation of character. Dam cies a e continu and laiman rese v s the right- to end. 7. How was the amount claimed above computedh(Include t ie estimated amount or any prospecive injury%lp damage.) Out of pocket for special damages, including billing from attorney at $3 , 787. 38 (from 8/23/99 to 11/15/99) , attached as Exhibit B. Wage garnish- ment amounts is known by CONTRA COSTA COUNTY (as $42 . 00 pay period) . 8. Names and addresses of witnesses, doctors, and hospitals. Kaiser Hospital (Richmond, California) . 9. List the expenditures you made on account of this accident or injury. DATE Mffi AMOUNT See Exhibit B. Wage garnishment is known by CONTRA COSTA COUNTY. ****************************************************************************************** Gov. Code Sec. 910.2 provides"The claim must be 'gn by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) JOHN E. GONZALES-MADRID ) JO N GONZALES-MADRID for Claimant DURAN, GONZALES, OCHOA & TAFOYA ) (Claimant's Signature) 3501 Mt. Diablo Boulevard, Ste. 2 Lafayette, California 94549-3800 ) 2 26 Emeric Avenue (Address) Richmond, California 94806 (925) 283-7201 ) FAX Telephone No. )Telephone No. (9 2 5) 283-9207 ****************************************************************************************** NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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(S 10,000),or by both such imprisonment and fine. 1 JOHN E. GONZALES-MADRID, Bar No. 139455 DURAN, GONZALES, OCHOA & TAFOYA, LLP 2 3501 Mt . Diablo Blvd. , Suites 2 & 3 u Lafayette, California 94549-3800 NOV 15 1999 31 (925) 283 -7201 FAX: (925) 283 -7207 K. �FT SUPERIOR!!V OR\SA 4 Attorney of Respondent JAVIER RIVAS-MONREAL ey .Deputy cI"k 5 6 7 SUPERIOR COURT OF CALIFORNIA, CONTRA COSTA COUNTY 8 9 10 i 11 MATTER OF: ) 12 ) No. F98-00755 CONTRA COSTA COUNTY, ) 13 ) MOTION TO SET ASIDE DEFAULT Respondent, ) JUDGMENT AND FOR ATTORNEYS 14 ) FEES AND COSTS; POINTS AND AUTHORITIES IN SUPPORT OF 15 ) MOTION TO SET ASIDE DEFAULT V. ) JUDGMENT; DECLARATIONS IN 16 ) SUPPORT OF MOTION TO SET JAVIER RIVAS, ) ASIDE DEFAULT JUDGMENT 17i ) Respondent . ) C.C. P. § 473 . 5 18 � ) DATE : December 9 , 1999 iql ) TIME : 8 : 00 a .m. DEPT: 32 20 ` ) 211 Respondent JAVIER RIVAS (hereinafter, Respondent" ) hereby 22 submits his Motion to Set Aside Default Judgment : 23 24 I• 25 FACTS 26 The full and correct name of Respondent JAVIER RIVAS (here- 27 inafter, Respondent" ) is JAVIER RIVAS-MONREAL. See copy of Cali- 28 fornia Driver' s License, attached as Exhibit A (Expiration Date : 1 06/08/99) and as attachment to Exhibit E (Expiration Date : 06/08/ 2I 99) . 3j In August 1994 , Respondent lived in Ontario, California i 4 (which is in Southern California) . He was married to Lidia 5 Alvarez in Riverside (San Bernardino County) , California on 6 September 4 , 1994 . See copy of Certified Abstract of Marriage, 7 attached as Exhibit B. Previous to this time, he had never been 8 to San Pablo, California or to Richmond, California . He never 9 knew, heard of or impregnated a woman by the name of Rosa 10 Moscoso. He is not the father of any children of Rosa Moscoso, 11 including a Jonathan Jesua Moscoso. 12 Respondent lived in Ontario, California from 1988 to 1994 . 13 After their marriage, they lived in Riverside, California. On or 14 soon after November 1994 , Respondent and his bride moved to 2309- 15 8th Street, Berkeley, California, a building with various units . I 16 One of the tenants at that time was a "Jose Ramirez . " 17 � In 1996 , Respondent and his family moved to Richmond where 181 he purchased a home, located at 2526 Emeric Avenue, Richmond, i 191 California 94806 , where he has lived continuously to the present 201 time . Soon after moving, he informed the Department of Motor Ve- 21 ; hicles of the address change . He also issued a Change of Address 22 with the U.S . Post Office . See Notification on article from Bank 23 of America, dated 02/25/97, Attached as Exhibit C. 24 He never moved back to 2309-8th Street, Berkeley, California. 25 Respondent is not related to Josh Ramirez in any way (by 26 blood, marriage, employment or through baptism) . Jose Ramirez 27 never acted as agent for Respondent who has never authorized Jose 28 Ramirez to accept service of process for him. 2 1 ' Respondent first found out about this matter on or after May 211 18 , 1999 when he received a Demand for Payment letter (dated 04/ 3 29/99) from Child Support Collections (State of California, Fran- 41 chise Tax Board) . Mr. Ramirez was able to locate the mother of 5 Respondent' s wife and gave him the letter. She then gave it to 6 Respondent' s wife who gave it to Respondent . 7 On May 20 , 1999, Respondent (with the help of an English- 8 speaking friend) called the District Attorney' s Office - Family 9 Support Division of Contra Costa County (hereinafter, "FSD" ) . He 10 was told to wrote a letter which, he did on May 20, 1999 . (See 11 letter, attached as Exhibit D. ) He also sent, via facsimile, a 12 letter to FSD with a copy of his California driver' s license, ad- 13 dressed to the attention of "Leslie" with whom he had spoken. 14 (See letter, attached as Exhibit E. ) 15 On August 24 , 1999, Respondent was forced to retain the ser- 16 ; vices of John E . Gonzales-Madrid because Respondent was not re- 171 ceiving assurances that FSD was investigating this matter in a 18 ; timely manner . On that day, Respondent and his attorney went to 19 II FCS and spoke with Marilyn Hannon (FSD) about this case . He sta- ff 20 !, ted that Respondent was willing to submit to a blood test . Ms . 211 Hannon said that he could not do so She stated that she would 22 � make arrangements for the mother to be contacted (it had appar- 23 ently not been done despite Respondent' s prior communications to 24 FSD) . Ms . Hannon also stated that the information about Mr. 25 Rivas in Ms . Moscoso' s application "is similar but not identical 26 to that of (Respondent) . " 27 On August 24 , 1999, Mr. Gonzales-Madrid wrote two letters to 28 FSD (See lettere, attached as Exhibits F and G) . In the latter 3 11 letter, he enclosed a colored copy of a photograph of Respondent 21 with a copy of the certified abstract of marriage of Respondent 3 ' to Lilia Alvarez . 41 On August 24 , 1999 , Respondent' s attorney viewed the file 5 about this matter at the County Records Department and obtained a 6 copy of the complete file, including Cuestionario Sobre El Mante- 7 nimiento de Hijos (Child Support Questionnaire) which Ms . Moscoso 8 allegedly filled out (See Exhibit H) . 9 On August 25 , 1999, Mr. Gonzales-Madrid wrote another letter 10 to FSD (See letter, attached as Exhibit I) . 11 Mr. Gonzales-Madrid went to offices of FSD a total of four 12 times about this matter, including August 24 , 1999, September 1, 13 1999 , September 7 , 1999 and November 8 . 14 Respondent has never been served with a written notice that 15 the default judgment in this matter has been entered. 16 , 171 II . 13 ' ARGUMENT i 191 Respondent has not been served with notice of the iudgment: 20 , Code of Civil Procedure § 473 . 5 (a) indicates that a notice 21 , of motion to set aside the default or default judgment may be 22filed: 23 "When service of a summons has not resulted in actual no- tice to a party in time, to defend the action . . . (by 24 the) earlier of : (i) two years after entry . . . or (ii) 180 days after service on him . . . of a written notice 25 that the default or default judgment has been entered. " 26 Respondent did not receive actual notice of the entry of 27 judgment until August 24 , 1999 when his attorney saw the file in 28 the County Records Department . Even so, Respondent has never 4 11 received actual written notice from the County of the entry of 2 default . 3 , The County did not publish notice . 411 5 Respondent' s lack of notice was not caused by Respondent: 6 Code of Civil Procedure § 473 . 5 (b) requires a showing that 7 Respondent' s "lack of actual notice in time to defend the action 8 was not caused by his . . . avoidance of service of excusable 9 neglect . " 10 Respondent contacted Office of FSD immediately upon receipt 11 of the first iota of information regarding this matter. Respon- 12 dent did not attempt to avoid service of process . Respondent' s 13 failure to receive notice and his subsequent failure to answer in 14 a timely way in order to prevent an entry of default was not 15 caused by Respondent' s excusable neglect . 16 Respondent is not the father of the child: 17 The Cuestionario Sobre E1 Mantenimiento de Hijos (Child 18 � Support Questionnaire) which Ms . Moscoso allegedly filled out and 191; submitted to the County of Contra Costa (Exhibit H) indicates i 2011 that someone with the name of "Javier Rivas" as the absent father i 21 of the child. Signed in August 9 , 1995 , it also states (in Span- 22 ish) . 23 - Address of father: "I do not know" 24 - City of father: "San Pablo" 25 - State of father: "California" 26 - Zip Code of father: 1194806" 27 - Telephone No. of father: "I do not know" 28 - Social Security No. of father: "I do not know" 5 1 - Date of birth of father: "I do not know" 2 - Last date that you know of father or received mail from 3 ; him: "august 1994 . " 4 As indicated in the letter of Respondent' s attorney to FSD 5 (dated August 24 , 1999 , attached as Exhibit G) : 6 1 . Respondent client never lived in San Pablo, California. 7 2 . In August 1994 , Respondent was living in Ontario, 8 California (Southern California) . 9 3 . Respondent does not know a Rosa Moscoso. 10 4 . Prior to August 24 , 1999, Respondent had never heard of 11 a Rosa Moscoso or Jonatan (or Jonathan) Jesua Moscoso. 12 5 . Respondent does not know any woman who was born in 13 Guatemala. 14 6 . Respondent is younger than Respondent . 15 Other than the briefest of information -- ie . because of 16 Respondent' s name (which is incorrect) -- there is a paucity of 171 sufficient information by which Petitioner CONTRA COSTA COUNTY 18 could possibly believe or discern that Respondent is the father 19 of Jonathan Jesua Moscoso . This is shocking, unjustified and 20 totally unreasonable . 21 Furthermore, this matter has traumatized Respondent . This 22 matter has effected his relationship with his spouse (who gave 23 birth to their second child on January 1, 1999) , made him the 24 object of jokes in among his family and friends and has caused 25 him to go to receive medical attention due to the stress . 26 27 281 6 1 IV. 2I ATTORNEY' S FEES 31 Code of Civil Procedure §473 . 5 (c) indicates that the Court 4 is empowered to grant such relief "on such terms as may be just 5 and (to) allow the party to defendant the action. " The Court may 6 therefore impose costs, attorney fees or other conditions to 71 remedy any unfairness to the Respondent in setting aside the de- 8 fault judgment . 9 Attorney costs and fees are climbing. Initially, Respon- 10 dent' s attorney attempted to clarify this matter through the 11 office of the Family Support Services, with the hope that the 12 matter would be dropped because of the clearly inadequate basis 13 upon which the District Attorney filed the Complaint against the 14 Respondent . 15 When it became clear that this was fruitless, Respondent' s 16 attorney had no choice but to file this motion. i 17 ; Attorneys fees are at $185 . 00 per hour (his normal rate is i 18 ' $225 . 00 per hour) . Total fees are $3 , 311 . 50 (at 17 . 9 hours, not 191 including transportation to file this document or time to argue i 20 this motion) . This does not include expenses . Respondent re- 211 serves the right to augment this to update costs and to include 22 expenses . 23 24 III . 25 PRAYER 26 For the above-indicated reasons, Respondent JAVIER RIVAS- 27 MONREAL respectfully requests that the Court set aside the de- 28 fault judgment of December 28, 1999 (filed on January 13 , 1999) , 7 1 upon complaint filed by Petitioner COUNTY OF CONTRA COSTA on 2I February 17, 1998 , and that such default judgment be null and 31 void in all respects . 4 Dated: November 15 , 1999 . 5 John E . onzales-Madrid, 6 Attctrney for Respondent JAVIER RIVAS-MONREAL 7 8 DECLARATION 9 I, JOHN E. GONZALES-MADRID, declare under penalty of perjury 10 according to the laws of the State of California that the above- mentioned is true and correct to thbest of my knowledge . 11 Dated: November 15 , 1999 . 12 13 JOH . GO LES-MADRID, Att ney for Respondent 14 JAV R RIVAS-MONREAL 15 DECLARATION 16 I , JAVIER RIVAS-MONREAL, declare under penalty of perjury 171 according to the laws of the State of California that the above- ' mentioned is true and correct to the best of my k wledge . 18 Dated: November 15 , 1999 . 19 t �. 20 I; JAVIER RIVAS-MONR AL 21 TRANSLATOR' S DECLARATION 22 I, JOHN E . GONZALES-MADRID, declare under penalty of perjury according to the laws of the State of California that I am compe- 23 tent to translate from English into Spanish and did fully and completely translate this document from English into Spanish to 24 JAVIER RIVAS-MONREAL. 25 Dated: November 15, 1999 . 26 27 JOH E. N A -MADRID 28 8 :TAY+tf 136t0Qt1{ 4ti�1 e2t9% F04 9 1031E EXHIRIT A gT4 g OK13 URN A 0 Gril FT ----------- ....... _� C ounty of San Bernardino This is to certify that this CE IFIED ABSTRACT OF MARRIAGE document is a true abstract of the official record filed with GROOM:JAVIER RIVAS the County Auditor-Recorder, BIRTH DATE:JUNE A. 1971 BRIDE:LIDIA ALVAREZ MAIDEN NAME:ALVAREZ BIRTH DATE:AUGUST 10, 1970 ERROL J.%4ACKZUfvt Auostor Recorder DATE OF MARRIAGE:SEPTEMBER 4, 1994 copop COUNTY OF ISSUE:SAN BERNARDINO co FILED:SEPTEMBER 9, 1994 ISSUED:SEPTEMBER 9, 1994 LOCAL REG. NBR.: 1994-004399-0 ING `0 112942 6 'O � d mui�G O x 'n eo W4 r 0 W a1 O cr dp?D i a p ° -C=otp ! G •_ is �\ s r � • 4D ,r• sib Mr ii o • • W i 1 dp VA r+ Y i :.� ©?ptpx - �nA2� :• p"`Zit ' -`� =+ °° i UL •y r '' =. tit i mo r i W M r•+ A t i r 'i r Javier Rivas 2526 Emerick Ave. Richmond, CA 94806 (510) 235-6593 May 20, 1999 Contra Costa County District Attorney's Office Family Support Division (925) 313-4200 I recently received the attached notice from the Franchise Tax Board demanding payment of past due child support. The notice was mailed to my old address from several years ago on 4/29/99 and was not delivered to me at my current address until a few days ago. According to the notice, my case number with the county is *0535985A. The problem is that I have no children for whom I owe child support. In fact I have only one daughter who lives with me and my wife (a second baby is due any day.) Apparently there has been some kind of error: Please contact me as soon as possible to help straighten out the situation ! If assistance is available in Spanish it would be greatly appreciated. Thank you very much for your prompt response ! Sincerely, Javier Rivas This letter was prepared by Richard Fehr and any telephone response in English can be made to him at (510) 547-3583 (tel. and fax.) N1't � 1� Leslie, Thank you very much for your help in clearing up this situation regarding mistaken identity of someone who owes child support. I sent you a copy of my driver's license an hour or so ago via fax. Please advise me by telephone and letter once your office has determined its findings in this matter. A telephone message can be left for me today or Monday on the answering machine of Richard Fehr ® (510) 547-3585. Any written communication should be sent to my home address. Sin reT Javier Rivas EXHmT �-�-- uA LIFOR N . Ao*-vw DRIVER LICENSE CLASS:C A6816:547 EXPIRESrwl,n..n.. Tat.• 06-08-`'•1 se.."a".a&sw.n OU' •.a..,�l�rJI.TO�OY"w' . • roe nr..l�w o# NO a70' .14 . t JAV I ER R I VAS "AWEA; 2526 EMERIC AVE • R I CHM0N0 CA 94806 SEX:M HAIR: BRN EY'.., 9RN -� HT: 5-06 WT: 175 Ou8: 06.03.71 09/27/1Q S66 ,O/ FO/9v 1 is s /1 C_ mz (A Lo cli o ro ro ro ro o ro LA � < -.(10 ,-• ro t 0 N 00 o r-tno 7C Vl N :D Z4 p •... • E►-►0-" r* Z►-'M W O b Ota• f") Nit "«► zoo • � � tD G? Ly Z • � O ao r •�m � o DURAN, GONZALES & OCHOA, LLP ATTORNEYS AT LAW LEANDRO N MIRAN jow,4 E.GoNZ�LES-MADRID � .l;t!NZ.�LE�•�L�pRID 1()►IrN EE c)�I�u� 3)OI MT. DI,kal-0 BOULEVARD,SURE 2 L,IFAYETTE, CAUFO RNIA 94549-3800 VOICE (925)283-7201 FACSIMILE (92S)283-7207 PERSONALLY DELIVERED August 24 , 1999 Family Support Division Attn: Marilyn Hannon, Supervisor Gail Elaine Graham, Director Office of District Attorney 50 Douglas Drive, Suite 100 Martinez, California 94553-8507 Re: County of Contra Costa v. Rivas Re: 0535985A Dear Ms . Hannon and Ms . Graham: I represent Javier Rivas-Monreal, aka Javier Rivas, regarding the issue of the child support . Please address all correspondence regarding this matter to me at the above-indicated address . The only thing that Mr. Rivas knows about this case is based on the Child Support Collections notices that he received from Franchise Tax Board (letters dated April 29 and August 3 , 1999) . He immediately had Richard Fahr write a letter to your offices (on May 20 , 1999) . Mr. Fahr wrote to Leslie and sent her a copy of my client' s driver' s license . Mr. Rivas never received paperwork from the underlying court case . Until this morning when I spoke with Ms . Hannon, Mr. Rivas did not know the name of the mother and of the child. He steadfastly denies knowing a person by the name of Rosa Moscoso. When asking the mother to identify the father, please ask her what he looks like. Mr. Rivas has light brown (almost reddish) hair and has freckles. His mustache is red. Mr. Rivas is willing to submit to a blood test . Lastly, Mr. Rivas cannot afford to have money garnished from his wages . His wife does not work and he has two children, one 2 months old. Letter to Family Support Division Re: County of Contra Costa v. Rivas August 24 , 1999 Page Two My client will be taking this letter to your office this morning and will speak with you only for purposes of taking his driver' s license . I wish to also confirm that you have informed me that the in- formation which your office used to identify Mr. Rivas "is similar but not identical to that of (my) client . " Please call me immediately after you make this determination. Mr. Rivas will again have to lose ijAtrXney to take care of this mat- ter. yours, nzales-Madrid at Law of er Rivas-Monreal, aka Javier Rivas JEG:vtg Enclosures RIVAS-DA. 01 Declaracion Yo, Javier Rivas, declaro bajo pena de perjurio segun las leyes del estato de California, que autorizo que Lic . John E. Gonzales-Madrid me representa en este caso. Fecha: August 24, 1999 . AVIER RIVAS-MONREAL Javier Rivas 2526 Emerick Ave. Richmond, CA 94806 (510) 235-6593 May 20, 1999 Contra Costa County District Attorney's Office Family Support Division (925) 313-4200 I recently received the attached notice from the Franchise Tax Board demanding payment of past due child support. The notice was mailed to my old address from several years ago on 4/29/99 and was not delivered to me at my current address until a few days ago. According to the notice, my case number with the county is *0535985A. The problem is that I have no children for whom I owe child support. In fact I have only one daughter who lives with me and my wife (a second baby is due any day.) Apparently there has been some kind of error: Please contact me as soon as possible to help straighten out the situation ! If assistance is available in Spanish it would be greatly appreciated. Thank you very much for your prompt response ! Sincerely, Javier Rivas This letter was prepared by Richard Fehr and any telephone response in English can be made to him at (510) 547-3585 (tel. and fax.) .......... Leslie, Thank you very much for your help in clearing up this situation regarding mistaken identity of someone who owes child support. I sent you a copy of my driver's license an hour or so ago via fax. Please advise me by telephone and letter once your office has determined its findings in this matter. A telephone message can be left for me today or Monday on the answering machine of Richard Fehr ® (510) 547-3585. Any written communication should be sent to my home address. Sin ret -7Javier Rivas .l ",rwAw CALIFORNIA "*VWAW DRIVER UCENSE CLASS:C A6816'54 -7 "%%"*Alto 4.641 tt 1 tN�. M.• wtOtN..w.tts t EXPIRES .a.�..n•.y .+,+«•+Rr.r� +N•+ • .w.O�r, too WMNn N 0114.w. .YM♦ ' 7•!�' JAV I ER R I VASA 44NRUt ZS26 EMERIC AVE IF RICHMOND CA SisO4 SEX:M HAIR: 0RN EY.3:QRN ` NT: S-06 WT: 17S C`-4d: 06.09-71 + r 46/11014 So* 33/ Liss 1 r f Yw W R• , t _An C Q z .� O b t0 E � C CEJ V E tJ 4O CN o M a z ++ M 3 -• p M CL N Q 5G o� a a0 F= , • uM-WE'ocnN oaut- M-- orvv z0a_04 DUPLAN, GONZALES & OCHOA, LLP ATTORNEYS AT LAW LE.k.14nRoff 011RAN ow%4 E.GoNZALES-i'MADRIO it 44N E, )*N7-%L0-M ACRM 3;01 MT.DIABLO BoULEVARO,SUITE 2 VICIOR OCHOA LAFAYETTE, CAUFORNIA 94S49-3800 VOICE (925)283-7201 FACSIMILE (925)283-7207 TRANSMITTED VIA FACSIMILE FAX: (510) 313-4222 August 24, 1999 (Letter No. 2) Family Support Division Attn: Marilyn Hannon, Supervisor office of District Attorney 50 Douglas Drive, Suite 100 Martinez, California 94553-8507 Re: County of Contra Costa v. Rivas Re: 0535985A Dear Ms. Hannon: After my client and I met with you today in your office, I viewed my client' s file at the clerk's office. Included in the file is the Cuestionario Sobre El Mantenimiento de Hijos (Child Support Questionnaire) which Ms . Moscoso allegedly filled out which indicated that my client is the father of the child states (in Spanish) : - Address of father: "I do not know" - Ciudad of father: "San Pablo" - State of father: "California" - Zip Code of father: 119480611 - Telephone No . of father: "I do not know" Social - Security No. of father : "I do not know" - Date of birth of father: "I do not know" - Last date that you know of father or received mail from him: "August 1994 . 11 See attached Questionnaire. Please note that : 1 . My client has never lived in San Pablo, California. 2 . In August 1994, my client was living in Ontario, California (southern California) . Family Support Division Re: County of Contra Costa v. Rivas August: 24 , 1999 Page Two 3 . MY client does not know a Rosa Moscoso. 4 . Prior to today, my client had never heard of a Rosa Moscoso or Jonatan (or Jonathan) Moscoso. 5 . My client does not know any woman who was born in Guatemala. 6 . My client is younger than my Gllefft% Have you: 1 . Called the message number she lists (ie. 510-215-9235) to locate Rosa Moscoso? 2 . Made contact with an investigator to locate her? My client will be taking a color portrait of himself to you to show Ms. Moscoso. Please return it to him after this matter is terminated. I want to make sure that Ms. Moscoso is not making her all-important decision based on a duplicated black and white copy of my client' s license. I also enclose a duplicated copy of Mr. Rivas' license as of June 5, 1996 . Please also be informed that my client informed me that he re- cently had to go to the hospital because of this matter. He was and remains nervous, angry, depressed and stressed by this matter. He can neither afford the wage garnishment nor legal expenses (which are climbing) . Your kind cooperation this morning is greatly appreciated. Please do not take personally my comment that "this is a slap on the face" after you informed me that you "cannot guarantee that (my client) will be reimbursed in the event that it is determined that he is not the father. " t yours, Jo G les-Madrid Javier jAtrn of Javier Rivas- Mo of IT r Mo ea aka Javier Rivas JEG:vtg Enclosure RIVAS-DA.02 CUESMONARIO SOBRE EL. NIANTENIMIENTO OE HIJOS SOLO PARA USO OEL CONOAO(j �0$0CA36NUWE Instrucciones: ASG 0 PA.4fikA cAse mQue '40* �4_n riene que cantestar sodas las preguntai y Ilenar todos los espacios. -.31i A s 0 _-A0A r"ACRENIACR- AUSENTE CEL C Px IE;% rt 140 r-SOWCAKEA NAMZNO CUE VI EiN 'tL HCGAR. �,3 Marque -I.. no,o r r .'t. , . >!,.ra ncia ;-]Pel :cr;eparaco sI necesita mas aspacto. I -COMPLETE LO SIGUIENTE SOBAE OSTEO MISMO w,:%1 R E. 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SOLO PARA MC!mcmeas:m.444c M 1`40.OIL SCGUAOSOCIAL FIECHA 04 MAr— LUGAR 04 MAC, mco SE:CION 4-SER` ICOS CE'CUMPLIMIENTO OE LAS OPOENES OE MANTENIMIENTO(SOLAMENTE MEOI-CAL) 0 No deseo otros seriiclos do cumplimiento do 6rdenes do mantenimiento. flow,% 1st Copy Farr*3uwad0MSJOn 2r,dCcoy CouriyWelarsOOVArr- "w r Al. ;;.ora ..,1:.��'H 1:•G.Vc'-AaE CE?�RT4ENT CF sOC:AL icr CUESTIONARlO SOBRE EL NIANTENIrnIENTO of HiJOs SOLO PARA USO OEL CONOA00 Instrucciones: :� A;♦tNAAIE FSO CASE NAME Tiene que contester todas las preguntas y Ilenar todos los espacios. 0 CASE tiuu Ea FSO CASE NUMBER "•1r'__ _UNa=CA�Ia SCSaE CADA PAOREtiiACRE AUSENTE DEL J — �3 S 3S• -� ,'NO NC�IcEa NAMEJ40 Fs0 WCQKEA NAME�NO P.ai.,RE 31,"1 CASAASc CUE VIVE EN EL HOGAA. y- - ; 'rc a. E;crta la respuesta ccn tetra de imprenta. Marque si, no,o ro ��. ��,e una hcla,Je Papel Por separado sl necesita mds espacio. 'EI•�P►�;"E VLMeER rEI.P1,CNE NUM©ER 5ECCION I -COMPLETE LO SIGUIENTE SOGRE OSTEO MISMO NCMdAe,CE cN ME0:0,APELLIO NOMSAE Of.SOLTE NO.OEL SEGuAO SOCIAL FECHA OF C. LU OEl1AC.. O,AECC:ON OEIC CGAa,CALLE.NO Of APAATAMENTO CtU0A0 C ESTADO ZO STA I_ NUMERO OE TEIEFONO s Via`' v S><o Su PA AE;'c; N LOS NI S SU PAA TESCO COY EL PAORCUAOAE AUSENTEMA0AE SIN CASAR OU vtvE EM EC NOGAq _ ft)11 l�Cdnyuge ❑ Exesposo(a}Cl Amigo(a)❑Otro Sc:CCICN :-COMPLETE LA SIGUIENTE SECCION SoeR•E�EEL PAORE/MAORE AUSENTE DEL HOGAR,0 EL PAORE SIN CASAR QUE VIV EN EL, OGAr A.-_PNiMEAO.OE EN NE010,AP!L:100 �'_ 1 /.' NO. EOUAO 30C�ALMCMER FECMA OE NAC.. Ur M U.:ER /�O c e fr �P W. 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M �+A:,TAL;O S;r�AA.;:<MA,j:•E1 ;Erl'/IC:Q 41LIrArl'r SI E3 ASI �CUANCOICUAL RAMC? K. J 31 i r1C Y•lo:E SEC CION 3•NINOS IEN EL HOGAR OE USTEO GE ESTE PAOREJMAORE AUSENTE 0 PAOR SIN CASARSE SOLO PARA USO OEC NCMBAE OEL NINO V M 1!&,VLSEGUIIOSQC FECHA Of..NAC. L'JGAA OE NAC.. `ACS NOMBAE OEL NINO M NO.Ott SIEGUAO SOCIAL FECHA OE NAC- LUGAA OE NAC. 4C� F NGM8At OEL NINO M No.OIL SEGURO SOCIAL FECHA OE NAC. L'JCAA OF NAC. MCo F LUGAA Of NAC, MCi NOMBAH OEL NIt10 M NO.OtL StGUAO 30CIAL FECHA OE NAC. i ' SECCION 3-SERViCIOS OE CUMPLIMIENTO OE LAS OROENES OE MANTENIMIENTO(SOLAMENTE MEDI-CAL) Cl No deseo otros 3ervicios de cumplimiento de brdenes de mantenimiento. FIRMA FECHA 131 Copy - Family SupPoR '^(i^ccv - C,)tjr?v•No!I,"" L ' O � EY tit.. �. N V E v �© :3c o M Q Z ('V�z c LTJ O QO N C L h-- L rL L +-0 7 ; +J r. (A N.., (1) C (LwG14U =5 • u Rf+� c'D Cn+N ZCYF-GM-XCLCv- EXHI9 DURAN, GONZALES & OCHOA, LLP K TORNEYS AT L.%w Le.�uoau H (71IR\?I JOHN E.GONZALES-MADRID J;mN E.(;A ININLES•.`ACRID 3 iO I NIT. DIABLO BOULEVARD,SUR'E 2 VICTOR()CH(�A LAFAYETTE% CALIFORNIA 94549-3800 144uJRGCNT fool* VoicE (92S)283-7201 FACSIMILE (925)283.7207 TRANSMITTED VIA FACSIMILE FAX: (510) 313-4222 August 25, 1999 Family Support Division Attn: Marilyn Hannon, Supervisor Office of District Attorney 50 Douglas Drive, Suite 100 Martinez, California 94553-8507 Re: County of Contra Costa v. Rivas Re: 0535985A Dear Ms . Hannon: I spoke with my client this morning to confirm where he was living in August 1994, the date that Ms. Moscoso states in her Cuestionario Sobre E1 Mantenimiento de Hijos (Child Support Ques- tionnaire) was the "last date that (she knew) of the father or received mail from him. " My client states that in August 1994, he lived in Ontario, California (which is in Southern California) and that he was mar- ried in San Bernardino County, California on September 4 , 1994 -- the month following the last month that Ms . Moscoso had last con- tact with the father. See attached copy of Certified Abstract of Marriage (County of San Bernardino) . I have the original and will show it to you if you desire . He also states that he did not move to Northern California until after he was married. Is this sufficient to drop the matter? Please respond. j I also enclose a colored copy of photograph of my client . Ve y yours, Jo nzales-Madrid A t me of Javier Rivas- 1 real, aka Javier Rivas JEG:vtg Enclosure RIVAS-DA.03 jWAnk UvWW1Y\Y W,YY�41\Y..M\Y.WY.WW.YY..WUI�YY.J... •Yyy COLint� of San B ernarchti ...•,ty 'hit this CEIFIED ABSTRACT OF MARRIAGE i ',rue abstract '-�I:ord filed with .�_citor Recorder GROOM:JAVIER RIVAS «" BIRTH DATE:JUNE 8, 1971 BRIDE:LIDIA ALVAREZ ` � .s S MAIDEN NAME:ALVAREZ BIRTH DATE:AUGUST 10, 1970 .1 A,, # DATE OF MARRIAGE:SEPTEMBER 4, 1994 y COUNTY OF ISSUE: SAN BERNARDINO a FILED:SEPTEMBER 9, 1994 ISSUED:SEPTEMBER 9, 1994 ;,, LOCAL REG. NOR.: 1994-004399-0 ��a/NO _ 12 9 4.2low n �•r ► v , .rY 1285.85 %rtoPNt:y t)i;OAR IY wirr4;)I Jr A r rf)RNI-Y 4)11 f')OWRNMEWAL A(,LN(*,Y V4 if sVrtif t ir,it :,)dow QR C 0 U R r U Si767 N—L—If -7 N-1-09 1W 110110W IfId ofitlf-fis) JOHN E. GONZALES-MADRID, Bar No. 139455 DURAN, GONZALES, OCHOA & TAFOYA, LLP i 3501 Mt. Diablo Boulevard, Suite 2 Lafayette, California 94549-3800 r F I_f-Pf A()NE 14f) (925) 283-7201FAXNO (925) 283-7207 JAVIER RIVAS, Respondent fC SUPERIOR COURT OF CALIFORNIA.COUNTY OF CONTRA COSTA rR E E T AO OR I-S S 725 Court Street MAILiNG ADORES3 P .O. Box 911 NOV 5 1999 CI TY ANO ZIP COCE Martinez, California 94553 K.TORKE ERK OF THE COURT BRANCH NAME SUPER) A ou T&FL C. ou S�TATEOFCAL?f by 'AA COSTA PETITION E RiPLAINTI F F CONTRA COSTA COUNTY RESPONDENT,'DEFENDANT JAVIER RIVAS OTHER PARENT PROOF OF SERVICE BY MAIL CASE NUMBER F98-00755 NOTICE: To serve temporary restraining orders you must use personal service(see form 1285.84). 1 1 am over the age of 18, not a party to this cause.and not a protected person listed in any of the orders. I am a resident of or employed in the county where the mailing took place. 2. My residence or business address is, 3501 Mt. Diablo Blvd. , Ste. 2 Lafayette, California 94549-3800 3. 1 served a copy of the following documents(specify): Notice of Motion to Set Aside Default Judgment and for Attorneys Fees and Costs; Motion to Set Aside Default Judgment and for Attorneys Fees and Costs; Points and Authorities in Support of Motion; Declarations in Support Of Motion; Order to Set Aside Default Judgment and for Attorney-- Fees and Costs (with attached Answer to Complaint) ; Proof of Service by enclosing them in an envelope AND a depositing the sealed envelope with the United States Postal Serjiceviith the postage fully prepaid at the place shown in 4 following our ordinary b placing the envelope for collection and mailing on the date and business practices. I am readily familiar with this business's practice for scilecting and processing correspondence for mailing. On the same day that correspondence is placed for collection and mailing, it is deposited in the ordinary course business with the United States Postal Service In a sealed envelope with postage !ully prepaid 4 The envelope was addressed and mailed as follows. a Name of person served Gary T. Yancey, District Attorney b. Address: CONTRA COSTA COUNTY, FAMILY SUPPORT DIVISION 50 Douglas Dr. , Ste. 100, Martinez, California 94553 c. Date mailed: November 15, 1999 . d. Place of mailing(city and state): Lafayette, California 94549 5. 1 declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date: November 15 , 1999 . JOHN E GONZ ALES—MAD R ID "7- (TYPE OR PRINT NAME) V *jNAr OF PERSON COMPLETiNc THIS FORMI (See Instructions on revej) FfYM AW*vod by R%"I M 45 itAlctal C04,M4 rA Calf(corwa PROOF OF SERVICE B�MAIL Cod*of Civd Pracedwe.5S 1013 -9, . J=5*4" (Family Law) JOHN E. GONZALES-MADRID, Attorney at Law 3501 Mt. Diablo Boulevard, Suites 2 & 3 State Bar No. 139455 Lafayette, California 94549-3800 (510) 283-7201 FAX (510) 283-7207 Javier Rivas November 17, 1999 2526 Emeric Avenue Richmond CA 94806 Invoice# 10368 Professional services Hrs/Rate Amount 8/23/99 Telephone call from client 0.15 27.75 185.00/hr Letter to FCS 0.45 83.25 185.00/hr 8/24/99 Conference with client 0.15 27.75 185.00/hr Telephone call to FCS 0.25 46.25 185.00/hr Letter to FCS 0.30 55.50 185.00/hr Telephone call to FCS (fax) 0.15 27.75 185.00/hr Conference with client(cont.) 0.75 138.75 185.00/hr To FCS 1.75 323.75 185.00/hr To Records 1.00 185.00 185.00/hr SUMS Javier Rivas Page 2 2526 Emeric Avenue Invoice 4 10368 Richmond CA 94806 Hrs/Rate Amount 8/24/99 Telephone call to FCS (fax) 0.05 9.25 185.00/hr 8/25/99 Telephone call to DA and M. Hanon 0.15 27.75 185.00/hr Telephone call to FCS 0.10 18.50 185.00/hr Telephone call to process server 0.35 64.75 185.00/hr Telephone call to client 0.10 18.50 185.00/hr Conference with client 0.10 18.50 185.00/hr Letter to FCS 0.30 55.50 185.00/hr Telephone call to FCS (fax) 0.05 9.25 185.00/hr 8/26/99 Telephone call to M. Hannon 0.05 9.25 185.00/hr 9/1/99 To DA 2.75 508.75 185.00/hr Telephone call to client 0.10 18.50 185.00/hr Javier Rivas Page 3 2526 Emeric Avenue Invoice # 10368 Richmond CA 94806 Hrs/Rate Amount 9/2/99 Prepare documents 0.05 9.25 185.00/hr 9/6/99 Telephone call to client 0.05 9.25 185.00/hr 9/7/99 Telephone call from client 0.05 9.25 185.00/hr Pick-up photos 0.05 9.25 185.00/hr To DA 0.85 157.25 185.00/hr 9/8/99 Telephone call from Dolores Freeman 0.15 27.75 185.00/hr 10/6/99 Prepare documents 0.05 9.25 185.00/hr 11/4/99 Telephone call to FCS 0.05 9.25 185.00/hr 11/5/99 Telephone call to FCS 0.10 18.50 185.00/hr 11/8/99 To DA 2.10 388.50 185.00/hr 11/9/99 Telephone call to client 0.05 9.25 185.00/hr Javier Rivas Page 4 2526 Emeric Avenue Invoice # 10368 Richmond CA 94806 Hrs/Rate Amount 11/11/99 Telephone call to PPS 0.05 9.25 185.00/hr 11/13/99 Conference with client 0.50 92.50 185.00/br 11/14/99 Read documents 0.25 46.25 185.00/hr Research 0.55 101.75 185.00/hr Prepare Motion 0.65 120.25 185.00/hr 11/15/99 Telephone call to client 0.05 9.25 185.00/hr Prepare MSA 0.55 101.75 185.00/hr Phone call to PPS 0.10 18.50 185.00/hr Prepare MSA (cont) 0.65 120.25 185.00/hr Telephone call to R. Fehr 0.05 9.25 185.00/hr Prepare MSA (cont) 0.35 64.75 185.00/hr Javier Rivas Page 5 2526 Emeric Avenue Invoice# 10368 Richmond CA 94806 Hrs/Rate Amount 11/15/99 Telephone call from R. Fehr 0.15 27.75 185.00/hr Telephone call to MSA 0.10 18.50 185.00/hr Motion(cont) 0.75 138.75 185.00/hr Telephone call from MSA 0.25 46.25 185.00/hr Telephone call from client 0.10 18.50 185.00/hr Motion(cont) 0.65 120.25 185.00/hr Prepare documents 0.84 155.40 185.00/hr Conference with client 0.65 120.25 185.00/hr Telephone call to clerk 0.20 37.00 185.00/hr For legal services rendered 20.04 $3,707.40 Expenses: 11/15/99 Facsimiles through 11/15/99 12.00 Javier Rivas Page 6 2526 Emeric Avenue Invoice # 10368 Richmond CA 94806 Amount 11/15/99 Copies through 11/15/99 66.00 Postage through 11/15/99 1.98 Total costs $79.98 Total amount of this bill $3,787.38 Balance due $3,787.38 Thank you. Please make check payable to JOHN E. GONZALES-MADRID. Please write your account number on your check. Cc CLAIM BOARD OF SUPERYISORS OF QMMA COSTA QD=. CAIHORN71A BOARD An= Dpc--Pmt)er 14, 1999 Mirn Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, j NOTICE TO CLAIMANT and Board Acton. All Section references we to The copy of this dommnt nefled to you is your California Goverment Codes. 1 notice of the action taken on your dairn by the Board of Supervisors. (Paragraph IV belovA, Oven pursuant to Govement Code Section 913 and 915.4. Please rote all "Warnings . A AMOUNT: $257000 Cotj,�,,-ry i..'00UNSEL MARTINEZ CALIF. CLAIMANT: Lidia Rivas ATTORNEY: John E. Gonzales-Madrid DATE RECEIVED: Duran, Gonzales, Ochoa & Tafoya C q� ! J ADDRESS: 3501 Mt. Diablo :boulevard, Ste,By DELIVERY TO CLERK ON: "lover6ber 17 19 Lafayette, California 94549-380gy MAIL POSTMARKED: har „Delivered L FROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. Pic Dated: ii'overdber 19, 99 By: DeputyIAAM IL FROM County Counsel TO: Clerk of the Board of Supervisors �.4e`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: lq-ql By: ul ...Deputy County Counsel IF 131 PROM Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant (Section 9113). TV. BOARD ORDER: By unanimous vote of the Supervisors present: i4This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 0-0,f -- PML BATCIMLOR, Clerk, By Deputy Clerk Iq WARNING (Gov. code se;t-icVn 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. Ste 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 mediately. *For Additional Warning Ste 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 full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. Dated: 9 By: PML BATCHELOR By Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the Califomia Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. i Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100''day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp LIDIA RIVAS RECEIVED x Against the County of Contra Costa(M (FAMILY NOV 1 7 1999 SUPPORT DIVISION, OFFICE OF DISTRICT =1 ATTORNEY, CONTRA COSTA COUNTY CLERK BOARD OF SUPERVISORS CONTRA COSTA (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ 25,000.00 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) Claimant became aware of the Complaint filed by the District Attorney' s Office (No. F98-00755) on or after may 18 , 1999 . Such complaint was filed against Claimant' s spouse, JAVIER RIVAS MONREAL, aka JAVIER RIVAS. 2. Where did the damage or injury occur?(Include city and county) Contra Costa County. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See and incorporate claim of JAVIER RIVAS MONREAL, aka JAVIER RIVAS, and his Motion of Claimant to Set Aside Default Judgment and for Attorneys Fees and Costs, attached as Exhibit A to his Claim. In doing the actions and omissions against Claimant JAVIER RIVAS MONREAL, CONTRA COSTA COUNTY caused Claimant injury and damages, including loss of consortium. 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See and incorporate Answer to No. 3 . above. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown employees of Family Support Division, Office of District Attorney, Contra Costa County, including, but not limited to, case worker(s) , J.A. Davi and others. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Loss of consortium, loss of community property income, attorneys fees and costs. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Out of pocket for special damages. See Exhibit B of Claim of Claimant JAVIER RIVAS-MONREAL. 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT See Exhibit B of Claim of Claimant JAVIER RIVAS-MONREAL. Wage garnishment of Claimant JAVIER RIVAS-MONREAL is known by CONTRA COSTA COUNTY. ) Gov. Code Sec. 910.2 provides"The claim must be ) Sig by the claimant or by some person on his behalf SEND NOTICES TO: (Attorney Name and Address of Attorney JOHN E . GONZALES-MADRID JO;ET. VNZALES-MADRID for Claimant DURANt GONZALESF OCHOA & TAFOYA 3501 Mt. Diablo Boulevard, Ste. 2 (Claimant's Signature) Lafayette, California 94549-3800 2526 Emeric Avenue (Address) Richmond, California 94806 Telephone No. (925) 283-7201 FAX Telephone No. (925) 283-7207 NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the 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. I C CLAIM BoAgp OF SUpEgN11SORS OF CO h" COSTA COLTN7TY. CAIHORNIA BOARD December 14, 1999 Claire Against the Courity, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Acton. All Section references we to The copy of this document mailed to you is your Califorria Governmrit Codes. I notice of the action taken on your daim by the Board of Supervisors. (Paragraph IV beloM, Oven pursuant to Goverment Code Section 913 and 915.4. Please rote all "Warnings". AMOLNT: Unspecified 2 3 19'xj cn. uNTY COUNSEL CLAIMANT: Sharon Renae Ruth MARTINEZ CALIF- ATTORNEY: Thomas N. Petersen, #103037 DATE RECErVED: November 22, 1999 Black, Chapman, Webber & Stevens ADDRESS: ON: November 22, 1999 930 W. 8th Street BY DELIVERY 7`0 CLERK Medford OR 97501 BY MAIL POSTMARKED.. November 19, 1999 L ?SROM: Clerk of the Board of Supervisors M. County Counsel Attached is a copy of the above-noted claim. PHIL B Clerk Dated: November 23, 1999 By: Deputy II. FROM County Counsel M Clerk of the Board of Supervit6rs (t,�7bis claim complies substantially with Sections 910 and 910.2. This claim MLS 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: CPOVL,�,- Deputy County Counsel f IM FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) Claim was returned as untimely with notice to claimant {Section 9113). 1`44 BOARD ORDEX By unanimous vote of the Supervisors present: This Claim is rejected in full. Other: - I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PFUL SATCH!EWR, Clerk, By Deputy Clerk WARNING (Gov. code secticK 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 MA IUNG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United ri States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, Postage full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By„ Deputy Clerk 4Z CC: County Counsel County Administrator n ' This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. s BLACK, CHAPMAN, WEBBER& STEVENS *DENNIS H.BLACK ATTORNEYS AT LAW LEGAL ASSISTANTS ROBERT L.CHAPMAN 930 W.8T"STREET ARTHUR W.STEVENS III MEDFORD,OREGON 97501 ROBERT F.WEBBER WORKERS' COMPENSATION -- *THOMAS N.PETERSEN &SOCIAL SECURITY (541)772-9850 TERESA RICHEY FAX(541)779-7430 JUNE RICH MEMBER OREGON AND bews(dinterneteds.com DON ETTE CRAWFORD CALIFORNIA BARS KLAMATH FALLS OFFICE:(541)884-5999 GRANTS PASS OFFICE:(541)474-3374 PERSONAL INJURY CLAIMS OFFICE ADMINISTRATOR BROOKINGS OFFICE:(541)412-0484 CLAUDIA MAXSON MARLA UHLES YREKA OFFICE:(530)841-0570 WENDY L.PLUNKETT MICHELE MYERS November 18, 1999 Rf CE, CERTIFIED MAIL - RETURN RECEIPT REQUESTED NOV 21,2 1999 CLERK BOARD OF S PERVISORS CONTRA COSTA Co. IZE Clerk of the Board of Supervisors Contra Costa County 651 Pine Street Martinez, CA 94553 Government Tort Claim Government Code Section 910 To Clerk of the Board of Supervisors: I.Name and P.O. Box of Claimant: Sharon Renae Ruth P.O. Box 572 Fort Jones, CA 96032 2. Claimant's Attorneys' Name and Address: Black, Chapman, Webber & Stevens Thomas N. Petersen 930 W. 81h Street Medford, OR 97501 3.Date, Place, and Circumstance of Occurrence: September 9, 1999 through September 19, 1999 12175 Alcosta Blvd., San Ramon, California On or about September 9, 1999, Claimant received a notice of award from Anderson Sweepstakes Services, Inc. by first class mail dated September 9, 1999. She was informed by the correspondence she received that she had won a computer and that she had to pick it up at 12175 Alcosta Blvd., San Ramon, California. The promoter of the sweepstakes was identified as Anderson Sweepstakes Services, Inc., America's leading sweepstakes distributor, P.O. Box 5148, San Ramon, California, 94583-1436. Anderson Sweepstakes is a fictitious entity created and operated by the City of San Ramon Police Department. It is believed that the Contra Costa County Sheriffs Department worked with e San Ramon Police Department in the execution of Anderson Sweepstakes to arrest and transport to the Page 1 of 3 Clerk of the Board of Supervisors Contra Costa County November 18, 1999 Contra Costa County jail wanted fugitives under the guise of a sweepstakes win. Fugitives are identified by law enforcement computer systems and court records and notified by Anderson Sweepstakes that they have won a prize. They are then directed to the above address to pick up their prize. Once they arrive,they are then arrested and transported to the Contra Costa County Jail in a bus owned or operated by the named law enforcement agencies. Claimant was directed by written and oral Anderson Sweepstakes correspondence to pick up her prize, a computer, on Sunday, September 19, 1999 between 8 am and 4 pm. Claimant, who lives in California near the Oregon border drove down to the San Ramon address given to her in order to claim her prize. When she arrived at the site referenced above, she was greeted by representatives of Anderson Sweepstakes Services, Inc. She was escorted into the building and required to present identification and fill out a W-4 form in order to claim her computer. She was then escorted into the back area behind a curtain where a number of persons wearing Anderson Sweepstakes tee shirts approached her. One of those persons, a female, grabbed the claimant by night wrist and informed her that she was under arrest. Claimant formed the people surrounding her that this was a mistake. They continued to handcuff, frisk and twist claimant. Upon further inquiry by claimant, she was informed that there was a warrant for her arrest for possession and /or sale of methamphetamine. Claimant again informed the persons, now identified as San Ramon Police (and also believed to be Contra Costa County Deputy Sheriff s deputies), that there was an error and that the warrant could not be for her. She demanded that they double check their records. One of the persons involved ran her identification again and determined that claimant was not the person they were looking for.According to information received,police were looking for a person by the name of Sharon Diane Ruth of Dublin,California who it is believed does not bear any resemblance to claimant and who has a different date of birth, address, and identification. Despite repeated claims of innocence, police officers disbelieved, ignored, treated claimant with disrespect, and illegally kept her in custody. Despite requests from claimant to officers that they help her retrieve medications she takes for anxiety attacks,the police ignored her. After it was determined that claimant was not the person police were looking for, they released her. However,by that time her boyfriend, who had been waiting for her, had been ordered by police officers to leave the area. Claimant was initially left without money or other ability to make her way home. Eventually, officers were able to contact claimant's boyfriend on his cellular phone and convinced him to return to the premises to pick up claimant. During that period of time officers admitted the error and gave claimant$5.00 for gas money,bought her a pizza at a local pizza parlor, and gave her and her boyfriend two tee shirts with the Anderson Sweepstakes logo on them. Officers also offered to put claimant and her boyfriend up in hotel overnight,which offer was declined. Thereafter,claimant and her boyfriend returned home to Northern California. 4.Description of Injury: Claimant,who prior to the incident on September 19, 1999 was being treated by a physician Page 2 of 3 Clerk-of the Board of Supervisors Contra Costa County November 18, 1999 for a shoulder injury, suffered an aggravation and additional injury to her right shoulder as a result of the treatment by San Ramo police on the day of her arrest. Further, claimant suffers from an anxiety disorder for whict,she is under a doctor's care. The incident caused and continues to cause claimant severe anxiety and related physical symptoms. Claimant suffered extreme emotional distress,humiliation,and anger. Claimant has suffered economic damages as well. 5. Name of Public Employees Causing the Injury: At this time the specific identities of the police officers involved are not known. However, claimant is informed that the Anderson Sweepstakes Services, Inc. was a sting operation created and executed by the San Ramon Police Department and the Contra Costa County Sheriff's Department. 6. Damages: At this time the exact amount of damages is unknown although they will fall within the jurisdiction of either the superior court or federal court. Please direct all correspondence to claimant's attorneys. Sincerely, AAJAI I If I_V R 1A T o as . e- tefsA, ar##103037 orney for Claimant cc: Ms. Sharon Ruth Page 3 of 3 k; �r r t 4' n a �1 WT e yir y s , �,�rel "s,;���'�• x " r t1�� a`,y r s F � w hl HIR �"sF'ht TM �r,c .��P1'�w� & ',�4 r's-a�:. • � a lH r w Z7 R r~a a i, •• U1 �1 li 44 x .y. .«• JF' � '� # �"� ;, +:^is n ¢ i�4� -. a '! i 'r1` 1 # r x t�+'' .,tQ"`>'�5' k: y.Y•,! -t`r a i k ..z. a w ' o-; 01 { , . Py. R F i CLAIM ct ( W 'BOARD OF �TTpFR��i�(1R� OF CO'`"IRA COSTA COITN7 Y. CAL IFORNT A BOARD AnOIV December 14, 1999 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 ttis document mailed to You is Your California Government Codes. I notice of the action taken on your daim by the � °« Board of Supervisors. (Paragraph IV belov4, Oven pursuant to Government Code Section 913 and N Cl` 915.4. Please note all "VWarningsCOU� ". AMOUNT: See settlement statement MAR `� �ZCALIF. MARTINEZ CALIF. CI-43MANT:Jerl Spinelli ATTORNEY: Mark V. Murphy DATE . Attorney at Law ADDRESS: 18 Crow Canyon Court #380 BY DhZ.IVERY TO CLERK ON: November 18, 1999 San Damon, CA 94583 1999 BY MAIL POSTMARKED: November 17, L PROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. pHII R, Cler -1 Dated: November 19, 1999 By: Depu II. FROM County Counsel 7Vt Clerk of the Board of Supe isors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated:_ ��—���� 7� By: CDeputy County Counsel 131 PROM: Clerk of the Board TO. County Counsel (l) 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: Ibis Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: G c PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov. code sectio 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 lois Notice. AFMAVIT OF h141LJ 1G 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 full) prepaid a certified copy of this Board Order and Notice to Claimant addressed to the cl imant as shown above. Dated: S By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Law Offices of MARK V. MURPHY Centerpoint Building • 18 Crow Canyon Court, Suite 380 • San Ramon, CA 94583 (925) 552-9900 9 FAX (925) 831-8483 November 17, 1999 RECEIVED Certified Mail/Return Receipt Requested NOV 181999 CLERK BOARD OF SUPERVISORS Clerk of the Board of Supervisors ONTRA COSTA CO. County Administration Bldg #106 651 Pine Street Martinez Ca 94553 Re: My Client: Jerl Spinelli Date of Loss: 6/13/99 Dear Clerk: Enclosed is Mr. Spinelli's claim regarding his injury accident on June 13, 1999. Please return a filed endorsed copy of the claim in the enclosed envelope. Very truly yours, MARK V. MURPHY MVM:lrl Enclosure (as stated) cc: Client G:\Spinelli,JerhCCC l ltr REPLY TO SAN RAMON OFFICE ANTIOCH OFFICE CONCORD OFFICE LIVERMORE OFFICE PLEASANT HILL OFFICE 511 W.Third Street 2045 Mt.Diablo Rd#104 197 South S Street 101 Gregory Lane#52 Antioch CA Concord CA Livermore CA Pleasant Hill CA Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY , —~ INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553 . C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp JERL SPINELLI } } RECEIVED Against the County of Contra Costa} or } } NOV 1201:9 District} (Fill in name) } CLERK BOARD OF SUPERVISORS } CONTRA COSTA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District Sinf the sum of $ 9 ,5 0 0.0 0 and SEE SETTLEMENToSTA`I'EMENTaANDrE�HIBIT�sF�LEI�oHER��iTH. 1. When did the damage or injury occur? (Give exact date and hour) June 13, 1999 2. Where did the damage or injury occur? (Include city and county) Bay Point, Contra Costa County Intersection of Pullman and Broadway streets 3. How did the damage or injury occur? (Give full details; use extra paper if required) Mr. Spinelli had been walking at the inter- section of Pullman and Broadway, Bay Point, when he stepped into a hole in the roadway and fell, injuring himself. 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? When paving and maintaining the street in question, the county or its agent created or failed to remedy the dangerous condition. (over) 5. What are the names of county or district officers, servants or employees causing the damage or injury? Unknown at this time. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. ) Mr. Spinelli suffered a very painful chest wall bruising and fractured ribs. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage. ) See the settlement statement and exhibits filed herewith. 8. Names and addresses of witnesses, doctors and hospitals. Sutter Delta Medical Center, 3901 Lone Tree Way, Antioch CA 94509. CA Emergency Physicians, 1601 Cummins Dr, D-21 , Modesto CA 95358. Bay Imaging, Walnut Creek, CA. Kaiser Permanente Med Group, Martinez, CA. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT 6/15/99 Sutter Delta, 7 : 08 p.m. $1, 082.05 6/15/99 CA Emergency Physicians 282. 00 9/,15/99 Bay Ima ing 41 .00 Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his SEND NOTICES TO: (Attorney) behalf. " Name and Address of Attorney ) Mark V. Murphy ) A • 09 Wdommiamm Attorney at Law ) (Claimant's Sig at e) 18 Crow Canyon Court #380 ) 122 N. Broadway Street Ir San Ramon CA 94583 ) (Address) Bay Point CA 94565 (925) 552-9900 ) Telephone No. ) Telephone No. (925) 709-6664 NOTICE Section 72 of the Penal Code provides: Every person who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand ($1,000) , or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10, 000, or by both such imprisonment and fine. 1 SETTLEMENT STATEMENT FOR JERL SPINELLI 2 TABLE OF CONTENTS 3 4 5 Page Number I . SETTLEMENT STATEMENT 2-5 6 7 Exhibit 8 II . EXHIBIT SECTION 9 10 A. Photographs of Accident Scene A 11 12 B . Sutter Delta Medical Center 13 Treatment Records and Billing Information B 14 15 C. California Emergency Physicians 16 Billing Information C 17 18 D. Bay Imaging 19 Billing Information D 20 21 E . Kaiser Permanente Medical Group 22 Treatment Records and Billing Information E 23 24 25 26 27 28 • I 'I a 1 MARK V. MURPHY [SB# 838841 Attorney at Law 2 18 Crow Canyon Court, Suite 380 San Ramon, CA 94583 3 (92 5) 552-9900 Fax (925) 831-8483 4 5 Attorney for Plaintiff 6 7 8 SUPERIOR COURT OF THE STATE OF CALIFORNIA, COUNTY OF CONTRA COSTA 9 JERL SPINELLI, 10 Plaintiff, 11 vs . SETTLEMENT STATEMENT 12 COUNTY OF CONTRA COSTA, CITY OF BAY POINT, CITY OF PITTSBURG, 13 Defendants 14 / 15 Plaintiff, JERL SPINELLI, submits the following settlement 16 statement : 17 I 18 LIABILITY 19 Plaintiff, JERL SPINELLI, was injured June 13, 1999 as a result 20 of the negligence of defendants, COUNTY OF CONTRA COSTA, CITY OF BAY 21 POINT and CITY OF PITTSBURG. The incident occurred in Bay Point, 22 Contra Costa County, California. Mr. Spinelli had been walking at the 23 intersection of Pullman and Broadway when he stepped into a hole in 24 the roadway and fell, injuring himself. See Exhibit A for photographs 25 of the accident scene . 26 27 28 2 SETTLEMENT STATEMENT 1 II 2 INJURIES/TREATMENT 3 As the result of defendant ' s negligence, Mr. Spinelli suffered a 4 very painful chest wall bruising and fractured ribs . 5 6 Mr. Spinelli received treatment with the following medical care providers : 7 SUTTER DELTA MEDICAL CENTER (6/15/99) 8 FINDINGS : 9 10 a. Left anterior chest wall pain with ecchymosis and bruising DIAGNOSIS : 11 a. Acute mechanical fall 12 b. Acute left chest wall contusion C. Left anterior clinical rib fractures 13 TREATMENT: 14 a. Emergency room examination 15 b. X-rays, chest C. Administers emergency electrocardiogram 16 d. Administers Demerol and Vistaril e . Prescribed Vicodin 17 See Exhibit B 18 19 KAISER PERMANENTE MEDICAL GROUP (7/14/99) 20 At the time of this visit, Mr. Spinelli indicated that along with the documented problem in his mouth, he was still having pain along his 21 ribs . The doctor failed to make mention of this continuing pain. 22 See Exhibit E 23 III 24 SPECIAL DAMAGES ITEMIZED 25 A. MEDICAL COSTS 26 1 . Sutter Delta Medical Center $1, 082 . 05 27 6/15/99 See Exhibit B 28 3 SETTLEMENT STATEMENT 1 • I 1 2 . California Emergency Physicians 282 . 00 6/15/99 2 See Exhibit C 3 3 . Bay Imaging 41 . 00 6/15/99 4 See Exhibit D 5 4 . Kaiser Permanente Medical Group (estimated) 70 . 00 7/14/99 6 See Exhibit E 7 TOTAL MEDICAL COSTS $1 ,475 . 05 8 IV 9 PAIN AND SUFFERING 10 Mr . Spinelli sustained the following elements of pain and 11 suffering: 12 a. Difficulty walking due to pain from his injuries . b. Loss of sleep for two weeks following accident . 13 c. Initial problems with the following: 14 1 . Fastening seat belt 2 . Getting in and out of bed 15 3 . Getting in and out of car 4 . Grooming 16 5 . Dressing 6 . Shaving 17 V 18 RESIDUAL DAMAGES 19 20 Mr. Spinelli is suffering from periodic chest wall and rib cage pain. 21 VI 22 CONCLUSION/EVALUATION 23 24 The following factors should be considered when evaluating Mr. Spinelli' s claim: 25 26 A. Nature of Injury: 27 Mr. Spinelli has suffered a great deal of pain through no fault of his own. 28 4 SETTLEMENT STATEMENT t t 1 B. Special Damages : 2 Mr. Spinelli has incurred special damages totaling $1, 475 . 05 . 3 In light of the foregoing factors, Mr. Spinelli' s claim has a 4 fair settlement value of $9, 500 . Settlement is hereby demanded on 5 behalf of JERL SPINELLI in the sum of $9, 500 . 6 DATED: November 17, 1999 7 a 8 RK V. MU hY Attorney for Plainti f 9 10 G:\Spinelli, Jerl\SETTLEMENT.STM 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 5 SETTLEMENT STATEMENT Legal Tabs Co.1-800-322-3022 Recycled Stock I R-EXA-10-S f _ . i. }I I j } 't f t S{ j Van s� VW, } F ' r f i i Legal Tabs Co.1-800-322-3022 Recycled Stock#R-EXA-10-S J:JVI LUwc incc vvn: I_IVICR%ACIVLr 1( �"(V (� ANTIOCH,CA 94509 M- odicai Cenky-fied .._��_ RU I L (510)7:9-7200 RECORD '.ATIENT ACCOUNT NO. AUTHORIZATION NO. DAYS REL. ADM:. DATE TIME MED._RECORD t -77,//4 ATIENT NAME BIRTHDATE AGEIMS SEX FC PT.TYPE OSP.SVC RACE PHONE T`iLLL I ,J^RL 'i'f X4 5 49- '. .; ECR '- ;;! G �, ATIENT ADDRESS COUNTY SOC.SEC.NUMBER VALUABLES TAKEN 22) N BROADWAY ST BAY FO I(,,T q CA 9456c5l 565 51A--? YES NO VIPLOYER ADDRESS PHONE RETIREMENT DATE 1, 10 yt: ra/♦:.;y--� r ;,= r+ G;� s 5 ;��—_y f_iY i:x'17 i...r':-1� i S va a•r .aT"?'a Via.+1 v+_.•L q'v I ! -, i RIMARY GUARANTOR PHONE BIRTHDATE . may- 7a =--.�! t= IS , .., DDRESS RELATIONSHIP BROADWAY5 s v i ,i _ r=PY t.—'t S 4 i t1 i �i''.I .1�'— UARANTOR EMPLOYER ADDRESS PAINTING 110 M!-tN.UAs i L T t,.YiN F RA i xC 1 Si.s..J L•A CONDARY GUARANTOR PHONE BIRTHDATE 925 DDRESS �+ t� RELATIONSHIP E�+DADWSJt'-'1� Sz 1 _ic? i'; i 4:'t.`_.: CONDARY GUARANTOR EMPLOYER ADDRESS 3 r A I�dT i NG3 1 10 M.A.i'DALL S TSnAiN F..A:'-;C I S=O,CA 9 MERGENCY CONTACT ADDRESS PHONE RELATIONSHIP �ar-:—p :�} }„V — hi; —ojT .�S CA 945' f= -•.-1 '666IFE Ll '.CIDENT DATE LOCATION TIME HOW P.S.D.A. �.' 41197 ' tt)_ r_;r_'atn F c �:� FST HOLE El YES NO iSURANCE COMPANY INSURED AUTH.NUMBER POLICY NUMBER GROUP NUMBER t--. . -1 .— - *—_ ' _L•: �:i raa"-'—a :— T',�,'� r`t '1t ''a T 0-28-340 —'f8''rte+'' `-1 - .. ,y._c i a a a.i i._ _. i�=:,L f = s 3...`l i v a S1 i v ✓''�^�1 HIEF COMPLAINT REFERRED/BROUGHT BY: CHE.Q-T WALL PATN W. RIVATE PHYSICIAN DR.CODE EMERGENCY PHYSICIAN DR.CODE —c: S j .0`THY 3 = = DF-A L is'•.a :..} -.a i•:i PHYSICIANS ORDERS ]CBC ❑UA X- YS w/ M.D.CONSULT: CHEM 7 _ ❑C&S EKG �-�_ DR: ]AMYLASE ❑IV ❑ABG ]SERUM PREG/OUAUQUANT ❑TET DTTT ❑PULSE OXIMETER TIME PHONED: ❑OZ UMIN SAW PT IN ER TIME J t A r 'HYSICIAN SIGNATURE 1.557(11195) . r 1. NURSING CARE • This hospital provides only general duty nursing care unless upon orders of the patient's physician the patient is provided more intensive nursing care. If the patient's condition is suc as to need the service of a special duty nurse,it is agreed that such must be arranged by the patient or his/her legal representative. The hospital shall in no way be responsible for failure to provide the same and is hereby released from any and all liability arising from the fact that said patient is not provided with such additional care 2. CONSENT TO MEDICAL AND SURGICAL PROCEDURES The undersigned consents to the basic care and procedures which may be performed during this hospitalization or on an out-patient basis. Special treatment or surgical procedures will be carried out upon the order of the physician and the agreement of the undersigned. Emergency treatment or services,which may include but are not limited to laboratory procedures,X-ray examinations,medical or surgical treatment,anesthesia,will be rendered to the patient under the general and specific instructions of the patient's physician or surgeon. 3. RELEASE OF INFORMATION Upon inquiry,the hospital may make available to the public certain basic information about the patient,including name,address,age,sex,general description of the reason for treatment whether an injury,burn,poisoning,or other condition),general nature of the injury,burn,poisoning or other condition,and general condition.If the patient or the patient's legal representative does not want such information to be released,he/she must make a written request for such information to be withheld.The patient or the patient's legal representative may obtain a separate form for this purpose upon request. The hospital will obtain the patient's consent and his/her written authorization to release information,other than basic information,concerning the patient,except in those circumstances when the hospital is permitted or required by law to release information. The undersigned agrees that,to the extent necessary to determine liability for payment and to obtain reimbursement,the hospital may disclose portions of the patient's record, including his/her medical records,to any person or corporation which is or may be liable,for all or any portion of the hospital's charges,including but not limited to insurance companies,health care service plans,or workers'compensation carriers.To ensure coordination of my medical care,I authorize release of medical information to my primary care physician,and/or referring physician. 4. PERSONAL VALUABLES It is understood and agreed that the hospital maintains a safe for the safekeeping of money and valuables,and the hospital shall not be liable for the loss or damage to any money, jewelry,documents,furs,fur garments or other articles of unusual value and small compass,unless placed therein,and shall not be liable for loss or damage to any other personal property,unless deposited with the hospital for safekeeping. 5. FINANCIAL AGREEMENT The undersigned agrees,whether he/she signs as agent or as patient,that in consideration of the services to be rendered to the patient,he/she hereby individually obligates himself/herself to pay the account of the hospital in accordance with the regular rates and terms of the hospital. Should the account be referred to an attorney or collection agency for collection,the undersigned shall pay actual attorney's fees,court costs and collection expenses incurred in the enforcement of this obligation. All delinquent accounts shall bear interest at the legal rate.PROFESSIONAL BILLING:Please be advised that the bill you receive from Sutter Delta Medical Center will be for hospital service only.All professional physician services will be billed separately. 6. ASSIGNMENT OF INSURANCE BENEFITS The undersigned authorizes,whether he/she signs as agent or as patient,direct payment to the hospital of any insurance benefits otherwise payable to the undersigned for the care rendered at a rate not to exceed the regular charges. It is agreed that payment to the hospital,pursuant to this authorization,by an insurance company shall discharge said insurance company of any and all obligations under a policy to the extent of such payment. It is understood by the undersigned that he/she is financially responsible for charges not covered by this agreement. STATUS OF ADVANCED DIRECTIVE 1. Information-Source: (circle one) Patient Spouse Other(who) 2. Does patient have an Advance Directive? ❑ Yes ❑ No If yes:Is copy in record? ❑Yes ❑ No (If no,instruct patient to provide) 3. If no:Would you like an Advance Directive brochure? ❑ Yes ❑ No 4. Info received/recorded by:Admitting Registrar Nursing 5. Advance Directive rescinded by patient: Date revoked Date changed The undersigned certifies that he/she has read the foregoing,receiving a copy thereof,and is the patient,or is duly authorized by the patient as patient's general agent to execute the above and accept its terms. Pt/ nt/Guardian(If othettarj pa ent indicate relationship) Financial Responsibility Agreement by Person Other than the Patient,or the Patient's t Legal Representative:I agree to accept financial responsibility for services rendered to the patient and to accept the terms of the Financial Agreement,assignment of Insurance Benefits. Date Time • Witnes Financially Responsible Party Sutter Delta Medical Center 3901 LONE TREE WAY ANTIOCH,CA 94509 CONDITIONS OF - - ' ADMISSION / REGISTRATION : 29-547(11/98) WHITE-Chart YELLOW-Patient/Guarantor PINK-Business Office SEEN BY ER M.D. PHYSICIAN'S REPORT HISTORY & PHYSICAL TIME (.�21- ZU _ C - -- �' ✓r Nvi -_ �_ Jam, `` fw`�/ _I •i � �F r ''��{�f ' '_ '�I lop DIAGNOSIS: C V / 'ONDITION ON DISCHARGE: C-1GOOD F-1STABLE [IFAIR ❑SERIOUS CCRITICAL Cl EXPIRED ❑CORONER NOTIFIED El POLICE NOTI+ ❑ADMIT TRANSFER ❑STABLE ❑UNSTABLE SIGNATURE Sutter Delta 3901 LONE TREE WAY ' ANTIOCH,CA 94509 Medical Center 510 779-7200 L64P'ATIENT ACCOUNT NO. AUTHORIZATION NO. DAYS IT DATE TIME MED.RECORD r, L:`- ,'; - ('4147394- -R'47-'9 PATIENT NAME �_C:?i. of'i?•iELl.._1, _ � — PH��7:�`7��1�� PAT -=�j--9 �,-:;-;r; - ADDRESS f N P-F'l01D�=j;�Y i S.S.N. - - i =:� P.T. �!=i '.ITY,STATE,ZIP DAY P j; , t CA �_; TAR NO. CLLERK. �' Q PLEASE ORDER OLD CHARY AC l LEVEL 1 3 TRIAGE TO: A O -3LWEIS CIOTHER NAME OB _ AGE Vg I SEX R4 DATE CHIEF COM tNT POLICE NOTI FIE D TIME A VE (x� �• ALLERGIES ONE UNKNOWN O ARRIVAL MODE: U7 TIME TRIP O Wal Q Carried Q WC Q Ambulance t' vt.Car Q PD/SO SIG TUBE IAGEL MEDICATIONS NONE O FAMILY M. PLAN:TRIAGE INTERVENTION PERTINENT MEDICAL HISTORY: Q CIGARETTES Q ETON Z Straight to Room To Waiting Room O CARDIAC O SEIZURE POSITION BLOOD PRESSURE HEART RATE Ice Dressing O ASTHMA O CVA Q-- Splint Other O DIABETES O HTN Medication: Time O PTB O PSYCH Isolation Precautions' HE L TM� RESP b TETANUS LMP NA WEIGHT Unknown SP02 /A*AP REFILL < 2 secs.• >2 secs. G AB T OOM P NA KGS TEMPe� � `I " R AX T EDC LBS S URE PRIMA BRIEF NARRATIVE j I T RPRETfj U 4NO TREATMENT PRIOR TO ARRIVAL Field'R port Q Yes Q No Phil ly/Collar-O 02 IV'S Medications N/1- Spine /Spine Board Q Splints Total Fluids PTA: SKULL Tender Nontender Deformities N/ C-SPINE Tender Nontender Deformities N/ FACE Symmetrical Asymmetrical Deformities N/ EENT V.A. OOS Drainage Deformities N/ NECK Supple Nuchal rigidity Othe N/ RESPIRATIONS�S !2?w Dee Slow L bore ffortless etr&Cti mmetri A rn trlcICHEST AUSCULTATI ar Stridor eeze - pp J�� C ��p Ul5 N�, OTHER: % (i ABDOMEN BOWEL SOUNDS: Present Abse A EARA'NCE:Distend n (sten Soft Rigid N/ Rebound Tender OTHER: Nausea VomitingB1e in G.U. Burning Frequency Urgency Hematuria Other Leu rotein Glucose Ketones N/ PELVIS: Stable Unstable Bili Blood Nitrites PULSES: DEFORMITIES: EXTREMITIES APPEARANCE:Warm Cool Pink Cyanotic Pale Mottled Edematous N/, Capillary Refill-1E:2 secs. >2 secs. LUE RUE LLE RLE SPINE ntencler Deformities N/: SKIN War ) Dry Cool Clammy Diaphoretic Mottled Cyanotic Pale Other N/ MU MBRANES: Moist Dry Pale Pink PHYSICAL (�"1rDVe—v-e—ic`pq-.8> Slender Frail Robust Obese Elderly U N/: AMBULATION Q Wheelchair Q Stretcher Q Cane Q Walker N/ Actual/Pot ntial ASS SMENT: Actual/Potential ASSESSMENT. Actual/Potential ASSESSMENT: O O 1. a Respiratory function O O 6.Impaired physical mobility O O 11.Altered or impaired vision O . O 2.Altered Cardiac function O O 7.Altered Comfort O O 12.Behavioral impairment O O 3.Altered or impaired Neurologic status O O 8.Impaired tissue/skin integrity O O 13.Otber O O 4.Potential fluid and electrolyte O O 9.Altered or change in elimination(GI/GU) O O 5.Altered body temperature O O 10.Infection O O �1 Sutter Delta Medical Center ; 3901 LONE TREE WAY • ANTIOCH,CA 94509 ,..; :; I ;•f.;:: ,., .• EMERGENCY DEPARTMENT TRIAGE/NURSING CARE PLAN 29-147(3%97) _ SUTTER DELTA MEDICAL CENTER DEPARTMENT OF MEDICAL IMAGING B.T. LEE, M.D. E. J. SALDINGER, M.D. , DIRECTOR K.E.M. TAO, M.D. S . CHOI, M.D. J.H. FISH, M.D. Radiographic Report Emergency Room: SPINELLI ,JERL X-ray No. 111516 Physician: DR. TIMOTHY DRAZEK Med Ree No 0147394 DOB: 03/24/51 48 M Hospital No. 2737047-1 Room #: Date: 06/15/99 PA AND LATERAL CHEST (71020 ) : HISTORY : Chest pain (786 . 5 ) . There is no comparison, FINDINGS : The heart is of normal size . No hilar or mediastinal enlargement is seen. The lungs are free of focal infiltrates or pleural fluid, . Pulmonary vessels are within normal limits , IMPRESSION: No acute disease , ER_. J, SALDINGER, M. D. 0 EJS/MRC74 06/15/99 : 06/15/99 17 : 07 .e r t s, a aq -+t♦Q1 sr _ SUTTERDELTA MEDICAL CENTER 3901 Lone Tree Way Antioch, CA 94509 (510) ??9-?200 s n EMERGENCY ROOM REPORT PATIENT: SPINELLI, JERL 147394 DATE OF ER VISIT: 06/15/99 TIME OF EVALUATION: 0720 PHYSICIAN: TIMOTHY DRAZEK, M.D. CHIEF COMPLAINT: Left sided chest pain after fall . HISTORY OF PRESENT ILLNESS : This is a 48-year-old male with multiple medical problems . He has a history of hepatitis, alcoholic cirrhosis, liver cancer, and diverticulosis . He claims that on 06/14/99 that at night while walking, he claims he tripped and fell onto a curb onto his left chest . He claims initially, he had the wind knocked out of him, however, he claims he had improved somewhat . However, since then, he has had increasing sharp, pleuritic pain localized to his left anterior chest wall . He claims when he rests, he still has a persistent dull- ache . However, when he moves or takes a deep breath he has significant discomfort to the left chest . He is starting to feel increasingly short of breath, especially with exertion. Concerned by this, he presents to the closest facility for further evaluation. PAST MEDICAL HISTORY: As above. s SURGICAL HISTORY: He has had shoulder. MEDICATIONS : Motrin. ALLERGIES : ERYTHROMYCIN. SOCIAL HISTORY: The patient has a history of IV drug abuse, however, claims he has been clean for some time . He is usually seen in the Kaiser health system. He is married. His wife is currently him. PHYSICAL EXAMINATION: GENERAL: Reveals an uncomfortable, but nontoxic, well developed, 48-year-old male . VITAL SIGNS : Initial blood pressure 132/76 . Heart rate 67 . Respiratory rate 20 . 02 saturation is 97% on room air, and nonhypoxemic . Temperature 98 . 1 orally. HEENT: Head is normocephalic . No evidence of acute trauma. Pupils are equal . Extraocular movements are intact . Sclerae are slightly jaundiced. Tympanic membranes and oropharynx are clear. NECK: Supple . HEART: Regular without murmurs, rubs, or gallops . ,S SDMC EMERGENCY ROOM REPORT PATIENT: SPINELLI, JERL 147394 PAGE 2 THORAX: The patient ' s left anterior chest wall shows ecchymosis and bruising of approximately 8 x 12 cm oval area. There is no evidence of laceration. No evidence of step-off . Palpation of this area is diffusely tender. No crepitation or subcutaneous emphysema is noted. ABDOMEN: Soft and nondistended. Positive bowel sounds . There is mild organomegaly and right upper quadrant fullness . The patient does 'have a history of cirrhosis and hepatitis . EXTREMITIES : No cyanosis, clubbing or edema. NEUROLOGIC: Nonfocal . SKIN: Slightly icteric with scattered spider angiomata. No petechiae or purpura. MEDICAL DECISION MAKING AND EMERGENCY DEPARTMENT COURSE : Given the patient ' s history and physical, it appears he has had a mechanical fall with left anterior chest wall contusion. Given his age and multiple medical problems, however, the patient undergoes emergency electrocardiogram to rule out for possibility of cardiac ischemia. This is interpreted by me showing a normal sinus rhythm with a rate of 62 with normal intervals and normal axis; no evidence of ST segment elevations or depression; nothing to suggest acute ischemia or infarction. The patient is , given parenteral analgesics, including Demerol and Vistaril with good results . The patient undergoes emergency chest x-ray, both PA and lateral, and interpreted by me as showing possible very mild anterior left rib fracture, nondisplaced; no evidence of pneumothorax; no evidence of underlying pulmonary contusion. ` It was discussed in detail to the patient that he has clinical rib fractures . The patient is given a prescription for Vicodin, and instructed to use these sparingly. He is to follow-up with his regular physician within 24-48 hours . He is to return to the Emergency Department for any increasing pain, shortness of breath, fever, or chills . He is given printed instructions on care for rib fractures . . The patient is discharged to home in the company of his wife in a stable and improved condition. EMERGENCY DEPARTMENT DIAGNOSES : 1 . Acute mechanical fall . 2 . Acute left chest wall pain. 3 . Left anterior clinical rib fractures . 4 . No current evidence of cardiac ischemia or myocardial infarction. 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Ic.99 8 17 AM EPRP i E-4 m cr% c� .0 1 0 1 WIT o z 1 0 4-1 -H I rn (n fn I o E-4 44 1 < ro > 41 cn W �" U Ln Z H I tn (a I ;X4 C-1 CIA a) r:4 4 %4 1 x 0) 1 Q) rC$ 1 C14 00 rl 0 r- f �4 1 �q' E-i i Z C I W. o H I E-4 rX4 rq 4J > ro -H 8- L) -H 0 rcl = �4 C�4 1 0 >1 Q) I It 1 = >1 :> E-4 i > 04 (13 1 + 0 0 to ;> �4 Q) 0 W w rc$ 0 4) E-4 r4 K U E-f .rq m —7 �4 U') �4 1 H 04 1 04 0 4 1 (13 O'A H 9 .0 1 r-I r-i tO Z o H I I 1:� --, H 0� 1 44 1 1 Lo > E 4-J 0 in '--i H E-4 -H I E-4 I'D I &) 0 tri rq ON > 0 E-4 -4* 1 1 E- Ef) E-4 0 H Lr) CO 1 %44 1 H H a) 9 U a) I -ri I % u H 00 1 -r4 H > g 1 .,4 %-D E-1 cq i -y F-i r--i 1 (1) 1 43 1 fil CL4 44 a4 4 M I (Z a4 1 0 �4 1 --f I < W - %4.4 4 * - C14 C) I a, Lf) C4 to I � 04 :9 0 1 0� rd l• _ - • • 1 • •�- i t -_j Z4 1i• 1 1 • 1 f 1 l!16 Su.tteY.Delta Medical Centel' 3901 LONE TREE WAY' ANTIOCH,CA94509 PATIENT PRESCRIPTION NAME:-JERL'SPINELLI DATE.: ©61'i511999: ADDRESS-. _. CHART: NO :273.7047 Vicodin Tabs.(Must be handwritten) PHYSICIAN 1MOTH :DRAZE.K, MD.: DEA NO.: BD4360688 3901. Lone Tree Way, Antioch, 94509,:,..(510)779-7200 PATIENT: JERL. SPINELLI MEDICATION'[NST RUCTIONS Vicodin Tabs.(Must be'handwritten) _ This product causes drowsiness, nausea constipation. Take with food. s FORM NO 29-M(8198) • is lei I 17 1 k I I • - -.. - Sutter Delta Califs I Law requires'any child Medical .under Lne age of 4 or under 40 pounds Center 3901 LONE TREE WAY . to be restrained:In a federally ANTIOCH,CA 94509 approved car safety seat whenever traveling in a motor vehicle. PATIENT AFTER CARE INSTRUCTIONS PATIENT: JERL SPiNELLI DATE:'6/1511999 8 46AM: PLEASE NOTE The examination,treatment and interpretation of diagnostic studies and laboratory tests you received to the emergency department have been rendered on an emergency basis only. They are not intended to be a substitute for or effort to provide complete medical care. Your X-rays and EKG have been interpreted by the Emergency Physician.on.a temporary bans If there are significant findings when interpreted by the _... _. specialist we will make every:effort to notify you promptly. A copy,of your record and reports of-all laboratory, X-ray and other tests will..be available to your follow-up doctor, if requested by,him The follow-up physician can evalOate you for any new,or continuing problems.at the thine of your visit, because it is impossible to recognize and treat.all elements ofinjury or illness in an emergency department visit. DIAGNOSIS: FRACTURE, RIB(S) You have fractured (broken), one or more-ribs. _Usually the first 3 days are the most painfulfthen your pain should decrease:graduaII over several'weeks. You wil[.be most:ur comfortable:.when #urning o ver or -in ar:out of bed There has beer�::a trend'awa from M. use of getting y _. rib':belts or taping because of the'increased:risk...of pneumonia or:a collapsed lung. Instead pain medicines should help you''breathe'deeply. INSTRUCTIONS: : Apply.ice.to injured area for.:15-20.minutes every 1 2 hours':for the first 1=2 days, then 4 times.,a:day far 'l-2 additional:days. Try to frequently take deep breaths ,to keep the lung well::-aerated Do not apply a brace or ace wrap around your rib cage Do not:sleep on the painful side--this will increase your pain. Contact the Doctor if: you develop shortness.of breath, a cough, fever:or increasing abdominal discomfort. Additional Instructions: CALL THE FOLLOWING.NUMBER TO ARRANGE FOLLOW-UP CARE IN 1-2 DAY'S. ANTIOCH CLINIC KAISER (925)779-5000 When. you call for`an appointment, say that you were referred front this Emergency Department, TREATING PHYSICIAN! TIMOTHY DRAZEK, MD. I hereby acknowledge that i HAVE RECEIVED AND UNDERSTAND THESE INSTRUCTIONS AS INDICATED. I understand:that= I may be released before all my_medical problems ate known:or treated. I Il.arrange fol w uP care as instructed above.,: k ? PATIENT's SIGNATURE: ; I have explained the instructions and Igen:a.co to the patient..: P 9 . Pyr - P ` . hIURSE's SIGNATURE, FORM NO;.29-22G(&98) _. • • • • I IF=&COXTI 06/21/99 Patient Biel Page SUTTER DELTA MEDICAL CENTER OUTPATIENT FINAL 3901 LONE TREE WAY Telephone: 9257797200 DETAIL ANTIOCH, CA 94509 Tax Id. No : 94-1552887 ----------- Patient ----------- ----- Responsible Party ------ Patient Number SPINELLI,JERL JERL SPINELLI 2737047 122 N BROADWAY ST 122 N BROADWAY ST #13 BAY POINT, CA 94565 Medical Record BAY POINT, CA 94565 0147394 Birth Date:03/24/51 Age: 48 Sex: M Admission Date: 06/15/99 07 am Soc. Sec. :554-78-8900 F/C: 10 Room: Discharge Date: 06/15/99 Admitt. Physician: Statement from: 06/15/99 Attend. Physician:TIMOTHY DRAZEK, DR. Statement thru: 06/15/99 Company Plan ----- Insurance Coverage ----- Group Number Policy Number 1. 10 AISR KAISER HEALTH PLAN CLAIMS/ER 03289840 2. 3. 4 . DETAIL Date/Cde Procedure -------- Description -------- Hcpcs Cd Qty Charge Amount 06/15/99 71402192 STAT FEE 1 0.00 06/15/99 71400220 CHEST TWO VIEWS (PA & 71020 1 196. 61 06/15/99 71100234 ELECTROCARDIOGRAM 93005 1 205.07 06/15/99 72351547 E.R. LIMITED MEDICAL VISIT 99282 1 141.75 06/15/99 72351463 E.R. OBSERVATION 3-6 HR 99201 1 412.42 06/15/99 72351646 INJECTION ONLY 90782 1 41. 10 06/15/99 71764047 HYDROXYZINE 50MG/ML 2ML INJ 99070 1 42.70 06/15/99 71795900 DEMEROL 100MG INJ 1 42. 40 Total Charges 1082.05 CURRENT DETAIL: 1082.05 SUMMARY Date/Cde Procedure -------- Description -------- Hcpcs Cd Qty Charge Amount 250 PHAR PHARMACY 3 126.20 320 X-RAY RADIOLOGY DIAGNOSTIC 2 196. 61 450 E/R EMERGENCY SERVICES 2 554 . 17 730 EKG ELECTROCARDIOLOGY SERVICES 1 205.07 CURRENT SUMMARY: 1082.05 TOTAL AMOUNT DUE: 1082. 05 Legal Tabs Co.1-800-322-3022 Recycled Stock#R-EXA-10-S PLEASE ILI 'T ,EA1'- TH '�:-L AIN C L A-T M F DO Nb F n 0 0.1", 4 1� STAPLE j .1, 1 - IN THIS 0r VAL A N D CA 9460A. AREA PV f !Nf-..j '�,J/ ATTACHMNT PICA HEALTH INSURANCE CLAIM FORM PICA 1. MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA OTHER la.INSURED'S I.D.NUMBER (FOR PROGRAM IN ITEM 1) HEALTH PLAN BLK LUNG (Medicare#) [](Medicaid#)[:] (Sponsor's SSN) f-� (VA File #) X (SSN or ID) ❑ (SSN) ❑ "D) 0*-'.?2 8 9 8 4 2.PATIENT'S NAME(Last Name,First Name,Middle Initial) 3.PATIENT'S BIRTH DATE 4.INSURED'S NAME(Last Name,First Name,Middle Initial) MM , DID 1 YY SEX cr"*P I NE07 8 1 5 1 5.PATIENT'S ADDRESS(No.,Street) 6.PATIENT RELATIONSHIP TO INSURED 7.INSURED'S ADDRESS(No.,Street) I N UR 0 A# W.A Y S T Self Y SpouseE] Childo OtherF] 1 P A2' N BR 0 A D W A Y S CITY STATE 8.PATIENT STATUS CITY STATE BAY POINT CA Single E] Married El Other El BAY POINI- CA ZIP CODE TELEPHONE(Include Area Code) ZIP CODE TELEPHONE(INCLUDE AREA CODE) Employed Full-Time Part Time - ?" 1, 4�,6'S (191 0 9 6- 4 Student 1:1 Student L] c4l 9.OTHER INSURED'S NAME(Last Name,First Name,Middle Initial) 10,IS PATIENT'S CONDITION RELATED TO: 11.INSURED'S POLICY GROUP OR FECA NUMBER a.OTHER INSURED'S POLICY OR GROUP NUMBER a.EMPLOYMENT?(CURRENT OR PREVIOUS) a.INSURED'S DATE OF BIRTH SEX YES FN/-]NO MM I DD i YY❑ M F lr%l 03 JR-Y4 19'S I Lz!!j ❑ b.OTHER INSURED'S DATE OF BIRTH SEX b.AUTO ACCIDENT? PLACE(State) b.EMPLOYER'S NAME OR SCHOOL NAME MM DD i YY MF-] FFYES Fv-1 NO-1 AID. PAINTIN'G c.EMPLOYER'S NAME OR SCHOOL NAME c.OTHER ACCIDENT? c.INSURANCE PLAN NAME OR PROGRAM NAME DYES ©NO KAISER PERMANCNT'r*' d-INSURANCE PLAN NAME OR PROGRAM NAME 10d.RESERVED FOR LOCAL USE d.IS THERE ANOTHER HEALTH BENEFIT PLAN? 11 YES Y NO if yes,return to and complete item 9 a-d. READ BACK OF FORM BEFORE COMPLETING&SIGNING THIS FORM. 13.INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize 12.PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other information necessary payment of medical benefits to the undersigned physician or supplier for to process this claim.I also request payment of government benefits either to myself or to the party who accepts assignment services described below. below. SIGNAWPE ON I-ZILE 07-08-- 99 �IGNATURE ON FII-i-7- SIGNED DATE SIGNED 14.DATE OF CURRENT: ILLNESS(First symptom)OR 15.IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. 16,DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION MM i DD i YY INJURY(Accident)OR GIVE FIRST DATE MM i DID YY MM i DD i YY MM i DD i YY PREGNANCY(LMP) FROM TO 17.NAME OF REFERRING PHYSICIAN OR OTHER SOURCE 17a.I.D.NUMBER OF REFERRING PHYSICIAN 18,HOSPITALIZATION DATES RELATED TO CURRENT SERVICES MM DD YY MM DD YY DRAZEK , TIM M .Q , FROM TO 19.RESERVED FOR LOCAL USE 20.OUTSIDE LAB? $CHARGES 1:1 YES E NO I 21,DIAGNOSIS OR NATURE OF ILLNESS OR INJURY.(RELATE ITEMS 1,2,3 OR 4 TO ITEM 24E BY LINE) 22.MEDICAID RESUBMISSION CODE ORIGINAL REF.NO. 1-l'86 --9 'CHEST FAIN NOS F SSE FALL � $ 1. r 3. ;--RO 1 23.PRIOR AUTHORIZATION NUMBER 2. La Q 0 F-CLOSED UNSPE L L._Q_ FX Rlr-; 24. A B C D E F G I H I I J K DATE(S)OF SERVICE Place Type PROCEDURES,SERVICES,OR SUPPLIES DAYS EPSDT From To of of (Explain Unusual Circumstances) DIAGNOSIS OR Family RESERVED FOR MDAXY MM DD YY Sorike." C"!�r CODE $CHARGES "y E-MG COB LOCAL USE �S MODIFIER UNITS Plan -RIP 19 1 0 0 1 A LEVEL EMERGENC" Y, PHY!-c; C,'-,1ARGE 2 C,cr P 0 6 1 1 E7, 19 9 C'3 0 0 1 XX fl T r'l-'H I (' ALL 4 06 '15 19S., 23 9 9301 ", 1 3s , OC O' l XX 5- PR LIN E K G 12 LUAU INTERP 6 25.FEDERAL TAX I.D.NUMBER SSN EIN 26.PATIENT'S ACCOUNT NO. 127,ACCEPT ASSIGNMENT? 28.TOTAL CHARGE LINT PAID 30.BALANCE DUE (For govt.claims,see back) 29.AMOUNT R YES NO $ oo $ P 1 8 0 P 73-1 047 0 � 0 0 $ 4 P 0 0 8-0-:3 2 9 S i I 31.SIGNATURE OF PHYSICIAN OR SUPPLIER32.NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE 33.PHYSICIAN'S,SUPPLIER'S BILLING Nfv* IJES INCLUDING DEGREES OR CREDENTIALS RENDERED(If other than home or office) &PHONE# 7 (I certify that the statements on the reverse C E DE(. TA M E M O R IAL HOSP ",A E M 1-FR "(S DEI TA apxVo this bill and Ore made a part thereof.) D E K T IM M .0 2'0 T �5 5 1- I CLIHI,4 7 1,'r CN 4 44 P #D - G7 9 18 ANT I Ok'--H CA 9"!`_30 9 MODES"I 0 CA 95--j,58 -6403 I SIGNED 0 -0-BA-f E9 9 PIN#C,7 9 9 1G S RP# 66-0 329 1 S-7 I (APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/88) PLEASE PRINT OR TYPE FORM HCFA-1500 (12-90) A4FBCJV�D�UB-0931f008 03 �-:.-7_00000. 000, FORM OWC P-1 500 FORM RRB-1500 ;7 PLEASE H;=-"'-Tw In' A'74 C L A 1 M F DO N& STAPLE IN THIS OAKLAND CA-1 9 46 0 q AREA PV1 IN 'W,` A T T A C H N N I 1 X7 PICA HEALTH INSURANCE CLAIM FORM PICA 1. MEDICARE MEDICAID CHAMPUS CHAMPVA GROUP FECA OTHER Ia.INSURED'S LD.NUMBER (FOR PROGRAM IN ITEM 1) HEALTH PLAN BLK LUNG (Medicare#) [:](Medicaid#)[:] (Sponsor's SSN) ❑ (VA File #) [X] (SSN or ID) ❑ (SSN) Ej ('D) 0 3 t-9 8 4 0 2.PATIENT'S NAME(Last Name,First Name,Middle Initial) 3.PATIENT'S BIRTH DATE 4.INSURED'S NAME(Last Name,First Name,Middle Initial) MM DD YY SEX C*P TNE I i 1 0 3 1 N EL L I ji- Rl- 5.PATIENT'S ADDRESS(No.,Street) 6.PATIENT RELATIONSHIP TO INSURED 7.INSURED'S ADDRESS(No.,Street) 12 2 N B R 0 A D W A T Self 2 Spouse D Child[] OtherF-] 122-' N BROADWAY S CITY STATE 8.PATIENT STATUS CITY STATE BAY POIN-i Single Married Other BAY PO!Nf C A D ZIP CODE TELEPHONE(Include Area Code) ZIP CODE TELEPHONE(INCLUDE AREA CODE) C" i:- - Employed D Full-Time Part-Time ' 0 Sj "-6 4 - -S Student El Student nt 9.OTHER INSURED'S NAME(Last Name,First Name,Middle Initial) 10.IS PATIENT'S CONDITION RELATED TO: 11.INSURED'S POLICY GROUP OR FECA NUMBER a.OTHER INSURED'S POLICY OR GROUP NUMBER a.EMPLOYMENT?(CURRENT OR PREVIOUS) a.INSURED'S DATE OF BIRTH SEX F❑YES Fv-�NO MM , DD : yy -I M F�'kl F I le,1 0 3 P-4 41 9 5 1 ❑ b.OTHER INSURED'S DATE OF BIRTH SEX b-AUTO ACCIDENT? PLACE(State) b.EMPLOYER'S NAME OR SCHOOL NAME MM DD YY I M F YES NO El L---J AC, PATNTING c.EMPLOYER'S NAME OR SCHOOL NAME c-OTHER ACCIDENT? c.INSURANCE PLAN NAME OR PROGRAM NAME 11 YES 1XI NO d.INSURANCE PLAN NAME OR PROGRAM NAME 10d.RESERVED FOR LOCAL USE d.IS THERE ANOTHER HEALTH BENEFIT PLAN? YES F7 NO H yes,return to and complete item 9 a-d, L.�,j READ BACK OF FORM BEFORE COMPLETING&SIGNING THIS FORM. 13.INSURED'S OR AUTHORIZED PERSON'S SIGNATURE I authorize 12.PATIENT'S OR AUTHORIZED PERSON'S SIGNATURE I authorize the release of any medical or other information necessary payment of medical benefits to the undersigned physician or supplier for to process this claim.I also request payment of government benefits either to myself or to the party who accepts assignment services described below. below.SIC-NAf1JP.'t--- O.N' FILE 0 0-CB- 9 9 SIGNATURE ON FII.-',: SIGNED ------ DATE SIGNED 14.DATE OF CURRENT: ILLNESS(First symptom)OR 15,IF PATIENT HAS HAD SAME OR SIMILAR ILLNESS. 16.DATES PATIENT UNABLE TO WORK IN CURRENT OCCUPATION MM DD i YY INJURY(Accident)OR GIVE FIRST DATE MM i DD i YY MM DD YY MM i DD YY PREGNANCY(LMP) FROM TO 17.NAME OF REFERRING PHYSICIAN OR OTHER SOURCE 17a.I.D.NUMBER OF REFERRING PHYSICIAN 18.HOSPITALIZATION DATES RELATED TO CURRENT SERVICES MM DD YY MM DD YY DRAZEK , TIM M .D . FROM TO 19.RESERVED FOR LOCAL USE 20.OUTSIDE LAB? $CHARGES 1:1 YES 0 NO I 21.DIAGNOSIS OR NATURE OF ILLNESS OR INJURY.(RELATE ITEMS 1,2,3 OR 4 TO ITEM 24E BY LINE) 22.MEDICAID RESUBMISSION 51,0-6 .�,9 CHEST PAIN NOS 3. CODE I ORIGINAL REF.NO. 1� 23.PRIOR AUTHORIZATION NUMBER 2. 4. 24. A B C D E F G H I i K DATE(S)OF SERVICE Place Type PROCEDURES,SERVICES,OR SUPPLIES DAYS EPSDT From To of of (Explain Unusual Circumstances) DIAGNOSIS OR Family RESERVED FOR YY Mm DD CODE $CHARGES EMG COB LOCAL USE YY��ce"rvice CFW9SO I ODIFIER UNITS Plan L V V V I Put SE HYTMETRYS INGLE I N FC RP 0 G is 99 3 4 11 020 21 6 f 1 's CO i71 3 IX -RAY NT RP CHST , PA&L� f 4 5 6 25.FEDERAL TAX I,D-NUMBER SSN EIN 26.PATIENT'S ACCOUNT NO. 27.ACCEPT ASSIGNMENT? 28.TOTAL CHARGE 29.AMOUNT PAID 30.BALANCE DUE (For govt.claims,see back) Y YES [] NO $ $ 6 81 -01 3 2 9 1 CS T F"I P 7?7 0 4 7 4 3 1`1 01.0 31.SIGNATURE OF PHYSICIAN OR SUPPLIER 32.NAME AND ADDRESS OF FACILITY WHERE SERVICES WERE 33.PHYSICIAN'S,SUPPLIER'S BILLING NtIJ `�, IQPIIF_�.bPJC5-7 " INCLUDING DEGREES OR CREDENTIALS RENDERED(If other than home or office) &PHONE# v (I certify that the statements on the reverse .1 t' - WgLy_to this bill and ire made a pa thereof.) C E F D fc-71. T A M E M OR I A L H I'S A E M R P1,1 YS 4- ED'E T A r' D 4 E K, T i t0j M 2 0-P S'51 7-I -L 1 1 1 ClU MPI I NIS D R G 79 9 1 S �ANTIOCH CA 911,509 MODESIO Cil 1)-c 51 6 -6 4 0 3-1 SIGNED 0 7--0:bATff,1'171 PIN#G 7 9";'I G, IGRP# 6CR-0329 1 157- (APPROVED BY AMA COUNCIL ON MEDICAL SERVICE 8/88) PLEASE PRINT OR TYPE FORM HCFA-1500 (12-90) APjPSqV�-Q.0080931-Q08 . ( :.# :m. - - 7-00000- 000,.7-; FORM OWCP-1500 FORM RRB-1 5C0 1 Legal Tabs Co.1-800-322-3022 Recycled Stock#R-EXA-10-S HEALTHCARE R-ECOVERIES, INC. FED.TAX ID: 61-1141758 P.O. BOX 37440 TELEPHONE : (800) 731-8060 LOUISVILLE, KY. 40233-7440 CONSOLIDATED STATEMENT OF BENEFITS PAGE 1 OF PATIENT' S NAME : JERL SPINELLI OUR FILE : T1-032898400 HEALTH PLAN: KAISER NORTHERN CALIFORNIA INJURY DATE: 06/13/99 SERVICE PERIOD: 06/15/99 TO 08/24/99 Instructions : 1 . Make checks payable to : Healthcare Recoveries, Inc . 2 . Write this number on your check: ==> T1-032898400 CLAIM NUMBER PROCEDURE/SERVICES PROVIDER OF SERVICES SERVICE DATE CODE CHARGES PAID AMOUNT C-1086246001 ICD9 : 922 . 1 Contu of trunk DELTA MEMORIAL HOSPITAL 06/15/99 250 Pharmacy/General $41 . 10 $ . 00 06/15/99 250 Pharmacy/General $42 . 70 $ . 00 06/15/99 250 Pharmacy/General $42 .40 $ . 00 06/15/99 320 DX X-RAY $196 . 61 $ . 00 06/15/99 450 ' EMERG ROOM $412 .42 $ . 00 06/15/99 450 EMERG ROOM $141 . 75 $ . 00 06/15/99 730 Electrocardiogram/General $205 . 07 $. 00 08/24/99 BNFT BENEFIT PAYMENT $ . 00 $1, 077 .05 C-1086246002 ICD9 : 922 . 1 Contu of trunk BAY IMAGING/WALNUT CREEK RA 06/15/99 71020 CHEST X-RAY R $41 . 00 $ . 00 08/24/99 BNFT BENEFIT PAYMENT R $ . 00 $41 . 00 C-1086246003 ICD9 : 922 . 1 Contu of trunk CALIFORNIA EMERGENCY PHYSIC 06/15/99 99284 EMERGENCY DEPT VISIT 1 $195 . 00 $ . 00 06/15/99 99052 MEDICAL SERVICES AT NIGHTI $18 . 00 $ . 00 06/15/99 ELECTROCARDIOGRAM REPORT 1 $35 . 00 $.00 08/24/99 BNFT BENEFIT PAYMENT 1 $ . 00 $195.00 C-1086246004 ICD9 : 922 . 1 Contu of trunk PITTSBURGH-ANTIOCH MEDICAL 06/15/99 93010 ELECTROCARDIOGRAM REPORT L $30 . 00 $ . 00 08/24/99 BNFT BENEFIT PAYMENT L $ . 00 $12 .29 T-924849007 ICD9 : KAISER-MZ1 06/18/99 99212 OFFICE OUTPATIENT VI $50 . 00 $50 . 00 COMMENTS : Please review statement and send TOTAL CHARGES $1, 451. 05 OMME�' reimbursement check to HRI upon PAID CHARGES $1, 375 .34 settlement of case . Thank you PAYMENT RECID qvpwwxvw�__" * " 0 0 3 6 9 9 2 21-2 flO f Si n Date BALANCE DUE $1, 375 .34 MSXQ 0102 0000 T1-032898400 BILL1 BNP99285 1 . 0 16 ,I l Legal Tabs Co.1-800-322-3022 Recycled Stock#R-EXA-10-S TPMG ,�,° 0 G. � = m 1 11 t = Y t co PLACE DRUG SENSITIVITY LABEL HERE (IF INDICATED) f 3 1 I f I I f r �y r u? ruco _.... M �N 6 r G 1N4CI =� W NJ --� nj LU Firl r © LO -T7 r CO ,l CS31 E--� k3� _ t I KAJ ERv Sj PCJ75MAN��TE - PLEASE IMPRINT OR PRINT _..... .....<.................................__.s..........._...................__..............._.........__...... _._._._.___..._.... PATIENT PROGRESS RECORD PATIENTS NAME(LAST,FIRST,MIDDLE) ;'t <F:i. r.}'fad xyytR t'V3tgRL JisRt F SPL1 f ADDRESS F ;.r t^0 Isr x CITY V ✓ BIRTH DATE I PrlONEQD RQUP t �`: ;sv .. 'Y'.;'><w ? SUB RA INAAppotntme , �A�rntPZ 4 7 DATETlM Provider JUL I A `&�C) � Regular M.D. Date: 1 ► 'Current►Meds: , i !�'�!. Caplan, NO. , i Temp. y Tobaccc no!4`Les Drug Allergies: L17 In orderto help you and your physician make the best usa Of your visit time,you may find it helpful t�write down the answers to the follow; questions.This will assure you that your important areas of concern are covered. 1. What are your main concerns or symptoms today? 2. Have you noticed arnithing that mak-as your symptoms worse? 3. Have you noticed anything that makes your symptoms better? 4. What treatment have you tried? 5. Please circle what you expect from this visit? A. Reassurance B. Evaluation and Treatment C. Work Slip D. Medication Refill E. Other: 01123-675(REV.12-S6) DATE TIME i Al L-4 i i 1 i t I f I 4 i f i 01123.675(REV.12-95)REti cP SE HEALTHCARE RECOVERIES, INC. FED.TAX ID: 61-1141758 P.O. BOX 37440 TELEPHONE : (800) 731-8060 LOUISVILLE, KY. 40233-7440 CONSOLIDATED STATEMENT OF BENEFITS PAGE 1 OF PATIENT' S NAME : JERL SPINELLI OUR FILE: T1-032898400 HEALTH PLAN: KAISER NORTHERN CALIFORNIA INJURY DATE: 06/13/99 SERVICE PERIOD: 06/15/99 TO 08/24/99 Instructions: 1 . Make checks payable to: Healthcare Recoveries, Inc . 2 . Write this number on your check: ==> TI-032898400 CLAIM NUMBER PROCEDURE/SERVICES PROVIDER OF SERVICES SERVICE DATE CODE CHARGES PAID AMOUNT C-1086246001 ICD9 : 922 . 1 Contu of trunk DELTA MEMORIAL HOSPITAL 06/15/99 250 Pharmacy/General $41 . 10 $ . 00 06/15/99 250 Pharmacy/General $42 . 70 $ . 00 06/15/99 250 Pharmacy/General $42 .40 $ . 00 06/15/99 320 DX X-RAY $196 . 61 $ . 00 06/15/99 450 EMERG ROOM $412 .42 $ . 00 06/15/99 450 EMERG ROOM $141 . 75 $ . 00 06/15/99 730 Electrocardiogram/General $205 . 07 $ . 00 08/24/99 BNFT BENEFIT PAYMENT $ . 00 $1, 077 . 05 C-1086246002 ICD9 : 922 . 1 Contu of trunk BAY IMAGING/WALNUT CREEK RA 06/15/99 71020 CHEST X-RAY R $41 . 00 $ . 00 08/24/99 BNFT BENEFIT PAYMENT R $ . 00 $41 . 00 C-1086246003 ICD9 : 922 . 1 Contu of trunk CALIFORNIA EMERGENCY PHYSIC 06/15/99 99284 EMERGENCY DEPT VISIT 1 $195 . 00 $ . 00 06/15/99 99052 MEDICAL SERVICES AT NIGHTI $18 . 00 $ . 00 06/15/99 93010 ELECTROCARDIOGRAM REPORT 1 $35 . 00 $ . 00 08/24/99 BNFT BENEFIT PAYMENT 1 $ . 00 $195 . 00 C-1086246004 ICD9 : 922 . 1 Contu of trunk PITTSBURGH-ANTIOCH MEDICAL 06/15/99 93010 ELECTROCARDIOGRAM REPORT L $30 . 00 $ . 00 08/24/99 BNFT BENEFIT PAYMENT L $ . 00 $12 . 29 T-924849007 ICD9 : KAISER-MZ1 06/18/99 99212 OFFICE OUTPATIENT VI $50 . 00 $50 . 00 COMMENTS: Please review statement and send TOTAL CHARGES $1, 451 . 05 OMME' reimbursement check to HRI upon PAID CHARGES $1, 375 . 34 1-4 ^r% settlement of case . Thank you PAYMENT RECID ""W11040NOW -e '__ Si n 00369922-2501 Date 1BALANCE DUE $1, 375 .34 M MSXQ 0102 0000 T1-032898400 BILL1 BNP99285 1 . 0 16 TO: BOARD OF SUPERVISORS FROM: Phil Batchelor, County Administrator ,,. Uont 1-ra DATE: December 14, 1999 i Y C;Utita 3 £ f SUBJECT: Final Settlement of Claim — Patty Barrett-Carroll vs. Contra Costa County uo"*, unty WCAB Nos. WCK 0045403 & 0047964 SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION RECOMMENDATION: Receive this report concerning subject final settlement and payment from the Workers' Compensation Trust Fund in the amount of$37,500. BACKGROUND/REASONS FOR RECOMMENDATION: William R. Thomas, defense counsel for the County, has advised the County Administrator that within authorization an agreement has been reached settling the workers' compensation claim of Patty Barrett-Carroll vs. Contra Costa County. This Board's October 26, 1999 closed session vote was: Supervisors Canciamilla, Uilkema, Gioia, DeSaulnier and Gerber, yes. This action is taken so that terms of this final settlement and the earlier October 26, 1999 closed session vote of this Board authorizing its negotiated settlement are known publicly. CONTINUED ON ATTACHMENT: YES SIGNATURE: RECOMMENDATION OF COUNTY ADMINISTRATOR JOMMENDAUOF BOARD COMMITTEE APPROVE OTHER SIGNATURE(S): �& ACTION OF BOARD ON DECEMBER 14, 1999 APPROVED AS RECOMMENDED X OTHER VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT COPY OF AN ACTION TAKEN AND ENTERED ON THE MINUTES OF THE BOARD X UNANIMOUS (ABSENT None ) OF SUPERVISORS ON THE DATE SHOWN. AYES: NOES: ABSENT: ABSTAIN: ATTESTED DECEMBER 14, 1999 PHIL BATCHELOR,CLERK OF THE BOARD OF SUPERVISORS AND COUNTY ADMINISTRATOR Contact: Tony Schleder—335-1411 cc: CAO Risk Management Auditor-Controller BY ,DEPUTY