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Home My WebLink AboutMINUTES - 10051999 - C7 CLAM MAMAM "OBER 5 1999 Claim asst ft Cwunly, or Dstrict Govelmedby the Board of Supervisors, RmAing Wi Drunnts, NOTICE TO CLAIMANT d Board ctio ` -Mar, refor es are �s rpt nailed i s r Ufforda Govrrmnl codes. notice of the action talo W your Balm by the Board of Supervisors. (Pwagrapllh IV 10 , Oven mss: to ° Code Section 1 and ,z 915,4. to i arrgt MMONT< $265.50 . t. ,. U Ct "r: Paper Circus West, Inc dba Aubergi-ne RN . DATE ` ��., �: Sept ber 7, 1999 ADDRESS. 1066 Po-Jrt Lords BY DMAIERY TO CLERKN. Sar, Francisco CA 941.21. Y MAILPOSTMARKMSetea� 2 19 FROM. Clerk of the Board of Supervisors a County Counsel Ached is a copy of the above-noted claim. PML BATP ELOP Clark, Dated- +J�L. iG. ateDeputy ,t . FROM County Counsel Clerk of the Board of S pervi ors (V This claire: complies substLwtially vddh Sections 910 and 914.2. This clslm FAILS to comply substantially with Sections 914 and 914.2, and we are so notifying claimant. The Bard cam°got act for 15 dkys ( salon 9101). 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 UtyCounty Counsel EL PROM Clerk off the Board M Comet° Comisel (1) County Administrator (2 Claim was returned as untimely with notice to claimant (Station 9113). ORDEX By unanimous vote of the Supervisors enty This Claim is rejected € full. Other: T c4rtify ffib this 1s a true and corrW copy of the Board's Order entered Its minutes for this date, Dated. � L BATCA llcrk, By DeputyClerk WARNMNG (Gov. code sectio 913) Subject to certain exceptions, you have only six (6) months from the date this notice vas personally served or deposit in the mail to file a court action on this claim, Sec Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this utter. if you w t to consult ars attorney, you should do so ftwnodistelya *For Additional Waming Set Reverse Sade of This Notice. AFMAVIT OF MILLNG 1 declare under penalty of 1 t 1 arra now, and at all tomes herein mentioned, have n a citizen of the United States, over age I k and that today 1 deposited in the United States Postal Service in Maxtinez, Callfomia, postage ful prepaid a certified copy of this Board Oder and Notice to Claimant, addressed to the elalt as shown above. Dated: ,L /ff yo PFULBAMMLOR By, l ty Clerk t Claim to: BOARD OF SUPERVISORSOF CONTRA COSTA BOUNTY � Claluso Mating to emus of actions for due or for Injury to person or to personal property or xMwing crops and which accrue on or before December 31, 1987, must be presented ' tam than the 100* day aftw the accrual of the camw of action. Claims misting to caum of action for death or for Injury to pen= or to personal property or growInt crops and which accroe on or after Jamary 1, Ml,awst be presented not later than ill months after the wcmvj of the cause of action. Comms hating to any otbet cum of action = lirmated not later than one year dWr the accrual Of the Cause OfmcdOm (Govt Code fob N. Claims must be tiled with the Clerk of the Board of Supervisors at its offlee in Room 106, County Administradon 11WIding,651 Pine StCA %551 C. N Claim is against a d1suict governed by the Board of Supervisors, rather than the County, the name of the Didrict should be oiled in. D. If the claim Is against more than om public entity,separate d1inu must be filed x0ast cub public entity. , JMd. See penaltyfor fraudulent claims, Penal Code 72 at the end of this fog Claim by Reserved for Clerk's Filing Stamp County of Contra Costa SEP {., `i or € � Di (rill in Name) undersigned dal t hereby makes claim against the County of Contra nota or the above ed District in the sum of - and in support of this clams represents as follows: 1. When did the damage or injuryoccur? (01vt ewxt Date and How) / . Where did:the damage or injury occur? (iwwdo ctty wd c ast') 3. Now did the damage or injuryoccur? ............... m---- ,----------«-$b. ------- 4. What Particular act or Omission the part of county or dutrict officem servant or employ cmsed the Injury or damage? " ' :. a f "�` (Over) ... Whst are tete cum of count, r district cervan or empioyees causingthe damw or Injury? What damagez or injuries do you claim ? t Give ratat tvdarks or da magn dakvwd. Afto a%fur Moo awwae* 7L How was the above cWmed amount computed? :ladv&tht wdmauw amount of any Da aeWaa-or da � eo ....m..,.......®.......,.. .®®��u�� , �r�, ....... ...... ... . . �p �� e«e S. Name and addresso of wit s,ductom and hospitalt, 9. Ust the expenditum you evade on utount of t or injury, 2&U MH M Cede Sm 910.2 pomades: "The daim must be siped by tht cWmant SEND NOTICES TO: (Attorney) or by some person on his beta " Name and Address of attorney -2d6 � . Q� (Claimant's SIPAturt L212 � Address Telephoft No. Telepbone No. � . OTIC Section 72 of the penal Code provide,&- ,*Eyery person who,with anteot to defraud,prewnts for allowance or for payment to any,state board or officer,or to any county,cry or district board or ofter,wAbarbed to snow or pay the unit of genulne,my Use or frmdulent Balm,bill, account,voucher,or Wang„4 punishable eftber by Imprisoamtnt an the minty jail for a period of 004 maim than one year, by a fine of not excoding ont thgamod dolly (S1 ),or by both suck imprisonment and r by imprisonment In the swe prion,by a floe of not elcmdIng ftO th d d0lia (310,00), Or by both Rich imprisonment and 11M. a - .4' � C q L7 CLADI 617 CAUMEMA OBER 5, 1999 Urn Agahst ft CoLnty, or Distftt Governed b ft kard uf Spe,rVisDrs, RoirttiIN Endors : its, NOTICE TO CLAIMANIT Bowd Actiom ICti ' referaves are to The copy of tHs domnant filed to you is your Califorria Gover 'tt Gds: notice & the acctim taken} w yourins by the Board, of npsor . (P rograph IV OV4' oven sent to Govent Code Section 913 and 815.4. Ruse rite Wi AMOTUN7. To Be Determnined o Male=la Taber, and Michael Curr, ngsha., a Miner ATTORNEY: DAA RECIVED. September 3, 1999 ADDRESS; 950 Andrews Drive Y DEL Y CLERK ON. vMartinez CA 94553 BY MAIL POSTMARKED,.._.,Le2JQMkU 1,_ 1999 L O Cleek of the Board of Supervisors €my Corel Attached is a copy of the above-noted claim. FML BATICPELOR, Clerk Dated. Septeyr'ber 7, 1999 By. Deputy ' 'C%'�.1�.,�.,� ,-� r O County Counsel, M. Clerk of the Board of Supervis,6rs his claim complies substantially with Sections 910 and 910.2. This claim FAILS to wrnply scbstartially oath Sections 910 and 910.2, and we are so notilrying claimant. The Board cannot act for 15 days (Section 413.8). Claim 1s 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). Wiser. Dated: "4"'Deputy County Counsel EL . Clerk of the Board M County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely wad notice to claimant (Section 911.3), °s BOARD ORDM, By unanimous vote of the Supervisors present. is Claim is rejected in fall,. Other. I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: 5 , s' PHIL BATCHELOR. Clerk. By � < .k Dept Clerk WING {Gov, code sectio 913} Subject to certain exceptions, you have only six 6) months fres the date this notice vm personally served or depositc� in the mail to rile a court action an this claims. See Government Code Section 945.6. You msy seek the advice of an an—ney of your choice 1n. connection with this matter. If you want to consult an attorney, you shouild do to i=ediately. *For Additional Warning See Revcrt4 RevSide of This Notices AFFEDAVIT OF h1AUMiG I declare under penalty of penury that I am now, and at all times herein mentioned, have leen a citizen of the `gaited States, over age 18; and that today I deposited in the United Sues Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shovm above, Dated: y y. PLTC1Oy .sz Deputy Clerk � v8�r NTRA Claim to: BOARD OF +SUPERVISORS O UPEVISORSO `CO �y�yCOSTA C i7IN ' aL Claims relating to caum of Iction for death or for injury to person or to per nal p peM or gmwing crops and which accrue on or before i=tttber 31, 1487, must be prmented not later than the 100 day a r the accrual of the cause of actuate. Claims rusting to causes sof action for death or for injury to pejn or to per tta€ propor€y or growing crops and which accrue on or after January L 1988, must be por ted not later than six Months after the accrual of the cause of action. Claims relating to any other cause of aetioa must be pr rated not latex thin one year after the accrual of the cause of action. (GOYL Code§911.1 B. Cas ms mast be filed with the Clerk of the Board of Supervisors at its office in Room lob, County Administration Building,651 Pine Street,1 arti€t CA 945-93. C. If Claim is against a district governed by the Board of Supervisors, rather tbao the County, the o e of the .Districtshould be tilled in, D. If the claim is against more than one public entity,cepa to claims must be filed against euh public and y. E. =and. See penal for fraudulent claims, Hata¢Code Se--'12 at the end of this fonn. RE: Claim by Reseryed for C:erk's Filing Stamp y f..;?.`,y' ?t.a 9w is .s f •,:s�... i�s. Against the County of Colts Costa .J 7 Or District (Fill in Name) The undersigned claimant hereby makes claim agAinst the County Of COMM Costa, or the above named 6istrict its the sum of S y9 ';and in support of this claim represents as followsa to When dad the damage or injury occur? f Give eiaca Nee and F°Tou } ...,... ,.®_<-.,-a...,-...,naoa�..m.� 2. Where did the damage or injury occur; £Include Cary nj Ce l 3. How did the damage or injury=ur? g save rug deea2s:aft rit"P*PVr irr" ad I >' 4. -Wbat particular act or omission on the part of countyor dstrict ofcem sem-amts, or employees. caused the injury or damage? a < K > F 4 �4. (Over) S° What aree the names of count ee . s h ama e o inj y or district of servanm or empivy ARL, ing t c d g M -------------------------------------- ------------------- ------ What damages or injuries do you claim. rmited? Givt fUL'PMM Of lZiWift P?-dVM*9C6 ckuntd. Attach two CstiMllas fOr auto damap- 6" IA --f" "'.n z g L4 0 tornpute wds 3e"A 6,VedZrhVd%m' ------------- ------- -------- S. Nam e4i and Add M5595 of Witnesses,doctors.and hospilalL ------------- List the expenditures you made on account of this. accident or injury.. RA-TE 6-MMUN—T -o —4 Oo%% Code Sm 910.2 provides, ,,The claim muit be signed by the clant SEND NOTICES TO: (Attorney) or b�-some person or his hehaK." Name and Addrts3 of Anorney Claimant's Signature .fid'dress Telephone No. Telephone No. INOT ICE Section '72 of the Penal Code provides. "Every person who.with intent to defMC presents fOr Allowanct Or fOr Mment to any state board or officer, or to my county, city or disvict board or officer,author to aloes, or pay the same if gennine,any fall or f-rmdulmt claim, bill, account, vourher<or writing, is punishable either by imprisonment in the county jail fora period of not more th= one year, by a fine of not exceeding one thousand dollars (S1.000 " or by both such imprisonment and fiae,or by imprisonment in the state prison, by a fine of vot eiceeding ten thousand dollars(510 000), or by both such imprisonment and finc. C70/EO'd !VIW As I� Ain- disco d�iiNlco ve-:ST 66-61-10-d3s 241 S HICM Scl',;ool Aversue, Suite 300 Con Ora, Ca fora; 94520 S 10) 68 7-220 To Wnom. It may concern: in office on %_tL -was seen ana nas been. advised to stay off Wtrk7it-c rm-p u n t j I It vou nave any que!_'st ions, piease Teel free to contaCt the office if you nave a,,",y questions. 5incere#y, �;;arles J. Renner, M.D. ATT TOWS gqATE -ENT v°Y, rri;-sk'vs xls r,�Y3as sw7r Y:Fs dates is 'ss�i f: asr .R# P?mowMWOFT€ �s sE ass�e P?aaa m say sax s tta w zll -Ew . . sF Fee w Mot # MODAUTM s qi� 0,29211 ow ....�{ =�t!G{[' 4 .Y'.e$3ik.3 jY,fy /� ( a...wn.w+a.i.. ,P:?SS @fi w S #i "+e..i.w�-..Y v`..,r �eF§�� # 6, mww-WAwwdt RER MW Tb ? €�!I i X13 #�t#€ € I p� MW Cy42 ,£i fVIS `S�i..X(us yf S �M�:9 EI.S�S'(3�.� .jqqr ��'+�. ��Iei$�S�S"f � : .. :: n+... �#� �r �+y r 99-3138 Page 5 - eno,agh time to stop for the vehicle subsequently, co ll tided with it. Driver#2, CUNNINGHAM, stated that on today's date at approximately 16 15 hours, he was -section of Court and Green, Street. He stated traveling so-cthboutid on Court Street nearing the rote: that he was going within approximately 25-30 rnph and noticed the bus attempting to cross the intersection. He stated that he observed the driver of the bus look to his left as he was crossing the intersection. Driver#2, CUNN TLGHA-V4 stated that at nope did the bus driver look to his right. IN Driver 42 stated that he did not have enough time to stop prior to the intersection and bus collided Into ithe driver's side of lus vehi4cle. Driver#2 stated-,-Pat the accident could not have been avoided. Witness #1, H-aninreys, stated that on today's date at appIroxinnately 1615 hours, she was na7ked at the -iratersecti,on of Co-aft Street at Ward Street. He stated he was parked along the west cul-bline of that street facing south. At anpr=LTnatelly 16115 hours, he noticed a silver Mustang I ap- ach the intersection of Street at Green Street, He stated he noticed the bus crossing the pro vl — I V 11 intersection and collide with the NIustang. He stated that he noticed the bus strike the driver's side of t1he M.-astang and Push It approxi-mately 3'to 41. The was all he could recall. SIIIN �W Velhicle#I was entering the intersection and upon. doing so, did not see Vehicle#2, which was in the right-of-way on the roadway going southbound on, Court StIreet. Because he did see Vehicle #2, VeEcie #1 struck Vehicle#2 at Its point of impact d-irectly in the middle of the intersection. _L)-A The point of impact as follows:L Approximately 9' cast of the prolongation of the west c&biine of Couit Street and approxi mat P:ly 15' south of the prolongation of the north cwllibline of Green Street. _CAa private M Driver #11INehicle #1, caused the collision by crossing the intersection froom, roadway withoutregard for north and, southbound traffic,which has the right-of-way. His entry into the intersection unsafety caused him to strike Vehicle #2- T'his Mianewver was in violation of 218,04(a) CVC. This section states that a vehicle ftom a piAblic o.-private property o-1- alleys shall: Meld.to all approaching traffic close enough to be a hazard and to continue to yield until see. RECON �"I�N- None. 1� M. Estano. #101 DF W 8-25-99 Traffic Collision 99-31.38 Page 4 ?`SAME ALAI N.- On 8-1.9-99 at approximately 161.5 hours, I received a call from dispatch on report of a non-injunj accident at the intersectio. of Court Street and Green Street. I responded from the station and ar ived on scene approximately oneminute later. All speeds and measurements are approximate and were obtained by pacing, SCENE SCRIPTI N— Green Street at Court Street is a "T" intersection with Green Street ending at Com Street. Court Street is a two-way, one lane each way, not h/south roadway paz-ai°eiing the 3F, Green.Street is an east/west roadway ending at Court Street. It is constructed' of common. asphalt. CTeen. Street is controlled by a stop sign at its furthermost east point intersecting Court Street. Court Street traffic is three way in both directions. PARTIES: Driver #1, identified by his California driver's license, STEVEN CASAS, was the dnver of the Contra Costa County inmate bas by his own: statement, He was observed standing by the bus, which was left at its port of rest directly in the intersection.. I observed no mechanical defects vehicle 1. Driver #2, C INI N G .; , MICHAEL, was identified by a valid California driver's license, He was located standh^g next to his vehicle along the west curbline of Court Street at the i-tersectivr, His vehicle was a newer vehicle and I observed no mechwlical defects. h PHYEICAL EYMENCE; At the scene, I located approximately 51` sof skid marks from both right and left front wheels for vehicle #2. Vehicle #1 left no skid tnarks, T,-,e debris on the roadway consisted of small glass and paint ft-agmen s from. vehicle #1 and #2 at the point of impact.k.:act, o evidence or debris was collected at the scene. STATE-NI 'TS; Driver#1, CASES, stated that he was attempting to leave the sally port area and enter the city street at Com a-rid Green Streets in the MDF bus. He stated as he did so, he looked bath northbound and southbound to make sure the roadway was clear. He stated he let several vehicles pass. He stated that looked to northbound traffic and noticed that the roadway was clear. He stated that he looked to the southbound traf c and also noticed that it was clear. He stated that he began..:crossing the intersection and all of a sudden felt the impact of s g vehicle#2 directly in the middle of the intersection. He stated he did riot recall how fast he was going. '`he distance traveled from the edge of the curbline to the point of impact was approximately 30° and by the weight of the bus, his speed could not have been over 7-101 mph. He stated that he did not have STA-V,or-,c AjJ a'o Fes% , PP", *7 + _ TRAFFIC.COLLISION REPORT CHIP 655 PAG: 1 M&v 2-W) OPI 042 97 63763WUMD MOW ;{SF3aAC COSi`uPY,tk� rasxa�$� taz aa�vrt earn aaz.sxsTrx:.r �r�e.�;.�a$ruaH�u�afs$� yfr,�{�$R *}STS R:soa :x.•'� a€�t+srrsxa� �a4T �; C3e;!'RiCZ4t SrCC3,fRRfiC Ci4a uaC WAY i'ff,.AR -nus,E 2ew,} Mc S 777 A;. e { w o B. . ....,..«. .k..®a.--ted,---- m..,,...�..------------....----....�.,®..®m,..........{ _ gWaPOSTlNAJRMAi9'OM CAYAPSF'ffS}S •O'd AWAY :aMCYOGRA?448 IM '�CkR; F$^eTi 3aa?i.EB 3'_ *' A8O 3.{Jtfff PARTY u#2Y frR CA S£Sf€tt$ N SdR€C EiATE 'CEAS# °*4-rj'y VAK VSAR MAXI i MOO9L 4ZLOA 9 A4ieAkllnt STAY$ z. 4?i£m NAME;,$'!RST,wCCL$o LAST{� $� TRs$T ACC ffiS OWN&MV SAME AS " � n 0AAK10 ✓„.•E?Y?lIATE t$tip O!t•Ydt3R416&OOxEffi$ EASC$AS C14$R `?$4 LE RE Y. 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S :.] �. c ,k,.. :.£t :! }.{....hr } �3 4 ..• ,,.. .., n... {..... CLAM Claim Agalinst ft Cody, or 13istrict Governed by ft Board of Spervisors, Routing Endorsennts, NOTICE TO CLAIMAW rLd Board Acton. AJI Section teferexes are to N copy of i sc-€ nt celled to you is your California Govermnent Codes. wticeof the actim taken on your dah by the Board of Supervisors. (ftragraph IV below, Oven 'C se t to Dove , Code Section 913 and 11.5.4, Please rote all 'Warnings#® AMOUNT. $149180.00 CLAIMANT: R6cert L. Wal-ker and 1,411-- P. Walker est 30. 1999 �, DAA "Da ' ADDRESS: 2533 Grovev era Drive BY DE.TMERY TO CLM ON: t 3G X999 RicInmond CA 94806 BY L POST Auxulst 2 999 FROM Clerk of the Board of Supervisors M. County Corel Attached is a copy of the above-noted claim. PML Clerk L3 s199 � yapDe ity IL FR MA County Counsel M Clerk of the Board of Supervi t - ;Y) 71is claftm, complies substantially with Sections 910 and 910.1 `his claim FAILS to comply substantially with Sections 91and 310.2, and we are so ctif�inn claimant. The Board cannot act for I$ 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 claim nt`s right to apply for leave to present a late claim (Section 311,3). Other: ted M1 '€'y County Counsel M. FROM Clerk of the Board Ta unty Counsel (1) County Administrator (2 ( ) Cly was returned as untimely with notice to claimant (Section 11s3)� 8 BOARD ORDEFL, By unanimous vote of the Supervisors presents This Clain is rejected in M. ere I certify that this is a tame and correct copy of the Board's Order entered in its minutes for this dated Dated° >; L BATCHELOR, Clerk, By� � Deputy Clerk WARN"NIG (Gov. code section 413) Subject to certain exceptioars, you have only six ( ) months from the data this notice was personally served or deposited in the: mail to file a court action on this claim. See Government Code Section 345.6. Your 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 Waming See Reverse Side of This Notice. AFMANTI'OF MAIMG I declare ander penalty of peiJury that I am now, and at all taus herein mentioned, have been a citizen of the United States, over age 1S; and that today I deposited is the United Stags postal Service in Martinez, Californias Postage fully aid a certified copy of this j3o&rd Order and Notice- to Claimant, addressed to the claimant a shown above. Dated: l �✓ yo PMS, ATCHEL� Icy � �_ puty Clerk a co=ty Camel County Asn€motor BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY RLSTRUCTION-11 TO CLALMANT 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 3f, 198x, must be presented not later than the 100'h 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. (GovL Code§911.2. B. Claims must be filed with the Clerk of the Board Of SuPer'ViSOM at its office in Room 106, County Administration Building,651 Pine St et,Martinez,CA 94553, Co 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. RE. Cl aim by Reserved for Clerk's Filing Stamp Ai Against the County of Contra Costa or District 6L (Fill in Name) The -undersigned claimant hereby makes claim against the County Of Contra Cost's or the above named District in the sum of SL6��90,06and in support of this claim represents as follows- 1. When did the damage orinJury occur? Give exact Date and nour) 116, ------------ - -------- ------------------------------------------------------- 2. Where did the damage or injury occur? ,inciude sty and county) 7Y A?41't- L ---------- ------------- ------------------ -4 A-a V- 3. How did the damage orinjury occur? (Give full deteas:sane extra paper if r"uired) qx'ro� y--------------- - ------ --------------- ---- 4. What particular act ar omission on the part of county or district officers, servants, or employees caused the injury or damage? - 7-HC,0 1A45 r,#,L Aj e &,S 7'"6rV 7-0 r#� -56UIEIZ L- ""Veg S rACl 1 Arr/-/ r)9"01'C.1 7 CA�-O A e 0�ti AJC, ' V Cer- 4'A/ 7hl-el— ffc-&VY Ov ) S. What are the names of county or district officers,servants,or employees causing the damage or injury? ZK;__6------------------ ------------ -4 6. What damages or injuries do you claim resulted? 1%Give fullextent or injuries or damages claimed. Attach two estimates year auto damas'e. fi, How was the above claimed amount computed? (include the estimated amoun,of any prospee ive asijura v or xdatnage.) eA 8z Names and addresses of witnesses,doctors,and hospitals.. -m ,m-m 9. List the expenditures you made dare account of this accident or injury: m a �m m o- p DATE 1 IM011UNT g ' ° /121 ak a4 a� � gs ae s& �a Ns �a de at sk # st s§ � 3e aY ga i4 at �c rc � �t xh to �e tc �c x*e st sa # sx ah ss tc s: ate at ak #c sF �s a� Ax at �s �x i4 xY � # Gov. Code Sea. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO. (Attorney) or by some person on his behalf." _ t Name and Address€f Attorney 71 (Claimant's imaant's l mature - (Address) Lo{ _ rt Telephone No. t Telephone No. � aka t�sfret � � � # Se � aeakak �€ drtR � ssaIIes # 8s �z � � at � xe � � �c � ae �ssesx � s� nrat �snrr �a � st � at �s � s� � � NOTICE Section '112 of than 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 dollars ( S1,000 ),or by both such imprisonment anad ,,fine,or by imprisonment in the state prison, by as fine of not exceeding tend thousand dollars ($10,000 ), or by both such imprisonment and fine. LILLIE WALKER 2533 GROVEVIEW DRIVE RICHMOND,Cie 94846 August 27, 1999 Ms. Sharon ymes-Offord Liability Claims Adjuster Contra Costa County-disk Management Division 2530 Arnold Drive, Suite 140 Martinez, Ca. 94553 Dear Ms. Hymes-Offord; Enclosed is my completed Claim for your review wid handling. 1 arra also sending you copies of the proposal to complete the project. The construction is currently underway at the 5075 Hilltop site to replace the laterals frorn the house to the curb as well as from the curb into the street. 1 have no problem with the replacement from the house to the curb. 1 do, however have a problem with the replacement from the curb to the street. ley property does not extend to the street and this should n®t be my responsibility. The repair of the curb area(if nest all areas) should be the responsibility of Contra Costa County. Per Baur earlier conversation, 1 (as well as the utility companies) feel that the problem occurred when the County installed sidewalks last year. The County brought in heavy equipment to install the sidewalks and this is what caused the lateral to crag. If you need further information from sae, feel free to contact me during the clay at 800/923-9700 X151 and dwing the evenings at 510/222-4327. Regards, N { Lillie Walker Encl. PACIFIC DRAIN INT9 ....29,34 and ROOTER SERVICE r ; bi-ante, CA X48'3 s t j i i Z. 452-45 .223-3833 AMMMM— This is your invoice TERMS: CASH 1 0 SEWER C3 KITCH.EN C�IOATHS' 0—SATH TUB C-SHOWER CFWASHEA C�S:�te�Ftf7vsc ; 71 i R � , !IVE X, # l CASHWC} p1 V.FpRZY OTp 03 y 30 Days Guarantee No Guarantee DU�E� A ABLE PRESENTATION Eli Da; -- —� s p . Cued °gent .cb Address { i SM To 1 i Address I ^.7y s Customer Phone 0. Y RESCUE ROOTER RO. w33!- } 800,869-6915 � f roPOsAv - D`o b 'DATE F L �:M.�,' ,, °"v" •.«...l' `,,� '` ,myt' '� s ',a .,ems �. e;: z IK i ,$TRE 5� Y A3 CF'Sf:EC? DA"e OF PLANS We:ssreby subm;i sped"catlo is and e5'_frnates far: s: a F,4i eo,�-i e--;?I k Ol veo'�� k i ��u! {�.d� �rfi-..• �i,''�Y�4%.w Y.? �- �' �.r'`�3.'�o yF':.�iw...�� `m,.,.J it...# � ��yr''�. ��} �.'ar�2 irzy D 4y e�W.'r ` ' '" ' tZ � 47 ge ria OOk herei)to furnish material and iabor—compiat in accordance w to above spaclffica.icns for the stun of Payment to ba made as follows is rguararjltaad to be as scso fat X< ;vcrk ec feed'.r:a Svc x a s txe { ma-InGr atria;tirg 4s stant%rd rad css Any e is ^.or e r 'Ci? a aocva spe 'ra-ons �:I:«.Ang axrra ocs?s w 4 be exs uftd cgty Upo a :eta CY .' is x;axira �Ivr t4<"a '° ,ssre-OV8*and above oke 2^.a, Ail ggmsnnetma -ngam�m s kes, acc7denfs m r ere :a,s beyond Owner b car:a'ra icrr;aes w&ZKQ-,ss necessary insurance. dote:T roesa= may, €sus srrr ca's a#a.hce, am b Svcr"'W"s Cov-pan.saysei Zgamm withdrawn n bs us ff not a �#8d'Nitta, days. "'•`,,� qg p}gy yyy y5�;,y+y ,�pq( _ q�,ryy�ay,Q �}.py �{;,,y {-, y� t. ,e'-�. � .4�r +`W�RT Qh bT3' �Y. �� 4tl6 dY09 ."^}i.4'�fiV!<fr,ry�e�.fu t..'r•rS�� l+.li�:.S vr/ lei �V iy..l�e a ct Pot a segs-air r acid are hemby acep , You�e a..ff zirized sigratu:e to do the wok as spedfled. pa epi ref` be Tmde as ca°i:gid above. t Dat £of'A ^uperne:-� i "fyE^fLrg < AU 24-9 01 :44P Rescue Rootag^ BAE 1 510 784 61 15 -01 RG p F ,1 REPAIR AGREEMENT CHANGE ORDER Dated J i ,ire„ :. YER(S} HEREBY AUTHORIZE Rescue Rooter' (Seiler) to make the following change from she work as originaiiy seg crt� in the REPAIR AGREEMENT da �'`` ' "� � �e� /�� 's ate' `.,�-•- ,�,�,.- �'��c%G s..� �./' '' ` �„�'s-� ,r' "r',,,.i� �'��"'<" r='��✓� �' ,�,.,�s =ue- " %�-''r`"'-' ,� for which an addition a€ charge of � > 30 -__..�"�� _ is added to the Repa;r Agreern e t price. Ail changes made pursuant to tris Repair Acreement Change Order are subject to the terms and conditions of t Pepair Agrees'nant. Signature Dated .� Dated 1N#-!fv -rruxYJt�i rtt CANAgY•O`fiCe 5-;NiC•tr,vcsres GGL Jc R'J�-t^{2�G u rt�r; i� M,LER: Rowuo Rootet L.LG.,do-3 ReeRooter` C,or &,oitor`s Licsnse Number 744-542(Piu bint -36) ahiran = f Qpan ;3YE R%a-dishing SELLER with a PERSONAL STATEMENT OF BUYER STATINO NATORE OF EMERGENCY,SELLER a retie to maw the repafs's ivvor k!')dear-riboo on the at:achad DESCRIFt`#ON OF WORK AND lt+'ATER#AL ,at the abase job ad r as for BUYER d SU"M" P(jointly and saversAy if Moro than itrel a,Qareas to pay SELLER the oesh Price set forth holow foe the work The f e alre will bo rt;adaerraccordar-'CeWith and the fasubject to ;#oftheft3llts�e ingprovisions,ir�cfradln'gtapeT ANDCON. D ON Pet fadh on tea*roverae aide hereof, 1 COM,MENCEM,ENT AND COMPLETION OF WORK The following is substantial commencement of work:',')auppiying anyoftne mater isis so the job addrema or;2;labwft to Perform,the work errsWHIcomrnenceo c�rrir det y c d y r� rs two arl �f. r_o€'lroa which could-not be red"raadiy fSez Faracgraph 4 ofTERMS AND tvr'1.+1`a ON&)If work has not commenced uporihs da?*specified hsre n for rir"y reasons beyond SELLER'S oonlroi,ELLEP may,et"s option ducting tho period of time while SELLER refriaina ur-'ably to cos�rarnance wtiri.caz%ce;this Agreement bygivino BUYER notice thereof and rwurningYEcT de a;t. �A" pRiCE ANC) PAYMENT Z DePcilsio Now Dire f-rot more than 10 Cast'Fr`s ,................ .... � - . Due ata- -s - - - ---T l 4. Amount UPo?':�'a?f°#�;��'k�i',�� C3'd'"k..................... .......... ................ ...... ........ UIMt" D WARRANTY.T her i4nited arrantb prove dva hardi?r and i^ca,:�o:atai darn&g&s and 4'OrOts.duration of impfii isd W .rT'VLnb4 ;.5ee peragmph a of TERMS ANO CO #T;ONZ.3 ENTIRE AGIRCEM NT.`?kia;s the anbre Agreement Tl� ,-Vea are not DOUetd by any oral expresSion.or bS any ageng, wurproing tcaztfoForas"thelirbthalt�?'� ,g/ffi+`�.'',y�S 1"f'€�3"r($f'F�' Yf �Y 6#7�¢,3`i ,'"s�5b"1�.`tset fo?thh-ere)n'The��i'�4£'�r�°ff?3�f.F;35��JolriIYWA'a'tvoratsy M1 Signing&a Buyer,their tieir'a, and Isslgsrs. EXTRA la€ATER!ALS AND ADD,-'t°IONAL WORK-A;'wra materials ia, sin trse�sr r4y of th 60Fler. Except ag provided beiowi nc add.tiOnAi iivork oh&iI be done without prior written of gayer on a. eignod by both partist.Cath P(i-"ensu benoteesod by the orice of sszah addstionai work and avy'ar wili pay same as agreed§�the o"rige order. Pravideid,hoax ever,tthet if existing Cortdtt#oras,are not as represented#r:para;res,"3 or? -A-serSO eiAe s"grect fttereby rice �€ta##rr� additional ex iOn,l i t€ng� the addi':io al Wot'K ShSf ;be PSid fel`oy BUyerasrer;itUgh rho addffl0nA0 iso`c May be done wllhotgt prior written authorization. Provided, fur?her,that any a4diUorml work r erects ry to confVr a to oxis.ting or€otiry c. idin oodea,zonlri €awe'oy e" �riaf'sor?a of inspecting Ps2b3ic aut.hor#ts "all 00,16 ad�tt¢#or;al Wo€l;to tie said for,,y Buyer,even lho�gh the edd#tlor:e#work may be done: �s,lthot4t pr?or wr tteri autho zatic r.Additionally,in oordarrce with Paragraph 6 on the ravarse aide here-3f,no Perm wriftianauthorization Ghali be required for sidd t'sonei work necaitsfi-y to FSPIUce rxor#a slresdY PO&Ormled, and said additional Work sna:f be paid by buyer, EACH BUYER ACKNOWLEDGES THAT:(1)BEFORE SIGNING TH IS AGREEMENT BUYER FURNISH ED SELLER WlTH A PERSONAL STATEMENT T BUYER STATING NATURE OF EMEAGENCYAND BUYER RECEIVED AND READ A LEGIBLE,COMPLETELY F1 LLED IN COPY OF T"IS AGREEMENT SIGNED BY SELLER AND THE ATTACHED NOTICE TO OWNER; (2) BUYER UNDERSTANDS, APPROVES, AND AGREES TO HE BOUND BY ALL OF THE PROVISIONS HEREIN, INCLUDING THE 'FERNS AND CONDITIONS SET FORTH ON THE REVERSE SIDE HEREOF AND( THIS IS THE ENTIRE CONTRACT AND NO PROM96E N07 CONTAINED HEREiN HAS BEEN MADE TO B Y R> NOTICE., BUYER has the rig tto require SELLER to have a performance ana payment bond at BUYER'S EXPENSE. (Not applicable It cash price to 4500 or les*<) ."$:.met bLSsati c+ SEL ay Dated n RS ?x ' uCr.AU9. WH+ TECrs.tosnfv NARY•)ff;ioe P;NK7 fnvMIF c� to all ip th t (7 i AA CLAIM BER 5 1999 Dal it° t fie �= , Distrix Governed y ;��acf l-vi " "Itis Endowmits, NOTICE TO CLAIMWJ7 t Board Actori. AR Seclti n referawes we to The CDR Of tips d=Mft M8118d tO YOUi$ YOT Califo is Govan Com. mtics of the action takes w your dim by the and O isor& (Paragraph i ;: ; 'I" code setion 913 And, to Gave Piesse rote W1 NASns"® I SS OLrINT`: 1ION STATED C CLAIM&NM BILLY MYCHAE-L.-.. ROGERS, SR M RNEYs DAA RECE'VED. AUGUST 31, �?999 ADDRESS: 501, WEST `E—N- S`I'REEf BY DMAIERY TO CLERK ON. vu"IOCa Uri 0/4509 BY MAIL POSTMARXED FROM Clerk of the Dowd of Supervisors 70. County Corel Attached is sPy of the above-noted claim. PHILA Clerk;, Dated: SE 'SER 1� 1999 y, Deputy, E. FROM- County Counsel e Clerk of the Board of Superyi rs is claim complies substantially it:h 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 camnot act for 15 days (Sectio 910.8). Claim is not timely filed. 7be Clerk sold return claims on ground that it wu filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911-3). Other. F z p,"�"�" "JJf•�F 1{`r C�� ..Y-'`�S,��s` e � �i { �,C��i f;:, S..y. �� ,� � countyCounsel Clerk of the Bid County Corel I) County Ad i for ( ) ( Claim returned as untimely with notice to cls.i t (SoWon 911.3). 6 BOARD ORDEFU By unanimous vote of the Supervisors Present This Claim is rejected it 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- PIL BATCHELOR, Clerk, By - Deputy Clerk (Gov. code section 913) Subject to cer in exceptions, you have only sig (6) months from the date this notice vnis personally served or deposited in the mail to file a Court action on this claims See Government Code Section 945.6, you may seek the advice of an attorney of your choice its connection with this matter. If you want to consult an attorney, you should do so ediately. *For Additional " w i g See Reverse Side of This Noti � AFMAVIT OF declare under penalty of pejury that I am now, and at all times herein mentioned, have leen a c€tizeeD Of the United States, over age I$; and that today I deposited its the United States Postal Service in iner, California, postage full-, prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as s owT elove� Dated; y, PML BATCHELOR By, � Deputy Clerk ''c^,r "p .f,.S r op. + ""ht '�4'fZ> >,•-<a�+:wr oS..F�„�' -•lk.nt G..e _S..d�t 'i.. 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'atAA., ,' 'y,`�s's .,-%0. w:^� STA,»E OF ro.WORMA-STATE AND CONSUMER SERVICES AGENCY �3� tb� � �* 4 ..;....G6Y DA,,V1.5&0 BOARD OF REGISTERED ifttsf4aaa P.0 BOX 044210,SACRAMENTO,CA 94244-2100 TDD(916)322.1700 co.-—ss: mer TELEPHONE(916)322-3350 is Ruth Anja Terry, MPH,RN Executive Officer MAN Please print 0r type m��.� e t dome Address ber E city . State: Code: ° ' . Business � dumber tre 4 0 zlilState:' � oaCoder " k r. hone: Bus ess Phone K. T Name (Lase, First,. ', dkAdd , : X _ €mss tate'. � s Home Phone- - �- Boars Phone: .el ton i to Num " ', a � N € r Signature Date CPL-fes(rev 1P99) BOARD OF REGISTERED NG COMPLAINT INFORIMATION L PURPOSE AND FUNCTION The Board `Re istered Nosing regulates the practice of registered nurses and certified advanced practice nurses in order to protect the public health., safety and welfare, The Board exists to protect patients by ensuring that registered nurses are competent and safe to practice. The Nursing practice pct located in the alifo mia Business and Professions Code is the body oflater that authorizes the Beard to accomplish this. The Board is responsible for regulating the practice of Registered Nurses including: Public Health's arses, Psychiatric Mental Health Nurses,Norse Practitioners,Nurse Anesthetists, Certified Nurse Midwifes, and Clinical Nurse Specialists. THE COMPLAINT PROCESS r The following information is provided to help you understand the complaint process. Who CanlShould File a Coffl&1aing with the Board of Registered Nursing? A complaint should be filed by anyone who believes that a licensee eft e Board has engaged in illegal activities,Which are related to his../her professional responsibilities. ALLEGATIONS MAY INCLUD EW.Toss Legh gence or incompetence,unprofessional conduct, license application, fraud, misrepresentation, substance abuse,mental illness and unlicensed activity. Complaints received by the Board of Registered Nursing are reviewed to determine if the Board has the authority to investigate the complaint. The Board can only investigate registered nurses (R.Ns),%,ho are licensed by the Board, applicants for licensure or indiv<:duals who hold themselves out to the public as RNs. The Board can only investigate complaints thati, if found to be valid, are violations of the Nursing Practice pct or the regulations that have been adopted by the Board. Complaints involving allegations which are not within the jurisdiction of ttbis Board will be referred to other agencies which may be better able to assist the complainant. If the:board does riot know of another agency that car.investigate the complaint, a letter is seat to the person who filed the complaint advising that no investigation,till-be conducted. ALLEGATIONS WHICH ARE NOT°IT° e 4¢THE AUTHORITY OF THE BOARD include feelbilling disputes, general.business-practices,personality corfbidts,providers licensed by other boards/'bureaus, such as physicians, chiropractors, dentists,hospitals,vocational nurses, psychiatric,technicians, nursing assistants,physician assistants,respiratory therapists, and pharmacists. Complaints related to facilities such as Hospitals and Nursing Homes should be brought to dae attention of the Department of Health Services, Y cpN"info(rev 1/99) LLow,Qo. .Fileg Coin Wig To file a complaint, complete the attached Complaint Fora and rail it to: Board of registered Nursing,P-0-,. > Box 944210, Sacram. ento, CA 94244-2100. In filing your cc mplaint,the information you provide will determine the action the Beard will take. 'I"he :most effective complaints a:e those that contain firsthand,verifiable information. Theref-bre,please provide a statement', in your ewe c=ords,which describes the nature of your ccmplaint. Please incl :de as many speeidre details as possible, including dates and times, as well as any documentary evidence related to year complaint. The emphasis should be on providing necessary factual information. WIlule'anonymous complaints will be reviewer.,they may be impossible to pursue unless they document evidence of the allegations made. How Are Co Within 10 days after receipt ofthe complaint,the Board sends a written notification of receipt to the complainant. Complaints contaimng allegations of the greatest consequences(cog. grass rrw ;li :celi.,ico: potence,patient abuse, etc.) are given priority attention, The complaint is then-investigated by the Department of Censurer Affairs Division of investigation and/or Beard nursing consultants. if no violation can be substantiated.th case is closed and e complainant is notified, Inv stigatio.-s which provide evidence that the nurse has violated the'11\1ursing Practice Act and that the violationa�riants formal disciplinary action will be resolved by infornial or formal proceedings.If a case involvesunlicensed or criminal activity, it is referred to t ae local district attorney for pros cation. To ensure that the success of the investigation is not j eopardized in any way, the details of the investigation remain Confidential and are not public record. Ifs however, disciplinary or criminal action is taken, some infdrrration may become a matter of public record. In addition, if disciplinary action or criminal action is taken,you may be called to testify as a possible witness. GENERAL INFORMATION `ION T"he entire complaint review, investigation and legal review process may tale an extended period of time depending or,the complexity of the case. During the investigation stage, all information is confidential and may.not be discussed. When a case is finally resolved,you will be notified of the action taken by the Board -except in the case of anonymous complaints. Please keep in mind that any action taken by the Board of Registered Nursing has no impact on civil remedies which may be available to you. If you have questions about filing a complaint please call (916)445-5198. THE DIVERSION PROGRAM _.. The Board of Registered Nursing°s Diversion Program is a rehabilitation program for nurses whose practice may be impaired due to chemical dependency and/or mental illness. The progra m. is designed to provide intervention at ffie earh est signs of in'-paired practice ch point to chemical dependency or mend illness, hong before public hann,occurs. When a report or complaint corgi es to the Board,it is analyzed to deternime here the nurse is a candidate ger the Diversion Program. When a nurse qualifies to participate in the program is identified, the nurse is givers an opportunity to participate in the program as an altcrnedve to disciplinadry action against the license. The Diversion Program strictly monitors participants to ensure pdblic safety. For more information on the Diversion Program, please cal 1 1916)324®2986 or 916)445-7455, ,tea By law;this is a confidential prewar. 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Da=�`t•„.!,e a�.# �d ..•, i� "�`- rah• F � �J Is your completed San the reverse aide? _ NIS ;9 ItaAw1 am �m 0012 . s 22° # "i- Th8nic YOU#Or going ReW rn Receipt SomIC& d � 7 I m ...3388 Tim � w r ro cn; Xxf MM S , �. ms's J � 1 :J a CL to MEDICAL BOARD OF CALIFORNIA Or- COUP Central Complaint Unit 1426 Howe Avenue Sacramento, a i o a 95825 1-800-633-2322 (91 6) 263-2424 Notice; The information included on the Complaint forte is requested per Simon 2,220 of the Business and Professions Cade, Except for the name of t6 physician., all information reTaestea is voluntaq, but ai.lure to provide the requested#information �.y delay or prevent the investigation of y complaint. . �F3U c�rr� tiaz� p�s��i �� should � providedf%3 �a��tiaffi Ss`i� 41- et3 �� 3�Sp i t> ��i �brr�3�ti��on & complaint farm will be used in part to determine whether a violation of state law bas occurred. If a. violation is substantiated,the iniormation may be transmitted to oil- er goverment agencies,including& JA#oime enexags Offices. INSTRUCTIONS FOS COMPLETENiG THE COMPLAINT print or 'pe ir€fortio ,� to cotct yon to� � � ifor ; tiar�, it mill delay dte s . gill irk.the U name and address of the person.your complaint is against, 12. Fill in your name and address, and the patient's name and birth date. s 3. If the patient has seen another doctor for the same problem', include trhe nam.e and address on the records release section on the back of the complaint fora . Wrw�te your complaint and include as many specific details as possible (who, what, when,where, why). Include the date(s)of treatment and specific examples of the problems with the care and treatment. Please use. extra sheets of paper, if needed. Send us copies of any documents in support of your complaint. This may include patient records, photographs, cone'sp ondence,billing statements, etc. t "�a �i � d date tl�e com '�.i�t ¢� at�e bot<orn of the fromt � �. r orr�plete thxe r�.edic�l records release section.orb the back.of"t<�c corrrbplair�t f�:rr foiloso This document is €e '3ori .tion for the Medical Board's staff to obtain nformn tion about the patient's care from the doctors and/or medical facilities involved in the:medical care. ANY EXTRA O VMENTS,NOTA TIOM , ETC.,, I E FORM VOID,AND WE WILL H,4 VE TO ASK # YOU TO FILL OUTANOTHER RELEASE FORM. ffyouwish toprovide as with additional informado ,please do so on a separate piece of paper, If there are more than four physicians or medical facilities, you may copy the blank form in odder to have enough spaces. This fora, when it is filled out and signed, allows the.Medical Board to get records from ONLY the doctors or facilities you list on this medical records release form. f + Print or type the patient's Name,date of birth,, date of death and medical record number(if these are applicable). If we have to contact you to clarify your information, it will delay the process. Print or type the names and addresses of all health bare providers where the patient was seen for the medical problems in this specific complaint(doctors and/or clinics or hospitals, etc.). Pit the mime of the person your are complaining abort in the first section. Ther use the other sections for the other r places of treatment. + `I.he release forte must be signed and dated by either the patient or the individual legally authored to male medical decisions for the patient. If the patient is unable to sin the release, the form may be sued by; 1)the next of kir, if the patient is deceased(provide a copy of the death certificate), )the parent of a minor child, or 3)the person,named by the patient in a signed "Power of Attorney'; ting the person ority to make medical decision for he anent rode� co ofthis doc�erat . MEDICAL BOARD OF CALIFORNIA 1426 Howe Avenue, e o A"825-3236 Consumer Affairs CONSUMER COMPLAINT FORM Pl a Print or Tvoe 1> Last Name first M Pa tna t, oee `aeffaty Name- -'r, a e Street Address: � ntv S t Zip Code Phone Nu44-q s" mbw ; e tr, Last Na a First (ds�te Init�� 0 Mrs. Ms. Mailing Address � C. � County S � Zip Code Home phone; Daytime phone. - £ Your Relationship to Patient: fi patispt Nam ea �, � �'atie�t's date�f Bi�h. C Mrs. a ifs. l a 3 "" 3 3.Has patient been examined/treated by another physician for anis same eoaditiaiz9 es 0 No If yes,provide name,and address on reverse 4>Reason for Treatment. � Treatment Date(s): �. Details of your complaint (attach additional necessary) � tA �sfA a i n Q3 Signature Dam s37a-6?(Rev.4198) Q **C n INTJE ON REVERSE SIDE" o { ; MEDICAL BOARD OF CALIFORNIA Consumer Affairs AUTHORIZATION FOR RELEASE OF MEDICAL, PSYCHIATRIC, ALCOHOL O DRUG ABUSE PATIENT RECORDS Patient Name AJdate of Bim: {r Medici Record o. Datf Death (if appkable) (if spools) Social Security 'o: � l i, the undersigned hereby authorize: iOponal1 s Facility Address -4- Phone Phone Number ; Number Treatment Treet Facil€tyaim Fac€€ity l :3 Address a Address Y sPhony F PhoneNumber - - -- - Number Treatment Date(*) - rate(*) to disclose records in the course of my diagnosis and treatment, including medical, psych€atrri , alcohol and drug abuse records to the MEDICAL BOARDOF CALIFORNIA,ENFORCEMENT PROGRAM. This f disclosure of records aut oriz d herein is-required for official use, including investigation and possible administrative proceedings regarding any violations of the laws of the State, of California. This authorization shall remain valid until the Medical Board of California of the State of California completes ' its investigation and proceedings arising out of the investigation, A copy of this authorization shall be as valid as the originals i understand that I have a right to receive a copy of this authorization if requested by reset ry. Signatures tiara Date P • l or. Representative Relationship Date NOTE TO THE PROVIDER: Failure by a physician,podiatrist or health care facility to provide the reque-syad records within i5 days of receipt of this request and author€zation may constitute a violation of Section 2225.5 of the Business and Professions Code and may result in further action by the Board. 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Y. -..:u+ .,fvl:,:i:. c ,, , —Mm r:.if ; 4.. 4 t' T s: i .� n iy, r t; 4nt � -:mss' , k. f �•`' � :. i ` _ ��r f�yk•2 t xk r`y'r r,�s•jwr s,, r} � s.f.. , r•: k : t .. ..ref...... , -. . it WNVAKC.COW UWAIN*1514 1131) SIVA30, wit .. h: •.r i injury 7 tissue injuny and suvoro WOW in; Wo Oran. obil, £ core minor traw, vion 1010wow W, aw Kom jarap2pulu. jan"Amqla loco 5 n TUIV.&VAI cm April 17, 1004 , Wny LAW 1 out U0 r t y f8u,", thou to wuntaek, on, Sincerely ..k k a:.' t' ?s A GS+J:tt-0rt{M}C{{{:Y.+ttYC!?5..'.1?;.}., I.:iG:•f........ .:.:.' ...;{. .... x:.y..r r....rr s..,..,:. _:.,,.... .: :..is.,:?y .,vv......._.. _...y..,... _...._.HiN/.. ...r, Y{ .. ..,.. t > :.err ., .,..r.:. ✓ •y, Owymely the teo� Too musAs of Ow rancor W an t Thereis seen. the j1pt so that if there is any -;arolaj wan a 5 �r 'Thankyou i �,>�" �`�.. {. Fd'R.w� ,� #`a,.�'"'r'�,„�.�"as°`��'ei''syO •. � ��r� •� � �� #. f ° r # b a{ y r Y ; _ rANN {5 q MAN nib AX; w" r a ft s I a r y4........ err. 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V, • E ✓r*�'' n—, Y�d�✓Si�,..v'��'� ;O t S8sAK- f, " yi.' i e..-,S«�•- '1 (7 �R• r• Vie, ' f�, ; _ 3;.- .�° cvh • fP-t— ..-.�Y�! tpa-.erl�..__..��_y`� .. _... ... � � f a✓ �-�}�� s.s - '�� > ��d � gd��4,.�. f' CI esct �•,� �,,, ,fit '^-�, �„`• r'O"` � ,{., � � > � p � �,� !�f K _ .. _ -D -� # � s E g Dl c z s . ""� f t �8��! t � t.,,a�� ., ��j`S�'.-,-'�d�� •"`'a�l ��s1� ��L�i�+"ar' '� grd Lab 0 d - 4i.'E3" t v ! v I/Q Tr,�+�°. �';: y'�T°�= sem, yy � k' ! �; t." g:_.�j # � ss � 3� a. �'+�-•- .h E! l ; € S ¢, i i:.�'C ''„fie# 9 ~_} f �� tie? xf 5� VCIA p # S �F-4-t #6.•�" -%yf'.-• t{, � � ��5,�. ,'«+ `{ �'' # f (:3 ta'�nJ`'a,J' 9 �r� "�,s6.,�� r� w �"��'�:£� es' ,�fS F.�t;/ Q"r }" # e.. i��"'" -�F'''1 i�,x F�"+ i x'l+`��""• � ,t�iy'a S.R,p �„ ' � �r ; NONg `Zr $i ;. � Y ...y dna /�� a - "'� s °st"• .�'� - �, `: 4 �?. r Tv"�-x�,� � �� m.d � )��b�sr' .� 5 � sr7��i.` ''�'� �A � �.•. `'4�'an.G��m�� ,��f ?t 3 �#��. { Y c�LL- 'lk, P Ya '°°"'a'• -a9, �e�5 yL t �c t ,t - s!` 3` . Vt ✓ may. w."_'.�"Y"'�--�' *�.� �` 61� f { -� Az� w _ G K". { Y � �4"' �a�.s9� t•.-^r�`�'�,/� S Y'i '� X. ,:' i x s "YL'-.J.-�., ""'s.. .r �' ° t °°°'?� �} F f• __. :.F'^r { b vt-., a� !`a iy.. 4 Nk, �w.• S � ! - � / !9 l� �� ....I ,• v i 5 a ,.,:,,.. .s,,.,., s � ;.,to r'_v.?r �:: .,@: .�r-•, `m..y ?.3.'t. • d ; 1T TO: STATE O Of HT1 � ' r GOVERNMENT CLAIMS DIVISION P. 0. WX 3035 0A (Rey.'4191) SACRAMENTO, CA 12-3035 :EFORE COMPI-ETIN6 THIS FORM. PLEASE AWA FT9 _ '" T � � Y KEEP THIS LAST COPY FOR YOGAIR RECORDS. SUBMIT �« ? P THREE 0I .S T£ ? E S$ z E AF z CONTROL. �. � . ,P 0 U ~_ _ T3 ROR CLAIM MAY BE RETZMED TO YOU AS T E LET'E-IN A R CI IA � $ (� � � � � AS A DIRECT RESULT OF THE INCIDENT: s FAROUNOT IS TP FAQ 0AT T8IS T M 10,000, CJCW TME APPROPRIATE COURT" allRISOICTION. COURT SUPERIOR URT Gling Address "173011 r £ # i3 Y L z�€s s N $ CITY, COUNTY, AND STREET ADDRESS, INTERSECTION, ROA€T NUMBERS OR IL VAIJAWA € LT# T rS CLAINarYOND SIX MONTHS FROM THE ISCIDEMT DATE, PLEASE SEE INSTRUCTIONS FOR FILING LATE CLAIM APPLICATION "IME REVERSE TIDE LAST �' .: 4 3E LA e I S A4 H- ALL E DAMA E : Y. LL MV U �SLIR :LAIC? AGAINST THE STATE 0! CALITCRNIA, X40 WHY YOU BELIEVE THE STATE IS RESPONSIBLE FOR THE ALLEGED DAMAGE DR INAURY. KNOWN, I EkTI THE n OF T' E STATE =NCYIES3 AND/OR STATE EMPLOYEE(S) THAT ALLEGEDLY BASED THE DAMAGE OR 3 � r� p J � � .. , >t 41 LAP WAS THE A. UN, -H .TTACM TH EE COPIES TO THIS CLAIM. lv, 3 ' ATTER lPRCNTATI?a`F s at Zga '# 860 AP 76+.- f s < A. -aa !On WOQ0 PREFER (CHECK ONQ LOS ANGELES sxm FRANCISCO Q..I SAN OlEltt ctober only) N O T I C E SECTION 72 OF THE PENAL CODE PROVIDES: "EVERY PERSEN ice, WITS INTENT" TO DEFRAUOt PRESENTS FOR ALLOWANCE OR FOR PAYMENT O ANY STATE KARO OR OFFICER, OR TO ANY C NlY, TOWN, CITY, DISTRICT, WARD, OR VILLAGE SOARG €3R OFFICSR, AUTHORIZED fiC ALLOW OR PAY THE SAME IF GENUINE, ANY FALSE OR FRAUDULENT CLAIM, BILL, ACCOUNT, VOUCHER, OR WRITING,ING, IS GUILTY CE A FTLONY.', cTOY 6 PIS 41, ps JN fee Jvo # f aA t 4-. N)JA.. rl a t �`�. :.1"Y y'•dfyy.�. a� r�..�' �@.r`,4�E ' rl �� rS�.�i �,�fgr� �jRwa�e��s�'9� ✓��1'y�.�.. � �-VAF '+fib'"• .� <. a V �.�'-J`''t-� 43•' S a� 3' f f S �3 S i Cr�� t Tom , 0 1 Aj-Ak A �f - S � w -'s eANJ It- ... muss 7 x f,• MIA '�'-•.dam Y'w,,.{' g S"'r .�'" t. 4` `w° •. , . 3`aa yam ' V DAVID ', LEWIS Pok� e Department � Chief of Police .SL's€s 27, 1 999 Michael Rogers, Sr. { West Tenth$ sitrrC Antiodr,,, CA 945-10.9 R Incident of 03ru 199 Dear Mr. Rogers: In accordance wi4h Penal Code Section 832.7(d), this leiter is to inform, you the -it tens complaint you flied with this eeartment on June 9, 1999, has been fully investigated. The €s�st"". -itior- of this ;ornp,a "'not ,. ,� ri t � � r s; '"� l�'I#'�£ L��c°��; ct�ierr�tir� ��'i'iso, s#,.# tr�t`'€e .> Due to restrictions imposed by California Penal Cade Section 8327, we are una ;le to release ally fu"rlher f rmatfion concern i rithe office# s,. hpWs rec rds are con8idered confidential and :,.>half not be disclosed to anyone, o,. in an-:^' Crim',nal l r civil proceeding. except by discovery Pursuant to the Evidence Cede. If you have any questls: ns .pl'ea s'e contact Captain vSc +i`vltt vs at 779 w�aAll Sincereiy, A;-,- g G; i f Police _. ..... .............. .:. .. ' 1M .. THIS IS NUFA BILL Ex planation of Your Medicare Part B Benct WILLIAM M R04ERS Si�l W 10TH ST ANTIOCH CA 94509-1653s t,€z �t rtic. % 1, .Q0.00 Ywir ,MtA"v mama' ic 545--U-2227A your pfarvi-Aix ac'c� assigmax*w yg�g�� g;qq i tgg ��q�1g �sa��€y'��,��s•$a�ri��f��s�<� A.�8.8��.,a$$.:k.€MW I' ED HV; .�a�:.�fikx;h :� S�$wtu; IMFatt'.+10029fMI 425 XS l 1i Strc;�:t, f€.,cki<£;a.l, CA 94609-1,611 Notm $«t€ ttx_ salsvrykv £,' ap$'€0' lMow _.r �`l �$a �uaa&a•�l sa�$aal.�.r��-a3;�1`1�•>)<��73t l� ( is ,t#i: appl.39i#,'d iextowl f0v his procedure is .3:%:sal "m €fic .mcd1c"vc ICC si;i"e:.;d e t<E%. fa 1'hiai iaalbanati:on i lea>Ittl; w`Wt;t. to '1'6q will 1-cvWw it to sc;c if tacliliou tat �:an be plaid you 12.c€vv the a`t:ght to faE>kc a --q=sI. f#1 'v`ri in,;,, loo- an :tt'_..szod !i'alc#43cM F hlcis C6c:taik C,; £s mc'Llfi;avc ilt,- € o scrvidx iwlaidl-# VOU h vc rmlw£1 from your phys"ic:iall, 1tk Np tal, "r agq oatcsr licacltl: :sul p:t,,. or izcz'Jfls proli,m�lwd. $glmse a:mita,:t Iffiem ili€'i:c:t.€v, M wriung, il`You Would Ii1 an i€i;1uiri:cl stat tts . Ri~wn fN4Wi#; is fraud by caffing tlac; Mt;dic;avc Fraud I lodMo :#t a-P;£;t,-447-M7 i. `.l`lic: ':kbzdfEa4re lowed €$lc cwata«is€i helpful 8110t ilaiioil al3om Pvkciica c: covcratc $z£ispitisl; +uW ben0h 1wriods. VlcuN;; call us a. 1-A00-9S2-? ,)27 i you vioulcl Ilk,, Im €£;c:aivc° a cupy o,'tilt✓ if'You b-ave <a 11'y m4wh:m% € ow calii.rs 1`1''r' "c;c;i-ts list- tl:L; you, have �cai�Aica;za mg�tml,laag'Ivladk= pa€yamms pica;£: call f916)634. -7153S. Im1V `1"A1Vrt If yao haw alkg"fiom 241xmi €hen n€alla-$., v all i3 s.Aivaarlk at .862,17, or vivll les 0€9 450 W04t > g Avosl-av, Cbko, C'A 9!W26, Yw'll mwd dile notim whvn pm wrkv or c;;tll us. You em ffiacl . v,wW NHIC sm lr w Ww,lal Wids> W4' at It ils;s ,anc;ali rca¢laa .t aaas> 1 ci 41 1AW , ;Mi ataaht WRl'111' to cap Intra v Jimmay 14, 21€ B< Scl—#J2 on €lac° 1£c ci" , IOCH r ANT. :€ '..�.a' ;,i4.ak.� IVI a - A 3 G W wildfluwcr Driv) Ailiwdg, 4)4S09 DATE; ut�/Iwqq DA PA7=,T NUMBER. 19470 ra,� W.. - Rule out ,.0 i' r. ' €� �v'cS§'f�2#a W# E,t)3:; .fdf •it; � 3 F 7 `3 �. � y Y 117-0 33 d s;i t.e r: e f # HAW()W() # € Illt suctions; 4E3i #lz iXi # h�€?3w #t Vis{ f s ; dN ss e Ft #�SE T 1 with chemical it airn ��t �{;�, �##�� f�'� 's � J r tAM 11mi out , :4 Ono and WIN NAMPbove MCI se1F£ ds3, {A 3t9Y: 3 3f ,.sf�ti ttr, £sr z,b EMs 4 s`.,+t ;#w o Ant With appeals fL0 1`i#'k{.i It k.]i aD l�1. dJ FS 51Pi ea..,4e{ 'f<r�{[Es�itt {jESij ultimately te test The muscles s of i, r,",Iur cut! arc i¢:lwc, bu,. Me tc. i Oil 4 anangement of he bs.ibscapwatIs <u£€#.ion VVI€11 SPAS l d 4 , ,a#.r£ss..b .} Undust; � #E` 3o s #;` tt�3�uE3#3. The biceps tendon is not in its g r�aove at ;€ t M #`v8` n� '€�' � t`Feat t��e.4'; la t, � ;' :s�,Sst3# Eo#a �.s:3«;#,r #€;� �t€t; 43'1•.1£;=1� �f bony yd l�$,q�y,"pp.. q��y L;t( k .evufs hob'�>a'.Y tiJE;rs t% eeVu ti45Fx.#F�yl t#.:ca�.� }€#.: No bony.dD��s6Y�fo3 E£"#�atlIAy is seen. �#r3 t£sithe u° . into that if thero is wlgs, ativ :.#rUlf itis,,is i. r for referring thizi Paliont W AN/H. � 9 t. 1 rynv r }}:: • i r..v.::::v.•Y:.' { o • ON lot s >}; ...... ............. ........... :}::::, :: ....... ...... ... ... ......................... ........... .......... sx><.......... >;::;:;::;>: . .. t { •::: .......... .......... ..........K:: ......... ............ ................. ............... ... ...... .. .. .. ...... .......... ........... ... ................. ................. ................ ................. ?t 1-117 { Y{ t ? r _ � W { a � } t ? q� f is s ° ' } X4''4,. '= ..:. :•: .. 4 } f? } a :. }::::•}:::.....' ::.. �u n ' ...._.:...�_:_ ....,-,:...-::.. .:}:i:vx• r.vv 4 iY.} .. '":'>'•i.}':n'r�•:r�..;��.r'v.,]Ctii:{:ii:;iJ:•,i ... .. ._... ......�..... .........«.. ........... _..„.......,....._.vim .. .:�•. ? v...ryA. , f PPJ Lf " ------------- �1 f' 3 .f. 4 gg T k ; y q.. r . # f f: Y xt� } . t r z; t S S 9^k ... .;....a•: t • f A" X jgry LA C a �• 3 f y f { i � f r N b } y r a � 3 s t a a e tN,I "' AL _ l sem° � ��' till, S$pyp rq l \k "II oq9^tv£ip : 2 J• t. 5� 4 t 4J } { ..:..::::::::::.:x............ 1DAVID T..LEWIS ....... M. chi of Police rr;%;rr ty dr,} y,Yffn ::r { k •{�'r yf� t4 {'v/,r'?{�'•y'••:,Jrfvv+i%•Y{''S{•{:L L c.33 7 99 • F•••yr:•:Ly:;r::;:;iiiii}:j:i}i:•}ih::};'y:{j};�!v:: .n. rvy}ii. r;;':}; t 7 fK•^,r+yc'Y/y,,''}° .f,'.tf m Ar IN ' 1 X. r i:. Re: Incident of 03304/99 }Y € €�da e with Pen lh ode Section: .7(d), this letter : t inform you the itiza oor lit you filed with this depart€ent on Jure 9, 1999., has been fully iny � d he disposition of this complaint was determined to be "got sustained." "restrictions imposed y California Peas; Code Section 8327, we are unabl-040.419899 any further information concerning the officer(s). These records are 40 € fid nti l and shah not be disclosed to anyone, or in any criminal or civil .. .. by discovery pursuant to the Evidence Code. � €� have any questions pease contact Captain Schwitters at 779-6964i { LSKI f t rr k:v:..'r}:?:%i?}S?::}:::.v;•:}}{lily:vm.:...%Y :{ ...::::::.:::::....... Acting Chi Police `{.fir {• f �r5:''•,•:..'•.2 f ft tti,�i'r+y Tu yf�tf � .......... � fir' r//'�• }i::::: ::•:f�•.:{:jv'iji'ii'{%•: ''v •'''{•f• .yr' � rl.........i};•}}}:4;}:J:•}w:•i:•Yrl',;rf�;{{'if{r. v :r-'}i}}iiia i::is i:v. :..:.::... } � ..:..... .. ....: LLQ.'•....:.• .: .. ' DAVID T. LEWIS L tf t.Antioch, CA 94509-1 100 � f (925) 77!�- 900 i Ui d�I Billy Michael Sr 501 West Tenth iree Antioch, CA 94509 f � � :� .: Dear Mr. ae£.s V , „ ct In accordance e with, Pena,,Crude Set ,o # 832 7(d',� #s :eiter #; to s-#f rim you the �{ i f# � #t t £ > f �; J �rfi � � ��-itizens p3mp#a; t yY �z . £x ' £': £i I £ ff 1 Oto'.. tt I ?c f. ..'rbr 3u } "z"zaE:# 0 {,3 :£ €G zas#:�s : € £ ' ..... .,. Due to, re, t?`sei#ons mposed by C;a€# oiil t3 Pena Code Sectfan 832 T we are unable to'-release any furthe., infC;k i'; a?1(n3 ('t)i i£:E'f Bi:E q the Cat£ cci I :'?espe records are considered o ffd nt > and shams" ro? be tc) anyone, n a..-v c #mfna; or civ # procaeding, exce It by discovery pufswl, o fli,,& Lv#Genre Code If 3ti have any questionsii#'.i jfr' <�!. k> 3# s£t t '.. { .. a �@; � ....Monday through Friday, aster 8 G €Q fV ;„:: �.. r :.:. : .::.::.:: �€� r n . 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LAW OFFWBS OF TAYLOR & GROUT J&in L.Taylv, 458 SEVENTH STREET Tel: (510) 893-9800 Daniel A.Grte€,at OAKLAND, CALIFORNIA 94607 Fax: {610}89369820 September 16, 1999 _.._ Contra Costa County Board of Supervisors County y d ini tration Building 651 Pine Street, Room 106 Martinez, California 94558--1293 RE: William Michael Rogers Date of Loss: March 1999 Dear Sir or Madam: Please be advised this office no longer represents William Michael Rogers in the above—referenced matter. Please direct all further correspondence to Mr. Rogers directly at 50 West 10th Street, Antioch, California 94509, until such time as you are notified that he is again represented° am herefore returning to you the unopened letter mailed to Mr. Rogers at my address post-marked September 13, 1999 Thank you Very truly yours, `m'AYLOR. & GROUT LANIEL K GROUT DAG pw Enclosure cc: M. Roger