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HomeMy WebLinkAboutMINUTES - 10261999 - C10 AMENDED CLAIM 6 1 / o CLAIM d BQAELID OF SUPLEXISf1Rfi OF C}'\"TI2.A =TA COLON" y, CA IM N A ..MARD A BM 16, 11119 CI at the Canty, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your California Goverment Codes. ) notice of the action taken on your dairn by the Board of Supervisots. (Paragraph tY beloM, given . � pursuant to Govemrnent Code Section 913 and 915.4. Rom mote >ddl Wrings". OCT 14 1999 AMOUNT: SUPERIOR COURT JURISDICTION CLAIMANT: RAYMOND TOM HARLESS, A MINORI�lAR COUNTY COUNSEL LCALIF, ATTORNEY: DEBORAH G. LEVINE DATE RECEIVED: OCTOBER 14, 1999 LAW OFFICES OF DEBORAH G. LEVINE ADDRESS: 1981 N. BROADWAY„ SUITE 405 BY DEL'I'VERY TG CLERK ON: QMDER 14, 1999 WALNUT CREEK CA 94596 BY MAIL POSTMARKED: H=-D 1VERED L FRONL. Clerk of the Board of Supervisors 7(1: County Counsel Attached is a copy of the above-noted claim. OCTOBER 14 1999 PML BATCHELOR, C1er Dated: ' By: Deputy ..,T IL IRON1 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 910.5). { ) 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). Cytlttr: , ? :r / t S Lam: 'fir.''/O; Dated: . f - By. r 7Deputy 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 9113). I'VE BOARD (MEM By unanimous tote of the Supervisors present: 7 This Claim is rejected in full. { } tither: I certify that this is a true and correct copy of the Bouts Order entered in its minutes for this date. Dated-& e,*- 2,-&qfl PWL BATCHELOP, Clerk, ByQ&YIr~eputy Clerk I , Z:(a4__WARNING (Gov. node 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 This Notice. AFFIDAVIT OF MAUXid I declare under penalty of perjury that I am now, and at all tunes 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:_ ' ?.-'/m97By. PHIL BATCHELOR By C i Deputy Clerk CC: County Counsel County Administrator .VICTOR J.WESTMAN DEPUTIES: PHILLIP S.ALTHOFF COUNTY COUNSEL JANICE L.AMENTA NORA G,BARLOW B.REBECCA BYRNES S(LVANQ B.MARCNESI ANDREA W,CASSIDY 014TRA COST�.VNTY MONIKAL.COOPER CH IEF ASSISTANT COUNTY COUNSEL C014TRA DAWES ESOFFIC OF THE 0pU -- NSELMARKE TIS MICHAEL D. R SHARON L.ANDERSON O :� q � ULLIANT.FUJiii ASSISTANT COUNTY COUNSEL tEET DENNi5 C.CRAVES r JANET L.HOLMES GREGORY�.HARVEY VEY MA"3 t�4EZ CA�.IEC3Rtri#A , 5$x1229 BEVIN RNARD L. K BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD v LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAR. .HA VALEafE J.RANCHE OFFICE MANAGER STEVEN P RET TIG DAVID F.SCHMIDT DIANA J. PHONE(925'335-1800 NOTICE OF UNTIMELINESS BARBARA3LVER MSUTLIFFE FAX(925)646-1078 JACOUELINEY.WOODS AS TO A PORTION QF THE CLAIM TO: Deborah G. Levine Law Offices of Deborah G. Levine 1981 N. Broadway, Suite 405 Walnut Creek, CA 94596 RE: Claim of Raymond Tom Harless Please Take Notice as Follows: In regards to the claim you submitted on October 14, 1999,portions of your claim are timely and portions are untimely. The portions of your claim prior to April 14, 1999 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2,because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to April 14, 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 on the timely portions of the claims. Your only recourse at this time is to apply without delay to the County of Contra.Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912,2, inclusive, and Section 946.6 of the Government Code. Linder 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 I By: �- Monika L. Cooper Deputy County Counsel Page 1 CER-11EIcATE OF SF&.V1. X MM (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. }:fated. October 19, 1999 cc: Clerk of the Board of Supervisors(original) Risk Management Page 3 AMENDED C3 4im to: BOARD OF SITPERYLS0 RS OF CONTRA COSTA COUNTY ttY!6X t C tY[iNS TO CC.a1XiKlLl�tt` A. Claims reLting to causer of action for death or Cot'injory to perm Or to perso"!Property AW Vowing m'o'ps said wtlich accrue on or befort limber 31.1"7. asst be preserved not Wa thob the 1W►` day afta dw accrual of the cause of action„ Claims rt•Iatxsg to sewn► of action for death or for injury to person or to personal propcM or growing crops=4 which acuate on or acuter Jastaaary 1. I918,saust be pe+taetttt#d not taar than sit months anter the accrual of tl.t came of actim Claiaras atiladttg to BAY other cause of wtbts most be praoentcd not later than one rear,after the accrual of tie cause of actio.,.. (G& t.Cwk J91 I.2.) H. CWms mutt be fikd with the Clerk of the Board of Supervisors at in 91rite is Room 106. County . Administratio.,Build ft,iS I Pint Street.Martivez CA %SS3. C. tf Claim is apinst a district pvtrued by the hoard of Supervisors, rat'ber than the Cmwaq. tht same of the District should be tilled in. D. If the claim is agasaast wwrc thin me public earthy.separate claims was( be fikkd against roar pubac totitr. L 9'tW. See pram y for fraudakatt claims. Penal Code Sm'12 at the cad of this form. P p M P • ■ ■ k ■ i ■ � ■ p P p # • P # • ■ • P # # ■ M ■ ! P f ! ■ # ■ P P # ■ P p p • p P • Y P ■ ■ C P • f0 AMENDF0 RI:Claims by } VAserved for Ckrk*3 filial Stamp RAYMOND TOM HARLESS, ) a Minor Against the Couau of Contra Cost or District) (Fill to NAW) amended The: undersigned claimatnt berebp makes/claiso against the County etc'Contra Costa or the above named District in dao suan or$ Super lvra„d in support of this claim represents as follows; Cc►urT-Jurisdiction I. When did the dAmage or injury occur' (ct..e=oc eau W now) Continuously from approximately January-February, 1. 999 through April, 1999 1. �A't*m did the damage or utjur7 ousar'................................. ..... (tars.cwy aw commy)-__... .... ............ ............. 328 Rheem Blvd . , Moraga, CA -- - - --- .....................------- 3. How dial the da maVc or in jury occur? <c.F..nn tmft*.a*tzar. r it reolvre�na� - -----» .._.. Raymond Rainless was placed in the foster home of Thomas Arthur Bertinuson by the Contra Costa County Department of Social Services. During the time Raymond was under the supervision of the Department of Social Services, he was sexually molosted by foster parent - t. What particular act or orninion as etre part of emery or district officers. srrvaots, or employees caused the injury or doge" Bertinuson and oxposed to sexual material in that foster placement. (Over) lea NS 1 ti A,? tt15C�_Y tialttg3 f t:01 bbbt-L -d9`a YO "d Y NISIVd 38VW AO 2OIAAO MVI VST TT 66-17y-I-:>0 Z0'd lH.L01 j_ Wkst are the osfttw of coonq•or district offieefs,screams.or empsioym coning the daerragc or iw:jor77 Unknown at this time 1....; .+•w at damAges or injuries do you clai CLAIM BOARD OF SUPERVISORS OF CQL7JRA =TA CClITN'I s CA MDENIe BOARD AM= OCrOBE t 26, 1999 Crim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this dowmnt mailed to you is your California Goverment Codes. ) notice of the action taken an your claim by the Board of Supervisors. (Paragraph IV below}, given pursuant to Government Code Section 913 and EF0 915.4. Please note all "Warnings". AMQUNT: $500,00.001:iia.1 E `3 £ 9 CLAIMANT: Raymond Tom Harless " N-;-y cXoUNG L C f+ T i;NEZ CA' F- ATTORNEY: c/o Deborah G. Levine DATE RECEIVED: September 28, 1999 Attorney at Law ADDRESS: 1981 N. Broadway, Suite 405 BY DELIVERY TO CLERK ON: September 28, 1999 Walnut Creek CA 94596 BY MAIL POSTMARK: Hand-Delivered L FROINL Clerk of the Berard of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA LOR, Clef°` Dated: September 28, 1999 By: Deputy � _ ��.. ��- II. FROM:--County Counsel TO: Clerk of the Board of Supervis rs ( This claim complies substantially with Sections 910 and 910.2. { ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for I5 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). ( ) Cather: Dated: ' `' ` 3 ..., Zkgj��L----Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). 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 BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AF'FIDA`V'TT OF MAUNG 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 l deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR ByDeputy Clerk CC: County Counsel County Adnn nimator Chum to: BOARD OF SupyRVZORS OF CONTRA COSTA COUNTY VS TRLtMOtTO C.`i AIM—ANT A. Claims relating to causes of action for death or far is jury to person or to personal property or growing carps and wench accrue on or before Decem M. iW, must be presented not later than the 100* day after the Accrual of the cause of action. Claims relating to t:auses of action for death or for injury to person or to personal property or growing crofts wad whictr accrue oa or after January 1. 1988, must tet presented not tater than sh months after the actrual of the cause of action. Claims relating to any other cause of action roust be presented not dater than out year after tate=ru f of the cause of action. (Crovt. Code§912.2.� B. Claims must be filed with the Cleric of the BoArd of Supetwisnr's at its cttrice in Room 106. County . Administration Building,651 Pine Street.Martinez-CA 94151 C. If Claim is apinst a district governed by the Board of Supernsom, rather thaa the County, the name of the District should be fitted in. D, if the claim is against more than one public entity.separate claims must be filed against each public entity. E. raud. See penarry for fmudulent claims. Pcnatl Code Sat.72 at the end of this form. sr x x s w w at ri W x a it * sr }� w st r x * x x x x x x x x x x x : x tt # x at s x x x x � x x t rr 1r x 3 ft xt x x x RE. Claim by } Reserved for Cleric's Filing Stamp Raymond Tom Harless A Minor (8/14/89) 1 Against the County of Contra Cosm or District (Fill in Same) T'he undersigned eJaimant hereby makes claim against the County of Contra Cresta or the above named District in,the sum of S 500, �O00and in support of this claim represents as follows: 1. When did the damage or ittjury"cur? (r*t" two Dat«aoj flour) Cha..or "about April 13, 1999 2. Where did the dl mage or injury ocrstr? (tws��c'wy a w counry)...... .... ......... ....... ._.............. Rheem Boulevard, Moraga, CA p*;ftr is MgWmd) 3. How diel the damage or injury occur?...... ............. %(vGt.a not a.trcit,yuse errr� !� __ _______ --------- Raymond Harless was placed in the foster home of Mr. Bertinuson by the Contra Costa County Department of Social Services. In that home Raymond was exposed to sexual material and was sexually molested. Y 4. What Particular act or amisaion oil tete part of county or district officers. servants or employees caused the injury or damage? The Contra Costa County Social Services Department negligently placed, supervised, entrusted, controlled, maintained and cared for Raymond Harless in the foster home Of Thomas Arthur Bertinuson. The Contra Costa County Social Services Department breached its mandatory duties to inspect, supervise, andcf� tr l said foster parent; to supervise, control, maintain and care for the person of'Fond Harless; to monitor the condition of Raymond Harless; and to take necessary action to safeguard the growth and development of Raymond Harless while placed In said foster home. The Contra Costa County Social Services Department breached its mandatory duty to notify the appropriate licensing agencies of incidents at the foster home of Thomas Arthur Bertinuson which jeopardized the health and safety of Raymond Harless. S. What are the names of county or .disuict officers,servants,or employees causing,the damage or ininry" Unknown at this time & what dansages or injuries do vOq claim resulted' (dive W*044 ofin}urfes ar a.mal:"elairrrd. Attach rwo esdmsf"for secs damste.? Emotional distress _ How wis the above claimed ansourst computed' ({ne1wie the e#ttrrm*o smoum of,nw s pr %%*sire injury or damage.} ----------------------------- 8. Sames and addrrsse,tsf witnesses.doctors,and hospitals. Michael Maes, Detective, Moraga Police Department 9. List tate expenditures you made on account of this&W4ent or injury; None to date DATE rrV4 AMCft'�`t ! Y ! * ! ! x ! ! * Y * fi * ! Y *'7Y rlt ! fF ! Y' x t ! fi ! 1► 1I lr't w * ! ! x ']! 7t Yi x ! h A ,1 9! X 9M !t lr x Gov. Code Sty 910.2 prowidts: "Titt ciAim nwst be Sighed by the claimant SEND NOTICES TO: (Attorney) or by some person on his befsaif.- Nasse and Address of Artorney �. DEBORAH G. LEVINE ; Attorney at Law 1*1 (Cfaistsnt's Signature) 1981 N. Broadway, Suite 405 Law Offices of Deborah G. Levine Walnut Creek, CA 94596 1981 North Broadwday, Suite 405 Walnut Creek, CA 94596 TelephoareNo. (925) 933-5100 TtlephoaeNe.(925) 933-5100 t ! * ! ! * ! ! Y ! ,1 R ! 7r R R It it R R # Y l x t R x It X Y R ie R x R R R R x * 1r t ! v► tr R * ! ! � * ! * * ie INOTICF, Section ?Z of the Penal Code provides: "Ere"person who.with intent to de€mad,presents for altow mce or for payment to any state board or officer,or to any"O'sty,taty or"rirt board ar vffKcr,authorized to allow ar pay the same if geftine,any false or franduicnt tizins,bill,accaw t,voucher,or writing„is punishable either by imprimument its the county jail for a period of not ((tare tlsaas ossot year, l+y 3 fine ai n<ot esctoding one thousand dollars(51.000),or by both such imprisaumeut mx d rune,or l>y iMPAWOMeSt i=t tht satM prima,Dy:fist t toot exeted at test thousand dotlan (Slo 000), or by both such inopriWalftent and fine. ulk, `0R J.WESTMAN DEPU71E5: PHILLIP S.ALTHOFF COUNTY COUNSEL �f JANtCE L.AMENTA f NORAG.BARLOW B.REBECCA BYRNES SILVANt7 ANDREA W.CASSiDY B.MARCFiESI C6 TRA,C4 �'A 1 i T i MONIKAL.COOPER CH IEE ASSISTANT COUNTY COUNSEL } x + MAR EL_bAWES OFFIGC' � > j+� NSEL MARKES.ESTlS SHARON L.ANDERSON ! r MICHAEL D.FARR LILUANT.FUJII ASSISTANT COUNTY COUNSELDENNIS C.GRAVES n� JANET L.HOLMES GREGORY C.HARVEY MAl IF, 229 KEVIN T.KERR i BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. �` ''� BEATRICELEU MARY ANN MASON CAYLE MLlGGLi w PAUL R.MUf41Z OFFICE MANAGER m PHONE(925)335-1800 November 1, 1999 FAX(925)646-1078 '' Writer's Direct Dial: "1 £ 'h (925) 335-1862 1...... Deborah G. Levine Law offices of Deborah G. Levine 1 cal C OP. 4� L. L e 1981 N. Broadway, Suite 405 ` Walnut Creek, CA 94596 �. cat; . Re: Claim of Raymond Tom HUless Dear Ms. Levine: C'-}} fg This confirms that the claim you filed on October 14, 1...., waI an amenament to your original September 28, 1999 claim. You are correct that the amended information relates back to the date of your original claim. Referring to the letter I sent you on October 19, 1999, you should replace the April 14, 1999 date with March 28, 1999. Therefore, the portions of your claim prior to March 28, 1999 were not presented within six months after the event or occurrence as provided by law and were not acted upon. You should continue to follow the warning set out in the October 19, 1999 letter regarding filing for leave to present a late claim within six months. I hope this clarifies the status of your claim. You may contact me at the above number if you have any questions. Very truly yours, VICTOR J. WESTMAN COUNTY COUNSEL Monika L. Cooper ..>�. Deputy County Counsel 1:\T©RT11 SK-MGT\CLAIMS12LevincOl,wpd AMENDED CLAIM k CL.A M B OAM OF E )aS OIS OF CQYI R.A 02STA CQ=. CA LM► NI A , .� OCTOBER 26, 1999 Crim Against jthp County, or District Governed by } the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section referances are to } The ropy of thin dOMMr1t mailed to you is your Califorria Government Codes. } notice of the action taken on your claim by the board of Supervisors. (Paragraph IV below}, liven pursuant to Government Code Section 913 and 915.4. Please note all Wrings". s". OCT 141999 AMOUNT: SUPERIOR COURT JURISDICTION COUNTY COUNSEL CLAIMANT: RAYMOND TOM HARLESS, A MINORMARTINEZ,CALIF. ATTORNEY: DEBORAH G. LEVINE DATE RECEIVED. OCTOBER 14, 1999 LAW OFFICES OF DEBORAH G. LEVINE ADDRESS: 1981 N. BROADWAY, SUITE 405 BY DORY TO CLERK ON: Q=ER 14� 1999 WALNUT CREEK CA 94596 BY MAIL POSTMARKED: HAND:J# LLLIMED L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 14 1999 PHIL BATCHELOR, Cler Dated: 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 right to apply for leave to present a late claim (Section 911.3). { 4 Other: h .5' C.Its//Y) 4,;4 ,+v —ej ,� r^/e),-- LJ Dated: Y-� ` ' ` By: '/(�zI Deputy County Counsel III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER.: By unanimous vote of the Supervisors present: { ) Trois Claim is rejected in full. { ) Other: I certify that this is a true and correct copy of the Board`s Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By . Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. 'For Additional Warning, See Reverse Side of This Notice. AFFIDAVa 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:-- By: PHIL BATCHELOR By Deputy Clerk CC: "�! Ccs�tfy CAtttftcl C,ry„rier� �tetrnir►imatnt CLAIM ]BOARD Of SUPERVISORS OF GY)NTRA MSTA CU=aCA IMMA BOARD AM :1"9 Claim Against the County, or district Governed by 1 the Board of Supervisors, Routing Endorsements, y NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document retailed to you is your California Goverrinent Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below}, liven pursuant to Goverrrryent Code Section 913 and >. 915.4. Please note all "Warnings". AMbLINT: None Stated SEP 2 2 1-999 CLAIMANT: Shirley Roberts WIART NEZ CALIF. ATTORNEY: c/o Robert Cheasty DATE RECEIVED: September 21, 1999 Cheasty & Cheasty ADDRESS: 1604 Solano Avenue BY DELIVERY TO CLERK ON: 2eptgmj�-.r 21, 1999 Berkeley CA 9407 BY MAIL POSTMARKED: , Hanoi-D .1-t ver rl L FROM- Clerk of the Board of Supervisors TY?: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHEW& Cle k Dated: Sapt=LaL 222, 1999 By: Deputy,, r , IL FROM County Counsel M. Clerk 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 1$ days (Section 910.0. ( ) 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: y: uty County Counsel 131. FROM Clerk of the Board TUB Cc my 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 �!Z2kAt � 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 94$.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. AFT~TIJAV'IT OF AL4rL1 d I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:OP&JX-21 By: PHIL BATCHELOR By Q I Deputy Clerk CC: County Counsel County Adrainistmtor Maim 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 105, County Administration Building, 551 Pine Street,Martinez, CA 94553, C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp RECEIVED Against th County of Contra Costa o ) S F P 2 1 1999 District) CLERK i MRD OF SUPERVISORS (Fill in name) ) CONTRA CQ$TA CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$��cbt� and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur?(Give full details; use extra paper if required) T 14 C ,S'r f)C WAL-1< cO 4 S 1/,u e u 6 AJ I 4A)Z) i s Ate ,S A r 4F. el S . ko 6 -1c_/?-T-$ F C-c-t. 4 S- A 415-YU& 7- 4. What-particular actor omission on the part of county or district officers, servants, or employees caused the injury or damage? #::',4 t L t k k « i fYU A SArdr 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.) ,Q I>b r I- -il //v. U,2 ZLJ 1,VC G. 6( b t eJ C b JCC X �,C_ 7-4 OCt S, IeO f _�7`S' 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) ?eru r Rte Q .5 A,"' �Eb I'C Aa< r 4 7-A 4-�c) 8. Names and addresses of witnesses, doctors, and hospitals. AL?"4 /4�*s10/7-4e- AC4 AvCrOAs VR6-' Ao,0,!Fe7- 4CZ-0/ce Asa . 1-0BG.' �Alac/3 At-t> - H6$P`t',04 ,. a� ��' r!'e�' '�i�ci�r4�����`a�S"to00 �..,a;'eif., +�c.rsc�l 9. List the expen�ltures yob made on account off is accident or injury. rt s . DATE TIME AMOUNT SC--eSC--e R r?`C e €A A14rAI PS� L70 64 7`E.S ,+ha501r.441 ar t S 7"e-A) C N i4 0,C7 F.S 1A)C 4f.<--t 6 oD 4.1'* 6.4 r 6�S b 4 eta !,Gl-72e,e Y l 4.� t..t 6!,S l/d.4/. AtG>fc��� l,td,+=�. Al of 7-/-0 00 40"44 6,` 0"4 ar+d a�"+D its /71- '17 44/4 e4-rtA4-4--. } Gov. Code Sec. 910.2 provides "The claim must be } signed by the claimant or by some person on his behalf" SEND NOTICES TO (A orney Name and Address of Attorney } zt 6 tt CA ST-IT s °7 q ) (Claimant's Signature) i , -kCr c%- f ff ` 76 ) (Address) ) Tele hone No. ) Telephone Na. 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(S 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. 6/23/99 12 : 54 :35 Patient Charge Inquiry HE820R Page: 1 Group# : -------------patient-------------- Med Rec.# ------------Guarantor------------ 892547 ROBERTS, SHIRLEY P 612321 1219807 ROBERTS, SHIRLEY P Phone : 510-526-9144 Pat .Type : ER EC: KM Charges : 1678 . 00 Bill Date : 4/07/99 Bill Type: E ServiceDt Service # Description Qnty Rate Amount Status 3/21/99 14966501 SOL, IV IN 15OCC BAG 1 16 . 00 16 . 00 3/21/99 18730051 EMRGT OBSERV 8 113 . 00 904 . 00 3/21/99 18730168 LEVEL 4 EMERGENT 1 491 . 00 491 . 00 3/21/99 41141102 XR-SHOULDER-COMPLETE (2 1 267 . 00 267 . 00 3/21/99 41141102 XR-SHOULDER-COMPLETE (2 1 267 . 00 267 . 00- 3/21/99 41141102 XR-SHOULDER-COMPLETE {2 1 267. 00 267 . 00 -----------Charge Summary By DEPARTMENT--------- 1449 MATERIAL MGT/IV SOLUTIO 1 16 . 00 1870 EMERGENCY SERVICES-OC 9 1395 . 00 4114 RAD-OP,UPPER EXTREMITY 1 267 . 00 6%23/99 12 : 54 :43 Patient Charge Inquiry HB820R Page: 1 Group# : ------ -------Patient-------------- Med Rec .# ------------Guarantor------------ 13793.97 ROBERTS, SHIRLEY P 612321 1219807 ROBERTS, SHIRLEY P Phone: 510-526-9144 Pat .Type : IP FC: KM Charges : 25219 . 48 Bill Date : 6/12/99 Bill Type : F ServiceDt Service # Description Qnty Rate Amount Status 6/04/99 10810059 6SW WARD 1 1952 . 00 1952 . 00 6/05/99 10810059 6SW WARD 1 1952 . 00 1952 . 00 6/04/99 13082342 NEEDLE, SUTURE 1 20 . 00 20 . 00 6/04/99 13121280 OR ROOM TIME/IP PER 115 46 . 00 5290 . 00 6/04/99 13121371 ANESTH LEVEL 4 GENER 115 14 . 00 1610 . 00 6/04/99 13001508 EQUIP, H/P MONITOR 1 125 . 00 125 . 00 6/04/99 13001052 EQUIP, NITROGEN TANK 1 109 . 00 109. 00 6/04/99 13020474 EQUIP, CO2 MONITOR 1 25 . 00 25 . 00 6/04/99 13026000 EQUIP, MITEK VAPR 1 77 . 00 77 . 00 6/04/99 13030002 EQUIP, VIDEO CART 1 150 . 00 150 . 00 6/04/99 13030101 EQUIP, POWER PER UNI 1 85 . 00 85 . 00 6/04/99 13093083 EQUIP, PUMP 3M 1 75 . 00 75 . 00 6/04/99 13093141 EQUIP, ESU BOVIE 1 50 . 00 50 . 00 6/04/99 13095575 PACK, SHOULDER 1 577 . 00 577 . 00 6/04/99 13030085 EQUIP, ENDOSCOPE 1 25 . 00 25 . 00 6/04/99 13082631 SET, MINOR BASIN MET 1 42 . 70 42 . 70 6/04/99 13082649 SET, MAJOR BASIN MET 1 81 . 20 81 .20 6/04/99 13092465 SUTURE, GEN/ORTHO 1 48 . 00 48 . 00 6/04/99 13092465 SUTURE, GEN/ORTHO 1 48 . 00 48 . 00 6/04/99 13092465 SUTURE, GEN/ORTHO 2 48 . 00 96 . 00 6/04/99 13092465 SUTURE, GEN/ORTHO 1 48 . 00 48 . 00 6/04/99 13092465 SUTURE, GEN/ORTHO 1 48 . 00 48 . 00 6/04/99 13092465 SUTURE, GEN/ORTHO 1 48 . 00 48 . 00 6/04/99 13092473 SUTURE, ROTATOR CUFF 1 506 . 00 506 . 00 6/04/99 13092747 BITS/BURRS, SYN/STRY 1 514 . 00 514 . 00 6/04/99 13093745 SET, ARTHROSCOPY TUB 1 533 . 00 533 . 00 6/04/99 13094388 KIT, SHOULDER SUSPEN 1 555 . 00 555 . 00 6/04/99 13094396 SLING, ARM 1 206 . 00 206 . 00 6/04/99 13094511 KIT, UNIVERSAL CANNU 1 242 . 00 242 . 00 6/04/99 13121074 TIP, ELECTRODE 1 48 . 00 48 . 00 6/04/99 13124441 FASTENER, ROC INNOVA 1 522 . 00 522 . 00 6/04/99 13125620 ELECTRODE, MITEK 1 422 . 00 422 . 00 6/04/99 13125954 CUFF LINK, PACK 1 601 . 00 601 . 00 6/04/99 13126230 BLADE, EP1 1 624 . 00 624 . 00 6/04/99 13126230 BLADE, EP1 1 624 . 00 624 . 00 6/04/99 13100235 RECOVERY LEVEL I/MIN 135 10 . 00 1350 . 00 6/04/99 13521109 LEVEL 2/PRE-PROCEDUR 1 405 . 00 405 . 00 6/04/99 13535000 PRE-OP TESTING VISIT 1 6/04/99 14966204 SOL, IRR 1000 CC BOT 1 17. 00 17 . 00 6/04/99 14966352 SOL, IRR 3000 CC BAG 2 95 . 00 190 . 00 6/44/99 14966600 SOL, IV 1000 CC BAG 1 28 . 00 28 . 00 6/05/99 14966604 SOL, IV 1440 CC BAG 1 28 . 00 28 . 00 6/06/99 14600050 SEVOFLURANE PER ML 20 9 . 87 197 .40 6/04/99 14553663 CEFAZOLIN IV 1G 1 44 . 00 44 . 00 6/04/99 14553663 CEFAZOLIN IV 1G 1 44 . 00 44 . 00 6/05/99 14553663 CEFAZOLIN IV 1G 1 44 . 00 44 .00 6/04/99 14512198 FELODIPINE 5MG TAB O 2 6. 35 12 . 70 6/05/99 14512198 FELODIPINE 5MG TAB O 2 6 . 35 12 . 70 6/06/99 14512198 FELODIPINE 5MG TAB O 2 6 .35 12 . 70 6/06/99 14512198 FELODIPINE 5MG TAB 0 1 6 .35 6 . 35- 6/23/99 12 :54 :43 Patient Charge ,Inquiry HB820R Page : 2 Group# : -------------Patient-------------- Med Rec. # ------------Guarantor------------ 1379197 ROBERTS, SHIRLEY P 612321 1219807 ROBERTS, SHIRLEY P Phone: 510-526-9144 Pat .Type: IP FC: KM Charges : 25219 .48 Bill Date: 6/12/99 Bill Type : F ServiceDt Service # Description Qnty Rate Amount Status 6/06/99 14630842 NIFEDIPINE 10MG C 1 4 . 94 4 . 94 6/06/99 14585665 NICARDIPINE INJ 25MG 1 57 . 82 57 . 82 6/04/99 14652598 MORPHINE IN 15MG/ML 1 31 . 65 31 . 65 6/04/99 14651053 FENTANYL IN 100MCG/2 1 31 . 65 31 . 65 6/04/99 14651053 FENTANYL IN 100MCG/2 1 31 . 65 31 . 65 6/04/99 14582910 MEPERIDINE PCA 10MG/ 1 51 .29 51 .29 6/06/99 14582910 MEPERIDINE PCA 10MG/ 1 51 .29 51 .29 6/06/99 14651053 FENTANYL IN 100MCG/2 2 31 . 65 63 . 30 6/06/99 14652457 MIDAZOLAM IN 2MG/2ML 1 36 . 39 36 . 39 6/04/99 14670772 PROCHLORPER IN 10MG/ 1 23 . 25 23 .25 6/04/99 14580609 PROCHLORPER IN 10MG/ 1 23 . 25 23 .25 6/05/99 14580609 PROCHLORPER IN 10MG/ 1 23 . 25 23 . 25 6/06/99 14580609 PROCHLORPER IN 10MG/ 1 23 .25 23 .25 6/06/99 14580609 PROCHLORPER IN 10MG/ 1 23 .25 23 .25- 6106199 3 .256/06/99 14580609 PROCHLORPER IN 10MG/ 1 23 .25 23 .25- 6/04/99 14510283 SOL IVPB BAG 1 27 . 90 27. 90 6/04/99 14510283 SOL IVPB BAG 1 27 . 90 27 . 90 6/05/99 14510283 SOL IVPB BAG 1 27 . 90 27 . 90 6/04/99 14500011 ASPIRIN EC 325MG TAB 2 6/04/99 14575682 ALBUTEROL INH 17G 1 63 . 19 63 . 19 6/04/99 14575757 BECLOMETH INH 16 . 8G 1 85 . 58 85. 58 6/04/99 14500011 ESTERIFIED ESTROGEN 1 6/04/99 14500011 ESTERIFIED ESTROGEN 1 6/04/99 14500011 ESTERIFIED ESTROGEN 1 6/05/99 14500011 ASPIRIN EC 325MG TAB 1 6/05/99 14500011 ESTERIFIED ESTROGEN 1 6/05/99 14500011 ESTERIFIED ESTROGEN 1 6/06/99 14500011 ASPIRIN EC 325MG TAB 1 6/06/99 14500011 ESTERIFIED ESTROGEN 1 6/06/99 14500011 ASPIRIN EC 325MG TAB 1 6/06/99 14698492 ROCURONIUM IN 50MG/1 1 74 . 57 74 . 57 6/06/99 14691059 BUPIVACAINE IN .25% 1 32 . 25 32 .25 6/04/99 14801104 CS TRAY, SIMPLE (OR) 1 140 . 00 140 . 00 6/04/99 14801104 CS TRAY, SIMPLE (OR) 1 140 . 00 140 . 00 6/04/99 14801203 CS TRAY, MODERATE (O 1 208 . 00 208 . 00 6/04/99 14801302 CS TRAY, EXTENSIVE ( 1 280 . 00 280 . 00 6/04/99 14801401 CS TRAY, COMPLEX (OR 1 344 . 00 344 . 00 6/04/99 14801401 CS TRAY, COMPLEX (OR 1 344 . 00 344 . 00 6/04/99 14911259 TUBE, ENDOTRACH HI-L 1 75 . 58 75 . 58 6/04/99 14914550 SUCTION, YANKAUER 1 11 . 91 11 . 91 6/04/99 14930853 PUMP IV TUBING PCA S 1 144 . 70 144 . 70 6/04/99 14934855 CIRCUIT, ANESTHESIA 1 37 . 71 37 . 71 6/04/99 14936322 CAP, INJECTION INTER 1 18 .40 18 .40 6/04/99 14937544 SUCTION LINER, FLX D 2 59. 13 118 .26 6/04/99 14938211 PAD, GROUNDING (3M) 1 40 . 01 40 . 01 6/04/99 14938872 PROTECTOR, NEEDLE HO 1 31 . 73 31 . 73 6/04/99 14939607 SHEET, DRAPE HALF 3 20 . 08 60 .24 6/04/99 14942445 NEEDLE, SPINAL ALL S 1 17 . 78 17 . 78 6/04/99 14981211 IV PUMP PLUM VNTD SE 1 241 . 58 241 . 58 6/04/99 14982532 SPONGE, X-RAY 8X4 1 18 . 09 18 . 09 6/23/99 12 :54 :43 Patient Charge Inquiry HB820R Page : 3 • b Group#: ----.---------Patient-------------- Med Rec .# ------------Guarantor------------- 1379197 ROBERTS, SHIRLEY P 612321 1219807 ROBERTS, SHIRLEY P Phone: 510-526-9144 Pat .Type : IP FC: KM Charges : 25219.48 Bill Date: 6/12/99 Bill Type: F ServiceDt Service # Description Qnty Rate Amount Status 6/04/99 14982540 SPONGE, GAUZE 4X4 ST 1 9. 11 9. 11 6/04/99 14982540 SPONGE, GAUZE 4X4 ST 1 9. 11 9. 11 6/01/99 18680306 EKG 1 365 . 00 365 . 00 6/01/99 23199094 VENIPUNCTURE 1 26 .25 26 .25 6/01/99 23100258 EKG WITHOUT INTERPRE 1 6101/99 23115256 HEMOGRAM 1 88.20 88 .20 6/04/99 41041104 XR-SHOULDER-COMPLETE (2 1 654 . 00 654 . 00 6/04/99 41083007 XR-PORTABLE EXAM 1 6/05/99 54088109 PT IP ASH EVAL 15 MIN 4 173 . 00 692 . 00 -----------Charge Summary By DEPARTMENT---------- 1080 6SOUTHWEST- MED/SURG 2 3904 . 00 1300 SURGERY-OC 231 6920 . 00 1301 SURGERY-ANESTHESIA 1 125 . 00 1302 SURGERY-EQUIPMENT 7 571 . 00 1305 SURGERY-PACK/SHEET/DRAP 1 577 . 00 1307 SURGERY-ENDOSCOPY 1 25 . 00 1308 SURGERY-SUPPLIES 21 5856 . 90 1310 SURGERY-PACU-OC 135 1350 . 00 1350 SURGERY-SDC-OC 2 405 . 00 1449 MATERIAL MGT/IV SOLUTIO 5 263 . 00 1450 PHARM-CHARGES-OC 20 197 .40 1451 PHM-ANTI-INFECTIVE AGEN 3 132 . 00 1453 PHM-CARDIOVASCULAR DRUG 7 94 . 51 1455 PHM-CNS DRUGS 8 297 .22 1457 PHM-G. I . DRUGS 2 46 . 50 1458 PHM-IV SOLUTIONS 3 83 . 70 1459 PHM-MISCELLANEOUS 11 255 . 59 1480 MATERIALS MGMT-REUSABLE 6 1456 . 00 1490 MATERIALS MGMT-OC 17 834 . 21 1868 CARDIOLOGY 1 365 . 00 2310 LAB-OC 3 114 .45 4104 RAD-IP,UPPER EXTREMITY 1 654 . 00 4108 RAD-IP,MISCELLANEOUS 1 5401 PHYSICAL THERAPY ASHBY 4 692 . 00 S"p--20-99 04:38P Scalnna AvGanuea Building 1 P.02 CHEASTY HEAT ATTORNEYS AT LAW 1604 SC3LAM AVE..P.0.BOX 8357 BERKE1XY,CA 94707 ce€: 51!7,55.i fax. 5M526.3672 TO. Contra Cost County Board of aSupervisoris RE; Shirley Roberts, Injury at or near Colutxa near rair"Gunt, Kens%n#ttari DOL: 0.3-21-=99 This is to certify that I the undersigned, hereby authorize Robert C. Cheasty and CHEASTY &CHEASTY, Attorneys at TAw, to act as my attorneys and to represent me in connection with any claims, insurance or otherwise, in this matter. Photocopies of this authorization, including signatures, are valid. Date= 09"-20-99 Saap--20-99 04 :3aP Sa lance AusanuQ Building i P'_01 CHE.A. TY & CHEASTY ATTORNEYS AT LAT 1614 SOY ANO AVE.,P.U ROX 8 357 BERKELEY,CA 94707 fax: 514.5263672 Sept. 20, 1999 Clark of the Board of Supervisors County of Contra Costa 651 Pine Street Martinez. 94553 FAX: 1-9*3 .1913 Re: My Client: Shirley Roberts DOD.- 07/03' 27 Location: Colusa Ave., near Pairmount St. D}I,: 3/21/9+ Dear Sir\Madam: This office represents the above-referenced client in connection with injuries sustained As a result of an unsafe sidewalk in an unincorporawd part of the county, near Kensington and El Cerrito, California, at or near 239 Colusa. I am Mreby making a claim for the damages she suffered including,,, but not limited to, the costs of the shoulder surgery she had to undergo as a result of the fall and the general damages she suffered in connection with the fall and the surgery. The damages suffered exceed the jurisdictional limit of Superior Court, Unlimited Jurisdiction and are expected to exceed $200,000. Enclosed is a representation authorization. I will be forwarding a claim farm, the medical records, and any other pertinent documentation regarding, the damages, when they become ,available. I look forward to working cooperatively with you to resolve this matter. Sincerely, 44'a- Robert C. t heatsty Encl.: Authorization