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MINUTES - 12192000 - C11
CLALM CALIFORNIA , BOARD AOM DECaIBER 19, 2000 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this document mailed to you is your California Government Codes. y X.: notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Exceeding $25,000.00, CLAIMANT: JOYCE ARMSTRONG, a minor, and DEBORAH COBB, her mother ATTORNEY: c/o RANDALL CRANE DATE RECEIVED: NOVEMBER 17,2000 ADDRESS: LAW OFFICE OF RANDALL CRANE BY DELIVERY TO CLERK ON: NOVEMBER 17, 2000 180 GRAND AVENUE, S`I"E 1550 OAKLAND CA 94612 BY MAIL POSTMARKED: NOVEMBER 16 2000 L FRO— Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk .. Dated: NOVEMBER 17, 2000 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( '- This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). { ) Claim is not timely filed. The Clerk should return claire 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: °� I By: uty County Counsel M. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. {" ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated ,2 i , a ;= PHIL BATCHELOR, Clerk, By "" pF 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. AFFIDANTT OF MA�iG 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 1$, and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By eputy Clerk CC: County Counsel County Administrator u r; wSAA: 888 8888 Date: LO/ 6/OC 8;010:42 am EStiwate ID: A17a39095201 P_eiinunary Prn-iie T(1: Cfi Ad-Tmpnrt Total :,Rbc,-: 316.00 II. Total Replacement Parts: C.00 ITT. Tctel. Aedi.`coal ^ itn: 2.43 Gross 'Coca_; 248.48 Iv. Total, Adjustr.,ents: 248.48- Net Totals O.CO This Is a prelir:inari estimate. Additional change; tc the estiw.ate ray ba required for the aCtUal rapair. FcinL(s) of Impact 16 Yon-C,llision IS) Ins,;rance Co: Ct.LI?G iPIIA STATE AUTO":OB_LF. ASSOC Add res s: 3C6D E3illu p Mall Fnad Richmond, CA 9:806 l EPhal:E: 510) 223-0791+ Fax ?hone: COMMA?iY 18rb5rs Auto Body° Inspection site; Address: 4C5 24-h S"reet - Add-,8s57 Aichnnnd, CA 94804 relephcnes Inspection Dates (51 c) 234-12D4 Fax Phones (c'-D) 234-7302 -PARTS PRICE'S S':B.'ECT TO CHAh'CE- ANY ADDITICHAL REPATRS RELATED 'C iAIS LOSS S CULT BE 3ROU^.ET CJR ATTENTTON FOR FURT?TS;R RFPA.'R3 OA AI:I GUARANTEES ARE VO:C. ALL PARTS GUARANTEED A5 PER t NJFAC:URER< i�AAFSaitiT", ALL WoiB+'iANSBiP GUA_RA;MEEO FIR AS LONG AS YCU SOWN YOUR l'EHICLE. T AUTHORIZE ANY ADDiTiONAL PARTS ANt LABOR N3--ME -0 CCMPLETE RZ?AIRS. REPAIRS AUTHORIZED BY DA,TE ESTEt—WE R3CRLL C IvEER. 10! 6/0D 08:00:25 A17B39C9120' CLtra'.Ma'te -6 a Trademark Cf Mitchll Inte:ndticndl Mitcheil Da`_a VerBiCna SEP-N A Cc�;yright (C) 1994 - 2000 Kitchell international Page 3 of 4 U1LraMa�� Versitm; 4.6.Oc4 All R1uL,L8 Rtne rued s Date: 10/ 6/30 8:00:42 EstiIcZte ID; A17c39C9520_ 35Li.i— Y—bW" C Preliminary s PwOO 4 10/5/CO WROTE 10/9/CO SCEDUAD YCA REPAIRS 5 10!1Oj06 ;O,R :TwL.:v-,Y •. Jlla.ja,mer:: .tem Fe cycler infcrma'ion 5��.t_or.. rY 1CY Damage Rema2Y'; Law 5'iblet. bator subtotals .nits Rate. mount A mtmt TcMrls 1L. 10 R.eni=:cemev SmnarJ nrour,t Body 4,C 54.00 0,00 0,01 21c.00 Taxable Patts L.00 RdY-S C.0 541C0 0.00 0.6C O.oD Parts Adjustments C.C,' Rctir.lsh 0.0 5i.oc C.Co 0.00 0,00 Glass CA 3.4,CC C,cD G.00 O,OG Gla>s ;Z u3'_ment3 ? O,OG6 C.oe M=_chanicai O.0 54.0C C.Co C.Co 8.3C Sales 'Iax @ 8,25( Frame O.Q 54.�' .,'C 0..^,0 e.O,' Taxahe Letcr 'VO -"Hxa:,1P ?ar'_S Pa-t,s djustrents Q, o Labor 'tax fa ..X00 p,Op vc,--Ta„ai�1Q Lahnr Nen-1'axat+le Lab+,Y21E.0 ,lass Adjustments Labor sumsna_ry 4,0 21'0.00 To-al aeplacement Parts Ancunt D.CC ---. Additional. Co is 1W Add'.n"wts Am^'uyt n"ableaCost.e ;O.OG ir.surance Dedactibla 500,C0 Re,tPwen:". LOU Sales Tax 2 6.250 2.48 ApPearaace A:iowance 433 Subtotal C1_ Ac' Cu>tomer Responsibil-ty 246.58- `J:;n TCxaul_ ccs_., To--al Te.dditicnal Case 3?,48 ESTSMATE RcCAL; ,'�:I ET.: ?C/ 51,'0 06:,'0:25 A1'B390.520: 41tY ""L9 '.5 a ademaCi( nt @[fir h.li er1a Mitchell Data Je sacn: SEP_OC_A Go f fight (C) 994 - 2000 Mit rill .r ernaticr.al Page 2 c_ 4 J1 L.-a:4a�� V�rsi c.ii. 4.6.D04 All R.iuhts Re,Iely-d i By:-� 10/17,14,CQ,I 56P,�J, page 1/",0 Se i SAA 8888; Ic/ 'i0o 8100;4.2Estimate -D: A17133909b201 Preliminary Prn'i 1. TD: r,SAA--nPnrt Aarber'a A-,to Body 405 24-h Street Richmond, CA 9464 ,,ax;(BM 234-7302 Damage Asse ed By Jose Gonzales A�ntajsecj -,c)r: Brandie Lane T-,,pq of :.ASS: Ccmpvehonsiv� nate cf Loss: 10/ 4100 ArrLval DAte'. Accident Tat=. payer: inz 11-arse rr,,icy No: Claim. N,.rober Al,B19095201 Elle Number.- Nozn^ MvIRI;1111N C"t PATTIR LIN,, MORGAN Or, PATTIE LEW Cl a lmaj,�, ;NddfL Tqlephone, Pnz!iw.€'qome -,hone: mitchelL Service: 51111211 Des Cr!pt 1:M 20C-1 Hcrda 00ySsey KX ve!)Icle Pro"Uction Det- 12/95 Body Style: VanpaBs Driya ':rain: 3.5'. In! C C"I 2n IIFXR L i 879 YF5.1 9 0 5 ,icenss: 4KA1975 CA M�.leaqe; 8,295 HEMI at LP• A SY.rch 7,,de- C946'.14 co'or'. CHAXP41ji — cations: —r ro-,-jtjcj)in,,,Tjit 5neerJnq Wh"l :ant--1 ,Crui5e - ,Electric Defogoer,AM stereo Nngine,Puwer Remota Li e -rntfy Labor Inc llo,*n Part TYLe/ Doha, It w% N ff t c Type OPDen cr 4 pt ior, PirtNullh,--v Amount is ur.,t i'JUouO BDYI XVIA17, F,�SOVR TAR OvER 82PAY :x15 11q 33cOC7 ALD'1, COS-. 5qop 'alrT.RTATI, 30.00 y,-gCTLL N-'1M3Z7_- ID? k,/OC 08;00:25 Al"B3909b2CI UltraMate .s a Gra-.emark of NdtCh?.71 Interna-icnPI Mitch,-1-1 DataE-,_Co_A Copyright (C) 1994 - 2300 Dt,-hel,- lnternatil�nal Psaa 4 V-1ul'; 4.6.004 All R-yhL, R—tv,,-! 11 .1111 { w f , -..{ £ s F f 7. {{ :' . ''-. ,.P f }• F \ { 'z , E L ,: : {{ii f v. :. 4l }. f: { } :.}-- : -.: . 1. vis F! ........ ......,. r- i " S i. ,. % .:. _: - _:: _._. ::.::.- .. 5: a :.. 0 s 4 fi :i - . :.-: .v - `� I. a� f » t { Cgwyt 7, 1.1. 4`{ ,;, 11 lillilliliiiillllllllililiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiilllllI -- 1, y Y p� P 4.d .,a •:n:: ::: .. .:: � r� : f .:. .. - - S 1. �. V p I, a 3 .: .. :. .,....: , ... : :.: : j�gqqq�h�(y� M ii� :.. ,.. ,�{ -:. o far _ 3� »: Ln +yak r <. Ln { 1. S : y :per Y • -..... . I R I I I - I . 1. .- , .. 1, im I ":, .- .1 ..:;�:.." ��:�::''�, :-t�! .�,-,---, :.,�.-:" ,"..,:,..,.,,�'..,',.',"....-".:""., . �k..". Y f evA b t ^F.0 f { 11 .� :. }r1F : r � ..... . ... :- „, .. `' x- , aL } _ :: 1. - i ¢: �y q S ". � Y il - ` C3 t ::. ....:. -:: ... .... ... F•, f { j� A ... .- :. :- .... ..fi.-. .. ': ...::. -: .:: .. - :.,- :.v. -:,.. , x. , { ✓ -. { t £' ..:.: ... ..: .x .. :. t f of �g a } F 4.. ..n.::. ..... ..,,..s.. ..r k•F ar� . f v\' � .:i : ,e r f.: ; u # i Y7 S F i l } f .' t S 6 { YT m } .} h yf { f .. } ts� f Y 1 -: v { F f . } uv.-m2 . .. CIA Y d b R5 C X _ ® BOARD AlmDECR11BER 19, 2000 Claire Against the County, or District Governed by $ the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Actinn. All Section references eel ..f 1..: The copy of this document railed to you is your California Governlnent Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AM0UN, T: jurisdictional Limit of Superior Court, State of California CLAIMANT: I10y NA�i4IZZi ATTORNEY: c/o Steven 0. Teal, Esq, DATE RECEIVED: N-OVEmBER 17, 2000 TEAL & MOIL 1+� ' ER 17 20003 ADDRESS: 815 Fifth Street, Ste. 200 B ' DELIVERY TO CLERK 01�: OVEI , Santa Rosa OA 95404 l0VRBER 1 2000 B4' MAIL POSTMARKED: 9 n L FROTM Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BATA OR, Clerk ,} Bated: NOVEMBER 17, 2000 By: Deputy II. FROM County Counsel TO: Clerk of the Board of Supervisors ( �4"This clam:. complies substantially with Sections 910 and 910.2. { This clam FAITS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Boa--d cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed tate and send warning of claimant's right to apply for leave to present a tate claim (Section 911.3). ( ) Other: -- f" Dated: 6 frs�:: By: � i3puty County Counsel III FROIN11 Clerk of the Board TO, County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. '70, : 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 1� �� iz(� ®, Deputy Clerk WAKINING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT GE NIAII.T�G 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 fully prepaid a certified copy of this Board Order and Notice to Claimant, ad4ressed to the claimant as show above. Gated: By: PHIL BATCHELOR By ^ .( a :- Deputy Clerk y` , X: County Counsel County Administrator 1 TEAL & MONTGOMERY STEVEN O. TEAT.,, ESQ. [State Bar No. 58454] 2 815 Fifth Street, Suite 200 Santa Rosa, CA 95404 3 Telephone; (707) 525-1212 Facsimile; (707) 544-1388 4 Attorneys for Claimant 5 6 7 8 9 10 I I In the Fatter of the Claire of CLAIM AGAINST PUBLIC ENTITY 12 LUCY NANNIZZI, [Govt. Code § 910] 13 Claimant, 14 v na 15 CONTRA COSTA REGIONAL MEDICAL CENTER & HEALTH CLINICS, 16 z y s 1"7 Public Entity. ' 18 19 L€JCY NANNIZZI, by and through her attorney, STEVEN 0. TEAL, hereby presents 20 this claim to the CONTRA COSTA REGIONAL MEDICAL CENTER &HEALTH CLINICS, 21 pursuant to Section 910 of the California Government Code. C 22 ' E 23 € 1. The name and post office address of the claimant is as follows; 24 LUCY NANNIZZI c/o Steven 0. Teal 25 815 Fifth St., Suite 200 Santa Rosa, CA 95404 26 2. The post office address to which claimant desires notice of this claire to be sent is 27 as follows: f 28 3 I STEVEN 0. TEAL, ESQ. TEAL & MONTGOMERY 2 815 Fifth St., Suite 200 Santa Rosa, CA 95404 3 3. On or abet May 24, 2000, claimant's daughter, YVONNE NANNIZZI, sought 4 treatment at CONTRA COSTA COUNTY REGIONAL MEDICAL CENTER & HEALTH 5 CLINICS for headaches and and neurologic symptoms. She was examined, and although Yvonne 6 € ` appeared confused, the physician attributed this to her pre-existing disability, in spite of the fact that she had actually been doing very well prior to this time. 8 Over the next several days, Yvonne's condition continued to worsen, and finally 9 she was admitted to CONTRA COSTA COUNTY REGIONAL MEDICAL CENTER & 10 HEALTH CLINICS on May 27, 2000, but at this time was admitted to the Psychiatry Ward, due 11 to apparent suicidal tendencies. 12 Later the same day, as her symptoms began to worsen, Yvonne had seizures and 13 became unconscious and was transferred to the Intensive Care Ward. Claimant,Yvonne's mother, 14 LUCY NANNIZZI, was called for the first time on May 29, 2000 and she immediately went to 1516 the hospital. Claimant asked that her daughter be transferred to UCSF for more advanced care, but this request was refused. Over the next several days, Yvonne continued to have farther 17 complications, including prieumonia and pneumathoraces. Once her condition became much 18 worse, on June 6, 2000, Yvonne was finally transferred to UCSF for treatment. Her condition 19 continued to worsen, and Yvonne Nannizzi died at UCSF on June 13, 2000. 20 4. Asa result of the failure to properly diagnose claimant's condition, claimant's daughter 21 died. 22 I 5 The amount of plaintiff's damages are unknown at this time. The amount of 23 24 plaintiff's damages are within the jurisdictional limit of the Superior Court of the State of California. 25 26 6 The name of the public employees causing the injury, damage and loss are DOES ONE through TEN. 27 28 7. The true names and capacities, whether individual, corporate, associate, or 1 otherwise, of the public employee or employees named herein as DOES ONE through TEN who : 2 caused injury and damage are unknown to claimant at this time; claimant will amend this Clain 3 to show their true names and capacities when the same have been ascertained. 4 Dated: November 16, 200 5 'TEA '& MONTGOMERY 6 ,r ,a y SThVhN 0. TEAL b Attorney for Claimant 9 10 CS 77 11 12 13 14 15 S 16 17 18 €: 19 ` 20 21 22 23 24 25 26 27 28 I PROOF OF SERVICE BY MAIL j I arn a citizen of the United Stags and a resident of the County of Marin. I am ove° the 2 age of 18 years and not a party to the within action; any business address is 3 815 Fifth Street. Suite #200, Santa Rosa, California 95404. On the date as executed below I 4 served the attached CLAIM AGAINST PUBLIC ENTITY (Govt. Code§ 910) Asn the interested Iparty in said action, by placing a true copy thereof enclosed in a sealed envelope for collection and 6 ;1 mailing on the date and place shown below, following our ordinary business practices. I am E 7 readily familiar with this business` practice for collecting and processing correspondence for �E S mailing. On the same day that correspondence is placed for collection and mailing, it is deposited 9 a; in the ordinary course of business with the United States Postal Service in a sealed envelope with 10E ii postage fully prepaid via certified mail. 3 11 r' Clerk of the Board of Supervisors Public Entity 3 12 ' County of Contra Costa 651 Pine Street, First Floor 13 Martinez, CA 94553 14 15 i s 17 �� � t I declare under penalty of perjury under the laws of the State of California that the 18 foregoing is true and correct. Executed on November , 2000 at Santa Rosa, California. � 19i i T r e 20 21 SHARON RENZO 22 23 24 4 25 26 27 28 T s Y , W,x 5 mix, CP Co FrP° f 0 ; th p.1 1 a CIALNI 8M.A001 DEC ER 19, 2000 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsennents, NOTICE TO CLAIMANT and Board Action, All Section references are to The copy of this dont mailed to you is your California Covernnt Odes, ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 9'5.4. Please note all "Warnings". AMOUNT: UNDETERMINED CLAIMANT: i0SEPH WAYN-, E POFF ATTORNEY: DATE RECEIVED: NOVEMBER 15, 2000 ADDRESS: 576 EL CERRO DRIVE BY DELIVERY TO CLERK ON: NOVER 15, 2000 EL SOBRANITE CA 94803 BY (MAIL POsr. 'ED, NOVDQER 14, 2000 L FRO.NE Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PFE,T BATC OR, Clerk Dated: NDVAER 15, 2000 By: Deputy > H. FF OA- County Counsel TO: Clerk of the Board of Supervisors ( ; ) his cla=m complies substantially with sections 910 and 910.2. "-.'his claim, FAILS to comply substantially with Sections 410 and 410.2, and we are so notifying claimant. The Board cannot act for 15 days (Sectio; 910.0, ( ) Claim is not tirnely filed. The Clerk should return claire 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; f F `< —arm_- By;�� / ' � �, �.�Deputy County Counsel IIL 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 ORDS: By unanimous vete of the Supervisors present: (} This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date, Dated: PML BATCHELOR Clerk By Deputy Clerk WARINTING (Gov. code section 13) Subect 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 N_1kHXN-1G declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United Mates, over age 18; and that today i deposited in the United States Postal Service in Martinez, California, postage fully )repaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: v',f By: PML BATCHELOR By �.�¢ � _ d��, � r3e;)uty Clerk 'C: County Counsel County Administrator e RECEIVED NOTICE OF CLAIM AGAINST THE COUNTY:-OF CONTRA COSTA. (Government -Code. s 910; 9fo. NCV 1 Z0 Return to CountyClerk' s OAffice 'CLERK3C r 09SUPE- USCnS 651 Pile Street CC�� AcflS7?C . martinez, CA 94553 Rhone Nur-ber: CLAIMANT CLAIMANT'S ADDRESS: umb r dd o- � Ity Stats Zf Cade NAME AND ADDRESS QR PERSON.'TO".. NOTICES' RE ��_ TH+.S CLAIM SHOULD! BE SENT (if different than ,4a: _ 1 k t a DATE OF THE ACCT SENT .OR OCCURENC E: PLACE O �':"�E A.CCI DENT' Oft '66CURENCE: � ;.v ;s .; C,s GENERAL DESCRIPTION OF .SHE ACCIDENT OR OCCU,RENattach additional pages ,_ if more space is needed) : .. ��- Y � � <. •, �,.w w � , °NAEES, IF ioi'Ok°M OF ANY PUBLI ' EMPLO , C �JSING HE INJURY OR LOSS , , ` s ':' v NAMES AND ADDRESS OF .WITNESSES NAME ADDRESS TELEPHONE (A d TCf. G v �f ' �. ut d•�: .ti..,^a,,- a�.a�r' s�,4 - n..r C +'A4�� NAME AND ADDRESS OF DOCTORS, HOSPITALS WHERE TREATED: L NAY.E ADDRESS TELERHON.E x, w 2 . GENE L DESCRIPTION iOF _THIi LOSS, INJURY OR DAMGAGE SUFFE j4.4y i "� ,s 4. •s.i�d'.;. „"v fs rl =S r o"-.i6 ¢/. j°� ..�,. ..�# "' a L c. 'Ai, AMO UNT CLAIMED: s �� i a BASIS OF COMPUTING THE TOTAL AMOUNT CLAIMED IS AS FOLLOWS: Damages incurred to date � � _ _ Medical. Expenses: �� — x � 11 r <�:tkf ';.x �`r` I 3 Loss of Earnings: $ Special damages I.for: Q Ez 7 �" z (attach cop es if—available) . We, the undersigned, declare under. penalty, of perjury that I/we have ad the foreg®ing 'claim .fog damages 7 end know the, contents -.°thereof p : that e same is true of -my/our- own knowledge. and belief, save sand except. -as these natters wherein stated ,on information and belief, and as to em, ,' I/we believe it °to, be true 0 ' . S `gnatL e of, Cla faPop ceived :at County. Clerk's Office this _-day .of signature . . )R CLAIMS RELATED TO INJURY .TO. PERSON OR-PERSONAL.PROPERTY THIS -FOR IST BE FILED WITH THE tCo. '*Co •,;County :WITHIN 1.80.-. Days - ;FROM THE :Ca UAL OF THE CAUSE OF ACTION. ' A CLAIM RELATED TO.,ANY OTHER CAUSE OF ` .,TION ,SHALL BE PRESENTED 1;0 LA 13P T LUT ONE YEAR .AFTER ACCRUAL OF THE FUSE OF AC`IIONe i P .................................................................................................__......_.._..._.... _.... ............. ......... ......... ......... ......... ......... ................... ......... ......... ......... ......... ......... ....__. _.... _..... _...._......... _... ......... ......._... ....... __..... .._ ....... .......... I [p�p Ko�1- 4 . y :.:3 cs !f k - CI ALM CQUA EQAR AC S DEJH�IBER 19, 2:000 Claim Against the County, or District Governed by � the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and ward Action. All Section references are to The copy of this document railed to you is your California Government Codes, l notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and - 915.4, Please note all "Warnings". AMOUNT: $79000 CLAIMANT: 3TLL RALS'.jA ATTORNEY: DATE RECEIVED: NOVEN31 ER 13, 2000 ADDRESS: 179 WILSON ROA:? BY DELIVERY TO CLERIC ON: NOVR,'IBER 13 2000 ALA:MIO OA 94. 07 BY MAIL R£7S T MARKEFD: NOVEIBER 9, 2000 L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BATCHELOR, Clerk NOVEIMBER 14 2000 x Dated: g By: Deputy IT, FROM: County Counsel TO: Clerk of the Board of Supervisars Ll)' this claim: complies substantially with Sections 9140 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 claire (Section 911.3). ( ) Other: 17 Dated: }' � By: ' Deputy County Counsel M. FROM- Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with notice to claimant (Section. 911.3), 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. Bated: } ' �` PHIL, BATCHEL�RC�Ik, y , Deputy Clerk ~ _ WARNING (Gov. code section 91.3) 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 maty 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, I declare under penalty of perjury that I am now, and at all tines 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: .1 B P'_-HL BATCHELOR B � � t�"� Deputy Clerk CC: County CbLnsel County Admnistrator Claims to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS Tn CT�ATM _T A. Claims relating to causes of action for death or for injury to person or to personal property or grooving crops and which accrue on or before December 31, 1987, must be presented not later than the 100'0 slay after the accrual of the cause of action. Clams 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, east be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) R. Claims must be filed with the Clerk of the Board of Supervisors at its office in Rooms 106, County Administration Building,6v1 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 Palled in. D. if the clam is fagairst more than one public entity,separate clams Frust be filed against each public.entity. E. Fraud. See penalty for fraudulent claims, Penal Code See. 72 at the end of this farm. RE: Claim by ) Reserved for Clerk's Filing Stamp Against the County of Contra Costa or District� T (Fill in Name) The undersigned claimant hereby makes claims against the County of Contra Costa or the above named District in the suns of S � and.in support of this claim represents as follows: 1. When dict the damage or injury occur? (Give exact Date and Hour) 2. Where slid the damage or injury occur? (Include City and County) s.a i v € k 3. Row did the damage or injury occur? (rive fin details;use extra paper if required) g' >' . �. 4. _What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? �g r I E,A ` y"e a'k € ,. t") �,.4,m bid x' 'r cex- F a. , T Z. (I Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? .i�,9 5 h `�!h ? � �'p+`.,m 6. What damages or injuries do you claim resulted? (Gi®e full extent afinjuraes or damages claimed. Attach trove estimates for auto damage.) , fir`.: fk+ Lwa sw - 2< �'63 � - y yf'} •. N r." "' �:$ kN y� 'oF,+... ,Y.+'- Y a'li '� C t GK ---------------------- ',tea 7. How was the above ciairaaed amount computed? ;Include the estimated amount of any prospective in.jury 3 ar damage.) ,A .� L A � � - - `� -------------------------------------------------------------------------------------- 8. °"Imes and addresses of witnesses,doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT 24 f 10 Gov. Bode Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney) or by some person:can his behalf." Name and Address of attorney (Claimant's Sign re (Address) Telephone No. �'� ®�' � `� >` ���� Telephone No �f�� � � 77 U e NOTICE Section 72 of the Penal wade provides. "Every person who,with intent to defraud,presents for allowance or for payment to arae state board air officer, or to any county, cite or distract board or officer,authorized toallow or pay the same if genuirae, any false or fraudulent claim, bill, account,voucher, or writing,is punishable either by imprisonment in the county,fail for a period of not more than one year, by a fine of not exceeding one thousand dollars ( S1,000 ), or by both'such imprisonment and fine,or by imprisonment in the state prison, by a fine of not exceeding tern thousand dollars ($10,000 ), or by broth such imprisonment and fine, �,AUTOMART. CAR,W Sari Raman 3 s 29p I 0-2 1.. SHIFT# I TERMINAL* I CAR* 186 SLSMNO 9 EXTERIOR Via*qt$:�� LABOR CHARGE 72.00 TOTAL a 78.95 CREDIT/ATM 78.95, -------------------- TEAK Y . V c AUT RT CAR W (9 5) 743- t1 48 HR RAIN GUARANTY _-PROTECT YOUR CAR— Sold Wosh & Hand Wax $10 off w/this. NOW ONLY $29. 95 .... -,i. 01mysm now _J 535 Son R�;ncn Way On Qvvn-� -------- 0032357 Bill 1 EE it_ .. . P4 Oh X E-.: .. 0032357 WOO- ......... . F fff r;�F'C Svc{, •?jx'{GE F F � Relvew Bill 00 0067941, # I` Wilson Road f'3..�•,} ,'�..'�.00 es'. ? ff:;d r•.; :!}•, `�7 } 2 Wil' ......n......:.....r.,........,...:.:.r....:......r.:.....r}:.•.:..:.........:r...r...ff......•....:...~.......•....:..r.....:........:....f...:.......:...:...:...•...{.r•...`:.f/vr..:v..:.::.>:o./n�r:.::.•%.}r..f... •r.•.rr:..:r...t.�...f:?,+..v.•rF...{..•r.......:.n.......•.:...r............n.:....:.r....:.v...r...:......:vr..F..{}7...,.:...`<..:...?:n.n...•Cv}.."�..:/.n.r�.rF+...r.:.rr•.n......vd$.+v...mt.?.:;•.:V'r:S7:`�.};'.¢-...:{wff�:p'�c{v:.I.r.`..'.�../}'..v:2..r..rr`Yr''�.....:.....;,::...{'..:s�.....,.......F.:..s...2r.r.`............ ....r.+..-.........."........v.t....`r..r.f.............................,.rv....r.:..r............... :....rr...............................v.....:..:......:...:...:...:...:...:....':............�......,...:......:....:....:..........:......,....:......:.....................................i...:................�:......v.,....:...:...:...:...:...:...:...:...::..,S....._......'...:v.:..,.,r.....r.:•.:.:.r..v.A.. :r.:::..:v:.:5:::r.:Fr..;'r r.}:.•,:::..,.::,.':.-:•...:::....::..�i} 'v............. kvvF.L :?? ..}:....:..w::.,.•r?.::•.:.:•:?.{•}:.:.:S•:f.:.:....:,..C/m......r..:r x.}r.::F.An}}}.;}.:.r:;..::,.:.:.i.ni....:}:::•..:::.:.: ...•:.:..:.:..A.f..r.•.:....•...•.f.:.....:..r•..:.n}.nnf.F:+..:FF F :.:.nv/•Sf r+.•.r C:.r{•..:v:r..}:r:{.i•..r•}vi.}.: .}:>.:x�•::.:?.?•{.fi+.: r'n:i?.A•::F:.r::}ff.......... ... .. ...... .. S { fF / :.. :::i ..:N'�.�rr.• •:� {•5.3.T •'f,.%ff... : F::::?:::::::::.......::::;:::::.i::r::::{{{{?{{?{:::::x::::::wrr:v'•:::fvw.w:::;:. }r.::..r T4000 Nth rold fag fry o ss1 w6 is and rotor P4,01' Labor 72 .00 Sublet L 00 Hazardous ONO O i e pry. f CIM BOARD OF SUPERYIS� O + COi CQSIA COI T-Y, CALMQJLNIA ANI HOUSING AUTHORITY BMM Q DEO '1-9, 2000 Claire Against the County, or District Governed by � the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document nailed to you is your California Government Codes. ; notice of the actio taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Covernrnt Code Section 0.13 and 915.4. Tease note all "Warnings". AMOUNT: $1,000,000.00 CLAIMAINT: AODRA SHAVOI4�: SPP AT3ORNEY: PAUL E, LEE, ESQ. DATE RECEIVED: November 29, 2000 I1AW,-' MS' CROUP, ILIAC. NOV ER 29 2000 ADDRESS: 4700 `('ELLER AVENNUE BY DELIVERY TO CLERK ON: s NEWPORT BEACH CA 92660 NOV lBER 28, 2000 BY MAIL POSTMARKED: L FRONE Clem of the Board of Supervisors TO: County Counsel Attached is a dopy of the above-noted claim. PML BATCHELOR, Clerk OVI� 29 2000 ' Dated: By; Depte H. (ROM: County Counsel TO: Clerk of the Boar Supervisors This claim complies substantially with Sections 910 and 910.2. ) This claim PAILS 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)° ( ) Claire is not timely riled. 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 claire (Section 911.3). ( ) Other: Dated: ' - By;_ � � Deputy County Counsel ffi, FROn- Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim. was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claire 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: ' :.� j _ `�°� PHJL BATCHELOR, Clerk, By '.' ; =4. ,o ` ' � , Deputy Clerk � -- Y WARM G (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 claire. 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. AFFEDAVI OF `G I declare under penalty of penury 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 Claimants addressed to the claimant as shown above. Dated:6 � < .: � By: PHIL BATCLOR ByDeputy Clerk CC: County Cuaartse! County Administrator Claim to- BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987,must be presented not later than the 1 00th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action, Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street, Martinez, C.A.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 Audra Shavonne Sipp RECENVED Against the County of Contra Costa or The Housing Authority of Contra Costa (District,) CLERK SOXIDOF SUP�MISORS (Fill in name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of$1& ,� Q..and in support of this claim represents as follows: PLEASE SEE ATTACHED 1. When did the damage or injury occur? (Give exact date and hour) 2. Were did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission or.the part of county or district officers, servants or employees caused the injury or damage? cimform 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 clam resulted? (Give full extent of injuries or damages clamed. Attached two estimates for auto damage.) T How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. 9. fist the expenditures you made can account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney i (Clainnant's Signature) (Address) 3 Telephone No. Telephone No. ?NOTICE Section 72 of the Peel Code provides: "Every person:who, with intent to defraud, presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ( 10,000) or by both such imprisonment and fine." cimform ® s GROUP, INC. A PROFESSIONAL CORPORATION A7 TORNEYS AT LAW 4700 Teller Avenue, Third Floor Newport Beach, CA 92660 Telephone(949) 261-7600 Fax(949) 261-76$0 November 22, 2000 C��ZTIELE-D MAIL -RETURIK �`��'7'AEOLE�7`E m 7099 3220 0006 2137 0823 13AYO VISTA HOUSING AUTHORITY Attn: Claims Department 2 California Rodeo, CA 94572 1V�3'JE'IGE �11n GLAIR l�°®R PE�2 ®'�AI �I�t�� iZIE RE: Our Client: Audra Shavonne Sipp Date of Loss: July 27, 2000 (Thursday) Dear Mousing Authority: The purpose of this letter is to file a claim for personal injuries pursuant to Government Code Section 911-2. All further notices and communications shall be directed to the claimant's attorney, Paul E. Lee, Esq. at the following address: Maul E. Lee, Esq. LAWYERS' GROUP, INC. 4700 Teller Avenue Newport 13eacli, CA 92660 (949)261-7600 CLAIM FOR DAMAGES TO PERSON Name of the claimant: Audra Shavonne Sipp Age of claimant: 31 DOB: December 31, 1968 Address of claimant: 1401 Arden Nay, Room 761 Sacramento, CA 95815 Phone number of claimant: (916) 922-8041 Bate of injury: On or about July 27, 2000 How did the injury occur: Mr. Stroughter was playing with a group of children who found flammable 'liquids in the backyard of an abandoned property owned and maintained by Bayo Vista Housing Authority. This property was unlocked and the shed which contained the flammable liquid was also left open and Claims Department Bayo Vista Housing Authority November 22, 2000 Page Twq unlocked. Subsequently, the children took the flammable liquid found on the Bayo, Vista Housing Authority property and walked through a hole in the perimeter fence of a neighboring oil refining company where a fire was started eventually causing Mr. Stroughter to catch fire and receive bums over 70% of his body. Mr. Stroughter removed the burning clothes from his charred body and ran home. Audra Shavonne Sipp observed her son's charred body. Theory of'liability,. Negligent infliction of Emotional Distress Name o4f'district employee(s): Unknown at this time Nature of the injury: Ms. Sipp suffered emotional trauma by observing her son with bums over 70%of his body. Amount of claim: $1,000,000.00. Should you have any questions regarding this matter please feel free to contact,me at your earliest convenience. Sincerely, INC . ERS' GROIN UP PeTZralh. Llee, Esq. cc: County Administrator Certified Mail Return Receipt- 7099 3220 0006 2137 0854 Risk Management Division Attn- Penny Bailey 2530 Arnold Drive, Suite 140 Martinez, CA 94553 PEL/amd imp f F F •<:. .:t - XAM to A. t } r We F : 1 L W\ kL Y.: 11 Z PIT, bBJ NOW4 z Q > On ro p g too to p 8 0 Yon MCA logo Inman MASS _17YRf Wain o log, jPW F x •'r ✓C <5 $� e h4� A A } A r': 5 J rc F t _. -Y� 2 J ITT who jj r F ,• A y _ ; C110055 s T � $ l-lO�ST�G AI;`I'I-10R1TY 0EC4B1 19, 200 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action, All Section references are to The copy of this docOMent riled to you is your California Government Codes. ) notice of the action taken on your clam by the Board of Supervisors. (paragraph IV below), give; pursuant to overnrnt Code Section and 915.4. please note all "Warnings". AMOUNT- $1,000,000.00 CLAIMANT: DOSES LORE::NZO STO.NE ATTORN`EY: C/o PALL E. LEE, ESQ. DATE RECEIVED: N ER 29, 2000 :AWYIMS° GROUP, INC, �0�1�� 29, 2000 ADDRESS: �4770g0 TELLER� AVENUE VE UE{� BY DET VERY TO CLERK ON: iV.iu4'VPOt�i Bd:�l'��LL t✓1'S 72660 BY MAIL POSTMARKED: iNIOVEMBEER 28, 0000 L CIS Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted clam. PHIL BATCHELOR, Cleric Dated: -OVEMBER 29, 2000 By: Deputy3 H. FROG County Counsel TO: Clem of the Board of Supervisors claim complies substantially with Sections 910 and M.2. { } This claim FAILS to comply substantially with Sections 9110 and 91-0.2, and we are so notifying claimant. The Beard cannot act for 15 days (Section 9113.8). { } Claire is not timely filed. The Clerk should return claire on ground that it was filed late and send warning of claimant's right to app`lly for leave to present a late claim. (Section 911.3). { } Ot deb. Dated: By:, �` _ >� Deputy County Counsel M. FROINI Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claire was returned as untimely with notice to claimant (Section 911.3). IV, BOARD ORDS By unanimous vote of the Supervisors present: {- This Claim is rejected in full. { ) Cather: I certify that this is a true and correct copy of the Beard's Order entered in its minutes for this date. Dated: `a' � PHIL BATCHELOR, Clerk, By �a , Deputy Cleric WARNING (Gov. cede section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action: on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This :Notice. AFFIDAVIT OF TVAIIING 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. By: PfflL BATCHELOR BDeputy Clerk CC: County Counsel County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987,roust be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, roust be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action, (Govt. Code §911.2.) B. Claims roust be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled in. D. If the claire is against more than one public entity; separate claims roust be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. REo Maim.By ) Deserved for Clerk's filing stamp Doses Lorenzo Stone RECEIVED : Against the County of Contra Costa or The Housing Authority of Contra Costa (District) f °_ # : (Fill in Warne) . n ..z..:: The undersigned claimant hereby snakes claire against the County of Contra Costa or the above-named District in the sura of$1.000.000 and in support of this claim represents as follows: PLEASE SEE A'T'TACHED 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. Flow did the damage or injury occur? Give full details, use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? 5. .What are the names of county or district officers, servants or employees causing the damage or injury? E. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors and hospitals. 9. Dist the expenditures you made on account of this accident or injury: DATE ITEM Aial0UINI T Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Marne and Address of Attorney (Clairnant's Signature) (Address) 3 Telephone No. Telephone No. NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud,presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year,by a faze of not exceeding one thousand($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding tern thousand dollars ($10,000) or by both such imprisonment and fame." C'M orm. LAWYERS' GROUP, INC. A PROFESSIONAL CORPORATION :\ ATTORNEYS AT LAW 4700 Teller Avenue, Third Floor Newport Beach, CA 92660 "telephone(949) 261-7500 Fax(949)261-7680 November 22, 2000 �'. I��`��`I�'�1l✓1'�4�Z, �.,� �'LI '��'�°��'�'�' _� �I .S�`��- ?L�99.�22(� �0�16 Zd37 Q�23 BA YO 'SISTA HOUSING AUTHO ITY Attn.- Claims Department 2 California Rodeo, CA 94572 N TICE OF CLAIM FOR PESO AE INJIJ IES ISE: Our Client: Moses Lorenzo Stone Hate of Loss: July 27, 2000 `Thursday) Lear Housing Authority: The purpose of this letter is to file a claim for personal injuries pursuant to Government Code Section 911.2. All further notices and communications shall be directed to the claimant's attorney, Pard E, Lee, Esq. at the following address: Paul E. Lee, Esq. LAWYERS' GROUP, INC. 4700 Teller Avenue Newport Beach, CA 92660 (949)261-7600 CLAIM FOR DAMAGES TO PERSON Name of the claimant: Moses Lorenzo Stone Ave of claimant: 28 DOB: November 2, 1972 Address of claimant: 1401 Arden Way, Room 761 Sacramento, CA 95815 Phone number of claimant: (916) 922-8041 Hate of injury: On.or about July 27, 2000 How did the injury occur: Mr. Stroughter was playing with a group of children who found flammable liquids in the backyard of an abandoned property owned and maintained by Bayo Vista Housing Authority. This property was unlocltee' and the shed wlzicli contained the flammable liquid was also left open and Claims Departrrgent Bayo Vsta Housing Authority November 22, 2000 P e TVyQ unlocked. Subsequently, the children took the flammable liquid found on the Bayo Vista Housing Authority property and walked through a bole in the perimeter fence of a neighboring oil refining company where a fire was started eventually causing Mr. Strou.ghter to catch fire and receive burns over 70% of his body. Mr. Stroughter removed the burning clothes from his charred body and ran home. Moses Lorenzo Stone observed his son's charred body. Theory of liability: Negligent Infliction of Emotional Distress Name of district employee(s): Unknown at this time Mature of the injury: Mr. Stone suffered emotional trauma by observing his son with bungs over 70% of his body. Amount of claim: $1,000,000.00. Should you have any questions regarding this matter please feel free to contact me at your earliest convenience. Sincerely, VERS' GROUP, INC. Paul E. L, sq. cd: County Administrator Certified bail Return Receipt- 7099 3220 0006 2137 0854 Risk Management Division Attn: Penny Bailey 2530 Arnold Drive,, Suite. 140 Martinez, CA 94553 PEL/amd .. !: . .z. : ,.. r. F"'> L , {L " ... - 1. } - , r.,.... .. ::�" � "I�,, ,��;-,-'K;:�;:":'��j;I--- x - 11-.", : . , . , ,.... - � , -.X,:��� �,� �;:;'�--,-'....-.,.,, � � . , .. -, - I I ..�..I.. , ., ,::.-,I - - ... - I-- -- , t , , � "-,-, "" "", -, ., - *:,X,-.,�,,� ",�,-..,, ....... ;. " —".,.,.,. -`�,-�'; .",',:�:�",.:.:. "'.,-:.'.' -.��".z - , .. -, , -::'..'�:�—'� .,.' ,7� , :.� , - " -,'"' -42x, . — . *� ,�'�-��,..,;, -:`.,-'-.. � �...�.�, I I — - �-, � ,., . � � � �M�. . 11 1-1--l-l".I.- -;;��.� " —,i�.�:�i�,'�::��:-]:];,.,�:-�� . -.------.l-l.-l- -- - - - ..---, , f€{ E 4 -. -11 ..-. .�_: _ .. { .-. " - { ( r ." - : :: -..t v. .....: . _ .. - :- :. .';, / .2 7 f " ,. >,:, _ .- L. (, .- , ..- .. _:- .. •: n 4 "J ; ,.A ,� ,� �c a " ,�,,",*--.�,�'.,�!�;:.;�.,.'-': —'. .- , � ,, I , fE S - {{ f } $ j5S tz 00 . "" r t x 1. " � a } . ' S 'a`.Aevn 1 °I S! '+� s ""'� °83 1 s ._--"'" Sat 0 fi a - •,�, y r :" !:, I I ,� Q---�j -.-,:�.,-,"", ,,�,�- � -""".,�--,,�,�-..-,, - ,. � ,f rva�la�G©b" 2�vYvw'od� ( ��,*�'r,�;- -��,�e'-;-,, -�I,- - - �' i :: - _. , 4 f } _ r7 I /t� S :, 1. ; ,p� "`"- r`m-Ls-�9y�avly� Y +".}"'. „Toc" , y Cly U''2i i 4 :11 MI, L% -: .., : - _ _ _ - .. - yf h` r...L e C f 0. > -.- .... t i f = x 1 h 1 ? FF , F It . S{f { y�w r % S i .. i !..� - `Nam✓ "a' - - MS 5 Y s $s� Y } t j E ij,a u } 11 I y y ..... .. l T k t f AA9 ... WihP.9,4S,P i _..r - <�:.. ...v....... .ice .1...,_ I. - .. rJ:._-rti v..-.,r n....c✓.,-N.-M.'r .._ .. ,v_ Y" _w... .x, r u--" vA:.;:: _. ._ _.. a _. #fie:.v.. ),. >OUSTN% AUr R 'TyCLAIM BOAM OF S BO l0 DECEIvIB 19, 2000 Clair 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 docurnent rnailed to you is your California Government Codes. ! notice of the action taken on your claim; by the Board of Supervisors. (Paragraph Its below), given pursuant to Coverer nt Code Section 913 and 915.4. Please note all "earnings", CLAIMANT: DEREN LEOI7ARD SIROUGhTER BY AND TF ROUGH HIS GUkRDIAI- AD LITFIM, AUDRA SIPP ATTORNEY: c/o PAUZ E. LEE, ESQ, DATE RECEIVED: NOVE�13Ea 29, 2000 LAW ERS' GROUP, INC, � £COV ER 29 2000 ADDRESS: 4700 `TELLER AVENUE BY DELIVERY TO CLERK ON: > Nh7,,PORT BEACH CA 92660 MAIL B� AIL POSTIPOSTMARKED: TOVEMB� 28, 200" L FROG Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PML BATCHELOR, Clerk Dated: 'IOVI_MBER 29, 2000 By: Deputy �� f.E%= d ` f f ,, ✓ H. FRONI County Co€rnsel TO: Clerk of the Board o"upervisors Y,,, 'This claim complies substantially with Sections 910 and 910.2, } This claire PAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for l5 days (Section 910.8). ( } Claim is not timely fled. 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 claire (Section 9111.3). ( ) Other: Dated: E, By: Deputy County Counsel M. FRRONI Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911,3). IV BOARD ORDER: By unanimous vote of the Supervisors present: This Claire 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. �s acv` L)e ut Clerk Dated: ,s PAIL BATCHELOR, Clerk, By r �, p Y 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 claire. 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 NJAHXNG I declare under penalty of perjury that I am now, and at all tires 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 Beard Order and Notice to Claimant, addressed to the claimant as shown above. Dated: w�, (. „ �> By: PHIL BATCHELOR By Deputy Clerk CC: County Coursei County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Maims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2.) B. Maims crust be Filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration wilding, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County,the name of the District should be filled in. D. If the claim is against more than one public entity; separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this forin. RE: Claim By ) Reserved for Clerk's filing stamp Deren Leonard Stroughter by and through his Guardian Ad Litem, Audra Sipp Against the County of Contra Costa or s The Housing Authorityof Contra Costa District (District) OAS (Fill in name) The undersigned claimant hereby makes claire against the County of Contra Costa or the above-named District in the surra of _1_&QQ Q00-and and in support of this claim represents as follows. PLEASE SEE A'TT'ACHED 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details, use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? cI:r_for 5. What are the names of county or district officers, servants or employees causing the damage or injury? b. What damage or injuries do you claim resulted? Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damaged) & Names and addresses of witnesses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT GOV. Code Sec. 910.2 provides. "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf" Name and Address of attorney (Claimant's Signature) (Address) Telephone No. Telephone No. NOTICE Section 72 of the Penal Cade provides: "Every person who, with intent to defraud,presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand( 1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000) or by both such imprisonment and fine." clmform LAWYERS' GROUP, INC. R PRORESSION1'iL CORPORATION AT ION 4700 Teller Avenue, Third Floor y Newport Beach, CA 92660 Telephone(949) 251-7600 Fax(949) 251-7680 November 22, 2000 T'.�EZED_MAIL v RETURN RECEIPT REQUESTED- 7099 3220 0006 213 7 0823 BA.YO VIS TA 1-1OUSING AUTHORITY Atm. Claims Department 2 California rodeo, CA 94572 r ' I I 'N._ALJNJURIES RE: Our Client: Deren Leonard Stroughter, by and through his Guardian Ad L item, Audra Sipp Late of Loss: July 27, 2000 (Thursday) Dear Mousing Authority: The purpose of this letter is to file a claim for personal injuries pursuant to Governr Sent Code Section 911.2. All further notices and communications shall be directed to he claimant's attorney, Paul En Lee, .Esq. at the following address: Paul E. Lee, .Esq. LAWYI R.S' GR.OUP, INC. 4700 Teller Avenue Newport Beach, CA 92660 (949)261-7600 CLAIM FOR DAMAGES TO PERSON Name of the claimant: I;Deren Leonard Stroughter Age of claimant: 10 DOB: December 30, 1989 Address of claimant: 1401 Arden Way, Room 761 Sacramento, CA 95815 Phone number of claimant: (916) 922-8041 Bate of injury: On.or about July 27, 2000 How did the injury occur: Mr. Stroughter was playing with a group of children who found flammable liquids in the backyard of an abandoned property owned and maintained by Bayo Nista Housing Authority. This property was unlocked and the shed which contained the flammable liquid was also left open and 01a.ns Department 13ayc V ists.Hausing .4.utncsrit;� November 22, 2000 Page Two unlocked. Subsequently, the children took the flammable liquid found on the Bayo Vista lousing Authority property and walked through a hole in the perimeter fence of a neighboring oil refining company where a fire was started eventually causing Mr. Stroughter to catch fire and receive burns over 70% of his body. Mr. Stroughter removed the burning clothes from his charred body and ran home. Deren Leonard Stroughter was present at the time his brother's clothes caught fire and observed hire on fire, remove his clothes and run home. Theory of liability: Negligent Infliction of Emotional Distress Name of district employee(s): Unknown at this time Nature of the ir4ury: Mr. Stroughter suffered emotional trauma by observing his brother with burns over 70/0 of his body. Amount of claim: 1,000,000.00, Should you have any questions regarding this matter please feel free to contact ire at your earliest convenience. Sincerely, LA�Y_YERS� GROUP, INC. Paul E. i-ee, Esq. cc: County Administrator Certified Mail Return Receipt _ 7099 3220 0006 2137 €1854 Risk Management Division Attn: Penny Bailey 2530 Arnold Drive, Suite 140 Martinez, CA 94553 CEL ama : ::.::. -..:. ":::i:• - i::. 4 .:C oil Sk VMS{ .. } AWO imp _ ~ 3 commit x avail I., 11 onto 0 1 110 A KNOWN SAVA 3 • r w 3 tz no 0. Cz : CL 0 lot T n -1r zg pill M FIR PARTS ITI 3i �$ ii > £r x . v.h'yeti+e't+'Gv'vr'rt�Wk'�#wrd-a^h'�Cb`i� i -...P+•.� > Ste '• G ins, -x. ,r"J ✓ -MY ONST TWA AM top; MUD V gas to ATIff4flig Moo into;;;IRMAN 4 j A s Zrs Y. y � t : : k F { i ... .. ... :. .... ,, r - 3 w Osseo joys tzoom o t {g ... ...,.. litCC { {.. ,- p.L4M�.t,•y'�„ad.^va�,AhA•A¢hAA x , �k 4 x Y v Rtl D A0 DE ITsER 19, 2000 Claim Against the County, or [district Governed by l the Board of Supervisors, Routing Endorsernents, NOTICE TO CLAIMANT and Board Action. All Section references are to The copy of this docurnent nailed to you is your California Government Codes, l notice of the action taken on your clam by the - _ Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $75,000.00 = CLAIMANT: JOHN 11101MAS WILLIAMS ATTORNEY: HARK MIC LALCHLIN, SBNO96575 BATE RECEIVED: NOVEN�FR 28, 2000 ADDRESS: 3012 LONE TREE WAY, #300 BY DELIVERY TO CLERK ON: ti0VDffiEIe 281 2000 AN'TIOOH CA 94509 BY MAIL POSTMARKED: HAND—DEI' ICED L FRONE Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PFUL BA CfjELOR, Clerk Bated: N_0VEMBER 28, 2000 B De ut� H. FRONt County Counsel TO: Clerk of the Board of Super sors This claim complies substantially with Sections 91.0 and 910.2. ) This claire 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). ( ) Claire is not timely filed. The Clem 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 claire (Section 911.3). ( ) Other: Dated:—i ; ,f:_ 1 - —By:� ?% ,y� (—'�= Deputy County Counsel IEL 2.OIVI: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with Notice to claimant (Section 911.3), IV. BOARD ORDER.- By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk, By , Deputy Clelk WARNING (Gov. code section 913) Subiect to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the Nail 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. AFMA`4fIT OF NIA112iO declare under penalty of perjury that I an: now, and at all times herein mentioned, have been a citizen of the United Mates, 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 Carder and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PIEL BATCHELOR By Deputy Clerk X: County Counsel County Administrator aim 'lo: BOAIM OF SUPERVISORS OF CONTRA COSTA UAINTY INMUCTIONS TO CIAL W a Claire re.Lating to causes of action for death or for injury to person or t per- sonal property or growing crops and which accrue on or before December 3l, 1987 must be presented not later than the 1100th day after the accrual of the cause of action.. Clause relating to causes of action for death or for injury to person or to pearsoral property or mowing crops and which accrue on or after January 1, 1988, wast be presented not latera than six months after the acerml of the cause of action. Claim relating to any other cause of action must be presented not later than one year after the accmal of the cause of action. (Govt. Code §911.2.) Ba Claims must be filed with the Cleek of the Board of Supervisors at its office in Roo 106, County Administration Building, 651. Fine Street, %%rtinez, CA 94553® if clsfa is against a district gcver�rred the Board of Supervisors, rather thaan g the County, the name of the District should be filled In. 0 1`f the cla~,m is against More than one public entity, separate claims must be filed against each public, entity. E. Fraud. See penalty for fraudulent claims, Perms Code Sec. 72 at the end of this f RE: Claim 3,v f Reserved for Clerk's filing stamp RECEIVED ns ga nst the C,o my of Contra- C:cs to f Aa istrr '• "� UFSUPFRVISORS ONPFIA, rw, rt ZFill in :e dens gnv'd laiaJa'et hereby 3 makes wall against, the Counter of, Contra Uo��ta or. the above-named 11strict in the sum of 75, 00.00 and in support of this claim represean is as f o'11,ow a -------------------------------------------------------------------------------- �a Wen did the dame or inWurgyp occur? (Give exact date and «^o=.yrs) 5-31-00 at 934 - 10p�a 2. 3Yia.. `�,'s d, Ld '.e 'wo+r inl jt nj ociw rO f.:..�cr.:..ude c+.:.,vy and �w�JLir�t�Y) ----------- •sr.. +a,es e,a,on Contra costa County Fairgrounds cuff W. 10th Street in Anti h,Ca m.94509 --------------------------------------------------------------------------------- How did he damage or ln.ury, C2<..w,u (Give full details; use e 11 a paper if requgyredi Claimant was assaulted by a nunber of Contra. Costa County deputy sheriffs then falsely imprisoned for two days. 14. %rh t par°'icular act or omission on the part of county or district officers, ser ,n is or employees caused the in j, or dame? use of excessive farce and faire to :release frar, custody after sufficient time to ascertain there �,as no reason to 'keep c."Laimant in custody, L oder) s 'What are the rams of co=ty or district officer servants or= employees causing .' the damage orin,,ury? unknown 6. What amage or in uries do you clW aim resulted? (Give full extent of injiries or damages claimed. Attach two estimates for auto dame. nerve damage to right shoulder, back strain & loss of freedom 7Y How was the azrunt claimed above computed? (Include the estimates: amount of any prospective injury, or damage.> $65,000 for general damages & 3,000 for past or future medical expenses ----------------------------------------------------------------------------------- . Names and addresses of witnesses, doctors and hospitals Dr Jacob Rosenberg 2299 Bacon st # 6 Concord,Ca. witnesses other then claimants. son Justin are unknown at jDresent 9. NLis, the mexpe-nditures you made on accou t of this accident or injury: DATE ITEM AIMOUN J unknown at present Gov. Code See. 9 .0.2 provides: "The claim must be signed by the cla.i:n not N0 NOTIMS TO: (Attorney` or by some person on his behalf.e1 Name and Address of Attorney Mark McLaughlin BBN096575 ;iii .a.°�t3s Sign tore, 3012 Trove Tree Way #300 attorney fob° ?Antioch,Ca. 94509 3012 ione '.Free Wauy #300 925-7542622 (Address) Antioch,Ca. 94509 t Telephone No. 925-7542622 Telephone No. 925 7542622 N0TICE ,Section 72 of the Pena. Code provides-. "'Ever'y person who, with intent to defraud, presents for r1.:.lGbvance CDS' for payment to any state board or officer, or to any county, city or district board or of`ficerR, authorized to allow or pay the same if genuine, any false or fraudulent claim, bili , account, voucher, or writbng, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fire of not exceeding o,ne thousand ( m,00101i, or by both such imprisonment and fine, or by imprisonnent in the state prison, by a fine of not exceeding ten thousand dollars ( 1G, 00, or° �y both such and fine. LAW OFFICE-OF RANDALL_CRANE !ED GRAND AVENUE,SUITE 1550 • OAKLAND,CALIFORNIA 24612 + 'TEL 510 4654808 * FAX:510 465-4543 November 1.6, 2000 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY RECEIVED Attn: Clerk of the Board 651Pine Street, Room 106 Martinez, CA 94553 RE: OUR CLIENT : JOYCE ARMSTRONG, a minor CONTRAS QSTAM, }ATE OF LOSS: MAY 19, 1999 LOCATION CONTRA COSTA COUNTY HEAD START Dear Clerk: E.closed please find a claim against The Contra Costa County Head Start, with reference to the above-cap-toned Matter, We would appreciate you filing the original and returning the copies enclosed conformed in the envelope provided. Thank you for your assistance in this matter. Very truly yours, r_ i X RANDALL CRANE NOV-07-2000 08=21 CONTRA COSTA CTY RISK MGT P.02/02 Claiim to: BOARD OF SUPERVISORS Oy CONTRA COSTA C0X7 TX INSTRUCTY NS TO-C A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps 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. Clams 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 f, 1988,mast be presented not later than sit months after the actrual of the cause of action. Claims relating to any other cavae of action must be prestnted not later than oat year after the accrual of the cause of action. (Govt.Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 pine Street,Martinez,CA 94553. C. If Claims 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 tate claim is against more than one public entity,separate claims must be filed against each public entity. E. }?fraud. Sec penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. EtE: Claim by, ) Reserved for Clerk's piling Stamp Joyce Armstrong, a miner } Deborah Cobb, her mother 3 Ag-tinst the County of Contra Costa or Contra Costa County Head Start District) (Fill In Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S strati in support elf this claim represents as fellows. A sum excee�din $25,000.01 according to proof. 1. When did the damage or injury occur. ( r=act Nts and '&r) _ --- May 19,- 2000 ----------------------------- ------------------_-------- Z. Where did the damage or injury occur' (1r dWv City and County) Contra Costa County Head Start 3. How did the damage or injury occur? (Give full details;was ertra paper it Mquired) Minor claimant was sully molested by another child while under the care and supervision of Contra Costa County Head Start. --------------------------------------------------------------------------------- 4. What particular act or omission on the pert of county or district officers, servants, or employees caused the injury or damage? Failed to prevent minor- child from sexually molesting claimant. Failed to expel or restrain minor child with known dangerous prepensiti.es. Other acts and omissions not presently .Known to claimant may also have caused the injury. (over) TOTAL P.02 NOV-07-2000 Oe 20 CONTRA COSTA CTY MSK MGT P.01/02 What are the names of county, strict officers,sezvaartc or employees causing damage or inj ar°y? Faris Bloomfield and others not presently known to claimant. s. What damages or injuries do you claim resulted" (Give telt extent of injuria or 4aaaargee dabaea. het&&two"twisae►for 4*0 General damages, psychologval care in an amount exceeding $25,000.00 according to proof. 7. How was the above claimed amount computed? (include the twimmed amount oraiy protpcc&c injury or damp.) ) General damages. 8. Names and addresses of witty esses,doctors,and hospitals. Doctors Medical Center — San Pablo. ....". __.._ . 9. List the expenditures you made on account of this accident or injury: _ fATZ 11-Km— AX 7A Gov.Code Sec.410.2 prm ides: "VwtlaifiNnust be sued by the claimant SEND NOTICES TO: (Attorney) Xr by some Person on his behalf." RANDALL CRAM Name and Address of Attorney *18Granrid Randall CaneLART OFFIC CSF RAN�DALL CRANE sta�lt's Signature) 180 Grana Avenue, Suite 1550 Avenue, Suite 1550 Oakland, CA 94612 Oakland, CA 9461�ddress) Telephone No.(510) 4654-44606 Telephone No. (510) 465-4506 NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowxaee or for payment to:etty state board or ofr r,or to any county,city or district board or officer,authorized to allow or pay the.same if genuine,any false or fraudulent claim,bili,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 and fine,or by Imprixonmeut are the state prison,by a fine of not exceeding tea thousand dollars(S10,000), or by both such haprimument and fine. c �» D IZJ P z € N (D rotot } oil i r � d �1ti}i! .,.,w,:�l►f#she"ir�F i�O�� •trr'+ftiir� ►fit �'' RFCMENT: PEEL HERE tr cr WIN mm On am cr cr 01 cr cr iy f I, ` 02Ma { v Ln 's .2 01 [j■rp � � d y �5 E loll ? . I-or. SAO tifj - Ifni F ' Lnr it - - no CI1AIM BOARD QE SUPEMMORS OE CONSCONSTRA,COS 1A C01 'i Ce, W RNIA BOARD AM DECEMBER 1.9, 2000 Claim Against the County, or District Governed by ) the Beard of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document mailers to you is your California Government Codes. I notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Goverrnt Code Section 913 and 915.4. Please note all "Warnings" AMOUNT: NONE STATE) CLAIMANT: CITE' OF WALNUT CREEK ATTORNEY:c/o RAYMOND L. MAC KAY, ESQ. DATE RECEDED: NOVII,13ER 14, 2000 McNamara, Dodge, Ney, Beatty, Slattery & Pfalzer November 14, 2000 ADDRESS: 1211 Newell Avenue, Second Ave. BY DELIVERY TO CLERK. ON: Walnut Creek, CA 9496 BY MAIL POSTMARKED: Hand-Delivered. L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL B4,TC-4ELOR, Clerk Dated: NOVEMBER 14, 2000 By: Deputy II. FRO.n- County Counsel TO: Clerk of the Board of Supervis "Ws { '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.$). { ) Claim is not timely tiled. 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 9113). ( ) Other: �, -..: �., B '�/,� �,s"s€✓' Deputy County Counsel Dated: / y` 01 D1 FROM: Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER. By unanimous vote of the Supervisors present: {� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: .( II& PHIL BATCHELOR., Clerk, Byeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAII rqG 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 :,repaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated:( v By: PHIL BATCHELOR By Deputy Clerk a 'C: County Counsel County Administrator CLAIM AGAINST THE COUNTY OF CONTIrA CpSTA " R 3 TO. COUNTY OF CONTRA COSTA NOV 1 ,2000 4 :. CLERK BOARD OF SCUP€ iSCUPS 5 FROM: CITY OF WALNUT CREEK 00NT?A GO L, f� c/o Raymond L. MacKay, Esq. 6 McNamara, Dodge, Ney, Beatty, Slattery & Pfalzer 1211 Newell Avenue, Second Floor 7 Walnut Creek, CA 94596 8 9 NOTICE IS HEREBY GIVEN that the above-referenced entity 10 submits the following claim for damages and equitable indemnity 11 pursuant to Government Code Section 901. 12 On or about June 6, 2000, the CITY OF WALNUT CREEK received 13 Summons and Complaint filed by or on behalf of Gary Lloyd 14 (Exhibit "A'+ hereto) . 15 In said Complaint, plaintiff Lloyd alleges that on or about 16 October 4 , 1598, plaintiff suffered injury and damages while 17 riding a bicycle on the north side of Rudgear Road west of the 18 intersection of Bishop Lane in Walnut Creek, California. 19 According to plaintiff, his accident was due to a defectively 20 designed street drain grate. For purposes of reference only, the 21 CITY OF WALNUT CREEK refers to and incorporates by reference the 22 allegations in said Complaint. See Exhibit "A" hereto. 23 On information and belief, the CITY OF WALNUT CREEK alleges 24 that the COUNTY OF CONTRA COSTA is responsible, in whole or in 25 part, for plaintiff's alleged accident and/or injuries in that 26 the subject grate was designed and installed by the aforesaid 27 public agencies and/or public employees within the aforesaid 28 public agencies. This Claim for damages and for equitable McNamara,Dodge,NeY, weary,%lWy s u.p ATTORNM AT LAW P.O.Box WALNLr CREEK CA W95 ! 9JP6w 1 indemnity or partial equitable indemnity is based upon Government 2 Code Section 820 which provides, in relevant part, that a public 3 employee is liable for injury caused by his act or omission to 4 the same extent as a private person and Section 815.2 which 5 provides for the State's liability for those employees' acts or 6 failures to act. Hoff v. Vacaville Unified School Dis riot 7 (1998) 19 Cal4th 925; Eder -vs. Stockton Unified School District 8 (1988) 202 CAM 1448. 9 DATED. November 10, 2000 10 McNAmARA, DODGE, NEY, BEATTY, SLATTERY & PFALZER LLP 11 12 By Ra and MacF;ay E 13 Attorneys for CITY OF WALNUT CR K r 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 K: \CWC\4258\RLMCLA1.PLD ys 'UP ATTORKM AT uw 2 PA Stat®Sea wrLWuT WEEK ca Uses ro" SUMMONS (CITACIONJUDICIAL) XL7+7��UNP USff?M4Y NOTiCS TO DEFENDANT. (Aviso a Acusado) 40tO .444 USO.2e .r+ coar�. STATE OF CALIFORNIA, CITY OF WALNUT CREEK, j and DOES 1 to 30 REC Ir.D TIME Zo 1115, a1r, YOU ARE BEING SUED BY PLAINTIFF: JUN - � 2000 (A Ud. ie estd demandando) GARY LLO'Y'D CITY LERK WALNUT REEK, CA i . You have 30 C L. NDAR DAYS after this sum- Despues de qua le entre;uen esra citation judicial usred mons is served on you to file a typewritten re- tierre un p/azo de 30 DIAS CALI.ENOARIOS para presentar sponse at this court. una respuesta escrira a rrraquina an esta corre. A ;atter or phone call will not protect You, Your Una Carta o una llamada teleranica no (e orrere"a typewritten response must be in proper legal protection; su respuesta escrita a maquina tiene qua form if Ycu want the court "' hear Your case. Cumplir con !as rr�rmaiidades le-piles propiadas si usred If you do not file your response on time, you may quiere qua la corre escuche su Casa. lose the case. and your wages. money and pro- Si usted no presenta su respuesta a tiernpo, puede perdar I peri/ may be taken without further warning, from e1 c'.aso, v le pueden guitar su salaro, su dinero v arras cosas the court. de su pro piedad .sin aviso .idldonal por parre .'e la core. There are other legal requirements. You may EYisten otros requisitos (e�41es. Puede qua used quie!�2 want to call an attorney right away. If you do not 11arr:ar a un abogado inmediaramente. Si no corroce i un know an attorney, you may call an attcrney refer- abogado, puede llarnar a un servici4 de mierentta de ral service or a legal aid office (listed in the phone abog'ados o a una oiicina de 3yuda legal Nea el dire--aric book). tal ei6nic'o). :Numem eat=11 7"-Ie name and address of :lie »blurt :s: iF .^t©!^ ore v ' ire='.Or; e .`3 C i-e sol C 0 - Q 1 Contra Costa County Superior Court 725 Court Street P.O. Box 911 Martinez, CA 94553 se sar^e. address. anc tatecncine numoer of :ilajnt&,"s atzurnev, or plaintiff witr^cut an at'Wrnev, 5: .^Crr crl; ;a Cirecc'ari y e! -'Uf Rero •.e :'t.'erOra -e! .icogad0 cel •:�'!77+:117C.i!`!f'. � ue! '.:r.r rarncar7re --ud "`•C ,r:ere 3C:z.ido' '?Sr JOSEPH SCANLON (State Bar #66353) LAW OFFICES OF JOSEPH SCANLON 166 Santa Clara Avenue Oakland, CA 94610 (510) 658-2500 CLERK OF THE SUPERIOR COURT jai E--: APR 2'6 2000 C:crit, cy ec.�al i.�cruartnl .Cal��ac'c: 440TTC TO THE PERSON SERVED: You are nerved 1. ' 7 as an :ndlviduai defendant. 2- '�� as the ,:arson sued under 'he fictitious name of /s;ec:ril: I 3. ' X p on behaif of tspec:fyi: CITY OF WALNUT CREEK i 1 416.60 irninarl under- F'1 CC. .115.10 (corocrratidn, CC. CCP 415.20 (defunct comoration) I 1 GCrp 415,r o tconsermtee? # i CCP' 416.40 (association yr rtriership) jr? C a16.9t3 lindfviduai) ko7:1 other. 4. ov oersonal delver/ an dorsi: 4 ' - A. SH F_Y QK NAHrY WITHOUT ATTORNEY(NAME ANr 4OURES5): T F'HONr-`l r0R COURT USE ONLY SEPI SCANLON State Bar 0353) {51.03) 658- 25�� ,AW OFFICES OF JOSEPH SC' "-,..JN . l :66Sant& Clara Avenue L=akland, . CA 94510 - ATTORNEY FOR(NAME): P l a inti f f GARY LLOYD ! !Heart name of court,judicial district or branch court.if any, and post office and street address: + 1 Contr4 Costa County Superior Court i S `, 725 Court Street P.O. sox 911 ( 11(1 APR 2 6 21390 Martinez , CA 94553 � � �I stir t irr �ns�earct=l�tn PLAINTIFF, Ay 0 1 GARY LLOYD LAW OFFICES of, _10SFP14 SCANLON STATE OF CALIFORNIA., CITY OF WALNUT CREEK and THIS CASE ASSIGNED M oOEs , TO .3 tl_ O DEPAIRYM1NY"`� E j CASE NUMBER: COMPLAINT--Personal Injury, Property damage, Wrongful Death MOTOR VEHICLE C7OTHER (specify): Premises Liability C 0 0 - 01788 :Property Damage =Wrongful Death & General Neg'igenti e =Personal Injury Other Damages (specify): Bodily Injuries i. This pleading, including attachments and exhibits, consists of the following number of pages: 2. a. Each plaintiff named above is a competent adult J Except plaintiff(name): a corporation qualified to do business in California an unincorporated entity(describe): a public entity(describe): a minor an adult for whom a guardian or conservator of the estate or a guardian ad iitem has been appointed other(specify): other(specify): Except plaintiff(namej: =a corporation, qualified to do business :n California =an unincorporated entity(describe): =a public entity(describe): =a minor �,an adult for whom a guardian or conservator at the estate or a guardian ad litem has been aoccinted (� other(specify): other(specify): b. Plaintiff(name): is doing business under the fictitious name of(specify): and has complied with the fictitious business name laws. c. } information about additional plaintiffs who are not competent adults is Shown in Complaint--- Attachment 2c, (Continued) Form Approved fly the JuCountil of Cailfornia Effective January 1. 1982 COMPLAINT -Personal Injury, Props" Damage, Rut*982.10,t Wrongful Death CCP 425.12 SHORT.TITLE: - CASE NUMBER: LLOYD v. STATE OF CALIFORNIA, et al. t COMPLAINT—Personal Injury, Property damage, Wrongful Death page two 3. a. Each defendant named above is a natural person M Except defendant(name): }Except defendant(name): STATE OF CALIFORNIA CITY OF WALNUT CREEK a business organization, form unknown a business organization, form unknown a corporation a corporation ® an unincorporated entity(describe): an unincorporated entity(describe): ® a public entity(describe): A State of a public entity(describe): An incorporated the United States of America city in the County Of Contra Costa, = other(specify): =other(specify): State of California Except defendant(name): Except defendant(name): DOES 1 to 10 and 27 to 30 a business organization, form unknown =a business organization, form unknown a corporation =a corporation an unincorporated entity(describe): {Q an unincorporated entity(describe): a public entity(describe): a public entity(describe): Cyl other(specify): Business organizations=other(specity): form unknown, and/or public entities b. The true names and capacities of defendants sued as Goes are unknown to plaintiff. c. Information about additional defendants who are not natural persons is contained in Complaint— Attachment 3c. d. Defendants who are joined pursuant to Code of Civii Procedure section 382 are(names): 4. C1, Plaintiff is required to comply with a claims statute, and a. plaintiff has compiled with applicable claims statutes, or b. plaintiff is excused from complying because(specify): 5. This court is the proper court because at least one defendant now resides in its jurisdictional area. the principal place of business of a corporation or unincorporated association is in its jurisdictional area. CM injury to person or damage to personal property occurred in its jurisdictional area. other(specify): 6. The following paragraphs of this complaint are alleged on information and belief(specify paragraph numbers): 1 i (Continued) page two SHORT T € L4 CASS NUMaER: ' 1LOYb STATE OF CALIFORNIA, et al. C?MP�LA1 1 —Personal ln'ury, Property Damage,Wrongful Death (Continued) €�age irf$a 7. The damages claimed for wrongful death and the relationships of plaintiff to the deceased are listed in Complaint--Attachment 7 M as follows: B. Plaintiff has suffered wage loss loss of use of property hospital and medical expenses ( general damage ( property damage loss of earning capacity other damage(specify): g. Relief sought in this complaint is within the jurisdiction of this court. 10. PLAINTIFF PRAYS For judgment for Costs of suit: for such relief as is fair, just, and equitable: and for [M compensatory damages (Superior Court) according to proof. (Municipal and Justice Court) in the amount of$ 177 other(specify): Interest pursuant to Civil Code sections 3287 , 3288 and 3291E and pursuant to C.C.P. section 998 . t f. The following causes of action are attached and the statements above apply to each: (Each complaint muss have one or more causes of action attached.) =]Motor vehicle CE General Negligence intentional Tort Products Liability Premises Liability Other(specify): J JOSEPH SCANLON (Type at print name) tAignattsre a mutt or attorney) COMPLAINT—Personal i Pale three rid'# Prti�llGo'rtY �elrn8g@, Aute 982.1(1)(cont'a) Wrongful eath(Continued) CCP 425.12 SHORT TITLE: CASE NUMBER: LLOYD V. STATE OF CALIFORNIA, et al. FIRST CAUSE OF ACTION—Premises Liability page - -4 (number) ATTACHMENT TO X711 Complaint 0 Crass-Complaint (Use a separate cause of action form for each cause of action.) Prem.L-1. Plaintiff(name): GARY LLOYD alleges the accts of,defendants were the legal(proximate,)cause of damages to plaintiff. On (date):October 4, -1998 plaintiff was injured on the following promises in the following fashion(description of premises and circumstances of injury): Plaintiff was pedaling his bicycle on the north side of Rudg'ear Read, a few feet west of its intersection with Bishop Lane, in Walnut Creek, California. Them was a defective street drain grate in his ath, which was defective because its design and manufacturefele below the standard c care insofar as it was not made "bicycle-proof, ' that is, it did not prevent plaintiff' s bicycle tire from slipping between the bars of the grate as he rade his bicycle along the street which efect caused him to fall, and suffer serious bodily injuries. Said grade should have been protected from such a mishap by the addi ion of 'waffling, ' ' strap�iin , ' or bY some other reasonable means . However, plaintiff did not learn T_ha the said grate was defectivel. designed and manufactured until. a consulting engineer so advised plaintiff' s attorney of this fact on or about September 10 , 1999 . Prem.L 2. Lr, Count One—Negligence The defendants who negligently owned, maintained, managed and operated the described premises were('names): STATE OF CALIFORNIA, CITY OF WALNUT CREEK, and C-4 Does 1 to 20 Prem.L-3. { ; Count Twos—Willful Failure to Wam [Civil Cade section 846] The defendant owners who willfully or maliciously failed to guard or warn against a dangerous condition, use, structure, or activity were (names): =goes to -- ----- Plaintiff, a recreational user,was =an invited guest =a paying guest. Prem.L-4. Count Three—Dangerous Condition of Public Property The defendants who awned public property on which a dangerous condition existed were(names): STATE OF CALIFORNIA, CITY OF WALNUT CREEK, and C_M Doses 1 to 2 0 a. CZ The defendant public entity had [Z actual EEconstructive notice of the existence of the dangerous condition In sufficient time prior to the injury to have corrected it. b. Cr The condition was created by employees of the defendant public entity. Prem.L-6, a. = Allegations about Other Defendants The defendants who were the agents and employees of the other defendants and acted within the scope of the agency were(names): STATE OF CALIFORNIA, CITY OF WALNUT CREEK, and CM Does - 1' -- to 30 b, C`? The defendants who are liable to plaintiffs for other reasons and the reasons for their liability are C)described in attachment Prem.L-5.b CM as follows(names): Plaintiff does not presently snow the names or reasons for liability of those defendants sued as DOES 21 to 30 , and therefore seeks leave to amend this complaint when the same have been ascertained. Form Approved by the JudiOiai Council Of Ca#fOrnia Effective January i•1982 ^`r1^1k1 .- W SI.ORT TITLE: CASs NUMSsA: ` LLOYD v. STATE OF CALIFORNIA., et al. SECOND CAUSE OF ACTION--General Negligence page S (number) ATTACHMENT TO 23complaint =Cross-complaint (Use a separate cause of action form for each cause of action.) GN-1. Plaintiff(name): GARY LLOYD alleges that defendant(name): STATE OF CALIFORNIA, CITY OF WALNUT CREEK, and MI Does 1 to 20 was the legal (proximate) cause of damages to plaintiff. By the following acts or omissions to act,-defendant negligently causer( the damage to plaintiff on(date): October 4 , 1998 at(place): Rudgear Road, in Walnut Creek, California . (description of reasons for liability): Plaintiff was pedaling his bicycle on the north side of Rudgear Road, a few feet west of its intersection with Bishop Lane, in Walnut Creek, California. There was a defective street drain grate in his path, which was defective because its design and manufacture fell below the standard of care insofar as it was not made 'bicycle-proof, ' that is, it did not prevent plaintiff's bicycle tire from slipping between the bars of the grate as he rade his bicycle along the street, which defect caused him to fall and suffer serious bodily injuries. Said grate should have been protected from such a mishap by the addition of 'waffling, ' 'strapping, ' or by some other reasonable means. However, plaintiff did not learn that the said grate was defectively designed and manufactured until a consulting engineer so advised plaintiff's attorney of this fact on or about September 10, 1999 . Form Approved 9y the Judicial Council of California Effective January 1.1982 o..,..nnn 11 t"AI ICC r%C AP"7I/1wt CLAM C'. ©ARS QF SUP RV t� ��_Ct7NMA COSTA C�?>�T' CA R1�JA BEARDAMOR DECEMBER 19, 2000 Claim Against the County, or District Governed by } the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the „i Board of Supervisors. (Paragraph IV below), given pursuant to Government Bode Section 913 and 915.4. Please note all "Warnings". AMOUNT: $800 CLAIMANT: NICK COURCOUNELIS ATTORNEY: DATE RECEIVED: NOVEMBER 27, 2000 ADDRESS: 840 IIAWTIIORNE WAY BY DELIVERY TO CLERK. ON: NOVEMBER 27 2000 MILLBRAE CA 94030 - 45w liVe- BY MAIL POSTMARKED: NOVEMBER 27, 2000 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claire. PHIL BATCHELOR, Clerk Dated: NOVEMBER 27, 2000 By: Deputy II. FROM County Counsel TO: Clerk of the Board upervisors (This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: `:' x": �' '- Deputy County Counsel By: 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: (-,4 This Claire 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: P) i �''" PHIL BATCHELOR, Clerk, By yv � , Deputy Clerk J, WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 1V[AIDING 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: i ` , ' , By: PHIL BATCHELOR By �- r `' Deputy Clerk CC: County Counsel County Administrator C'iaim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY SHARON HYIMES-OrORo+ INSTRUCTIONS TO CLAIMANT NOV 2 7 2000 A. Chums 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`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. (Govt. Code §911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,551 Fine 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 tiled against each public enrity. 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 Against the County of Contra Costa or District) ' ` (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S - C_C; and in support of this claim represents as follows: 1. When did the damage or injury occur' Give exact Date and Hour) -Joo - ---- ----- ---`i----- ----�-�a--�--------------------------------------------- -__ 2. Where did the damage or in jury occur? (Include City and County', = ------------ _}_( ( ------------ 3. How ;lid the damage or injury occur? (Give full details:use extra paper if required) � i� �t�'�� �¢2 Zai � r r � I t ,I 1 . C-11v r� plc-6eL QcVyl 4. What particular act or omission bn the part of county or district officers, servants, or employees caused the injury or damage? 5. What are the Warnes of eauxlty or district officers,servants,or employees causing the damage or injury? --------- ------------------------------------ -------------------------------------- 6, __--__-------_-___---.._-..---_--- _._6. What damages or injuries do you claire resulted? (Give full extent of injuries or damages claimed. Attseb two estimates for auto damage.) � _______________.._-____..______----____-______-_._---_-_--_-__-_-_--_---_-.----__------ 7. How was the above claimed amount compute& (include the estimated amount of ark prospective injure or damage,} i ------------------------ -------t t� ' - -- --` - Y_______________________-_-_---- S. Name,,,and addresses of witnesses,doctors.and hospitals. Dcryi 9. List the expenditures you made or account of this accident or injury: �- DATE TTEM } AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorney or be some persor on his behalf." Name and Address of Attorne} ( aan_t's Signature; h ,,Address j ,} IA,14 / Telephone No. Telephone No. i NOTICE Section 72 of the Aerial Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to ani state board or officer, or to any counts, cite 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, bi a fine of not exceeding one thousand dollars ( 51,000 ), or by both suchimprisonment and fine,or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars (S10,000 ), or by both su:,h imprisonment and fine. .. .. 41 CD . LL— LAX ` � 2 . � Pay�. �► ��i � r�ac 1 ' 71 - 940;0 (lo L"172.- 964- VESSEL ACMD ENT REPORT GAB. AN1A DEPARTMENT OF BOATING D WATERWAYS PAGE of 2. s'EtsAt NgT7(kiS NOI"RIM E A4E7K:Y JUDICIALCISMcT NUMBER 7N DUB' 0 ICOiv"IRRA COSTA Sl~�5 OFFICE. DELTA E1�, E12GENCY NOKLLFDaTr cxnxm MAT 00-14585 j VESSEL 0 E"`I ISLAND CONTRA.COSTA 31 ACCICShTOC,:.F i7(kF ` •rDNTFt DAr YEAR ruE,2{ao) oewm BER �FiCEr�>O LOCA. SAND MOUND SLOUGH 05 � 29 1 00 ';, 11:45 48472 TION NEAREST LANDMARK MVIGA71ONAID) �W-STiGATM- ay PHONES.; # 300 F T,At s NORTH PIPER SLOUGH(FP.Ai'�".�{.,S BEACH) ; D. :sCW T 427-8507 PARTY (fIAST,i00LE 1A5 SIRE AMSS 11 AVM WHITE (DEFT SHEIUM, 11990 MUIR RD, OENRFSCArCN :�RTFWTE SEX RACE aall7NEZ STATE ZIP PMCNEMS) OPMMR t^,A � 421-8507 VESSEL YEAR 6AkKEjWOEUENGT4 VESSELWABER `VIE ssawEL/A ONCHARGED MMW-R 9$ ESIGN CONCEPTS % 24' 384E XC 'N/A Fuy DENTiF1G1T fx1 N1E@ER ; HOtSEFow IWAiANCE oxrERS NAAE SAME moom GRZ10411L798 345 BYE NO CA.DEPAR11..L 1 OF BOA 72,110WATERWA` S "IESSEL gRECT,014 CF"PAVE �ON'.VA T_R'WAY #PoS owmERS AOORESS - -. - ' lip SAVE 1�'B SAIND MOUND SLOUGH 2 ! 2000 E'VirR�R E i ST. SACRacc ENTO, CA 95815 ' CT3ER #ES-,wTEDSPEM ICESPosno"oFv€ssa SYOPEUTOR ON OI OF v :AAtA ^ RANS�i.ONL.Y � � "5 �16GA7tCt1 110 I;7A.GL•1G"rr?AL'a'i' ', j0— is wNOR t .00E 1 _� MJQR L�.Tf)TALSal PAR S v NAME(FIRST,ADOLE.LAST)3 STREET ADDRESS P 2 � hDETtYIFlCA:1ON 3RS!if;rtTE ;SEX... ?RACE ,CITY STATE ZIP 'PHOS( ! { OPERATUA ; I VESSEL YEAR iAAKENOOF$0.ENGTH I VESSEL Nulw VESSEL X" IO ATION CHARM € swlaaAlER $0 . ALTA-LNE HOUSE BOAT/ 43 1 CF 970. 1`T/A INA 1# NUtU,OEHTL�CATKIN NLtiBERri A3/E I I ORSEPOV ER 1k5=AtliC€ ONNERS MllE ".4 SAME wma Ni'A434110979 1150YES ❑xo COURCOUN ELIS,N'ICtIOLA.S CIREC^ON OF TRAVEL ON WATERWAY ;PCB I OTHERS ADDRESS ZIP 0 SAME EACH ISAIND MOUND SLOUGH �p�i 4 ; 840 HAWTHORI�'E WAY MMBRAE CA. � OTKER EST RATE:SPw i DISPOSITION OF VESSEL i SY OPERATOR i ON ORDERS OF I o 3 I I vDAAUGE Ya0 f LOCATION 5 500.00 i I I MAJORFjTOTAL I EST S -- # DESGBP'ION OF OA"GE S i oP RTY ERGLASS L)AIMI AGE TO PORT GUINWALF. APPROXDAA.TELY 4 IN X 4IN CRs AAE ' T!AtW 7A0R 7E LP PHONE NonFIED COURCOUNIELIS, NT IC 1TOLA5 WAY WLBRA—P CA. g(650 ) 692-6421 �myn L',va ' VFTNESS :XTET_1TOFINX.PY iNJURED WAS a}vE5s8 FATAL i OTIERVSS191EINARY , CORPUINTOFRAIN OPERATOR PASS_ SKIER ! S5HMMF-R I CTiIER E # PHONE DISAPPEARANCE #SST t DON?11:"S (925 N 427-8507 rrr s e ADDRESS ZIP TAKEN TO(2 AAM ONLY) 11980 ML-a R.D.MART2—t7EZ # '> NAME PHC�E �',ASAPPK.ARAt# 8 ( / ' !ES L,-14 0 ADDRESS ZIP 1 TAKEN TO ON.UFED ONLY) ff; I 9 SKETCH(INCLUDE:VESSEL.WINO,CURRENT DIRECTION) MISCELLANEOUS f INDICATE +�„ TRUE NORTH # N i FCOPY OF STATE FORM A-1 > .I ;CW 4 TO s PERATOR(S) 112 I L # 1 REPORT FORWARDED TO: i I COAST GUARD BOATING AND WATERWAYS 1829 S STIR EV # +SACRAMENTO,CA 4581x.1,,`91 1 CORONER ( }E 1y !� C !i f 2 t'Aa$ OTHER ASSOCIATED FACTORS" ; VESSEL TYPE I 5-29-00 S�r j wEAT}iER i k- �, OPEN MOTORBOAT IMPROPER LOOKOUT' CABIN MOTORBOAT DAt$Of ACpO$fCT(!M.Dry.Ys.) ?fU$32444) - i 1NfAAMLWt N71}i WATER I 48472 � I RAFT (30-I+5$5 LCADP4G' !; { SAIL _ Gf!)C$R iC NUMSG j VESSEL EWlP4ENi"' i AUXtL;ARY SAIL- -. PRIMARY ACCIDENT FACTOR j WIND j t j VLSICNOBSCUREMENTS. 1cwSCAT.XAYAY,cwcE i SECT"VKRATIONN NONEt J t MONS D�mdl NATEFCJND - j I PERSCNAL WATER CRAFT OTHER IMPROPER GPH RATCkt' MODERATE f1-4 At") i STRt 4(15.23 A01) v SPEED t j ! HOUSEBOAT MER THAN OPERATOR* 5T0,qs."A t mr) NOT LEGALLY EQUIPPED L RENTA t)NNKww TTDE LL aPERATOR INEXPERIENCE` i RENTAL TYPE OF ACCIDENT i OTHER' EBB i PROPULSION j s1DES"PE )BRCNDS DE SLAC%'ttAiER(sand) NOT APPucaaLP I SOBRiSTY l DRUG OUTBOARD j j GRGt3NOING j C11P523tc ; HAD NOT BEEN DRINXM f i TEMPERATURE ESTIMATEINBOARD FLOOOiNG SiNKMi '�� - N80 NOT UNDER UNFLUENGE I t AIR 85 € WATER 65 - NBOARDtCUTBOARO i I 1REI EXPLOS)CN I FALLS OYER80. €-`-'�-� —— i HID UNDER INFLUENCE i SAIL I� SAIL ANO AUXILIARY i__, PER5ON5S':RLGK BURNS i{ LIGHTING { j H8GtYPAiRYENTUNKNOKM PADDLENv4w .wood) _ Hi,O9dECTFLXEDiFLOATING s DAYLIGHT 1 CU5ic-Mvat ;; �NOER DRUG IE;'DiiNE - - DARK I ART;Ffi7AL l)CakT ! f j OTHER PNr'S1CAL'dPA RNENTOTHER ...i { MPAIRMElNTUNKNOON I VESSEL INVOLVED MTN VISIBILITY ; ! KIND OF FU:L OTHER4ES5EL(57 R vGOD t FAIR f VCTAPDIIOABL� -��--�---- GASOLINE i I SiNMAIER FIXED OBJECT i;' raoR { 1 0VEIIENT PRECEDING ACCIDENT CIESEL OTHER GBiECT NCNDGLusxx+ PSRSONAL FLOTATION DEVICES I' N! - j_t O � � ! t � MANE4,NERINd3 I aaiauscry*aspu.a vNQt Cast j WATER sKsaNG ' HULL IMATERIAL I WEATHER ( Mara aacrevaa PPOs? ,�y E:!,. Wa03 I CLEAR CLOUDY Weri may accspid.? I RY XN t j ALUMINUM [FOG jRAIN Yvw.VISY::wrt? Xy C]H I 0RIF?3NG - —� j ' -STEEL AT MC HOR 3NGW _ I. HAZY -. ! - 7 ! j FiBER6 ASE f RLA3'flC FIRE EXTINGUISHER$ 'IED TODOCX - WATER CONDITION ` ; I OTHER I Was n.wor."NP.,v. ! , AtK CHOPPY +i qulo+nrrt.bora? :9 y Cl N i1 FISHING � :.Explain in Accident f nadva �!ROUGH 1 VERY ROUGH VJ.r.riy u..a? Y. ! PADD}G t 11 "Check 311 that 3ppf , N STRONG CURRENT i arwr ) SLMM.A—R+Y CAL./SE: P•( �3.lEPLI'I'Y WHITE) WAS L\.i.,JPL,11`91JlllTG 1O t9. :1VJtJPt.S B©f'4.111`HtJ ACCIDENT REPORT#00-1458 W��,E °OPERATING PATROL UNIT -48422. T 1( ) AND COLLIDED W ITII V-2. P-1 `viTHl HI`E IWAS RESPONDING TO SAND MOUND SLOU(Y-,1 AT APPROXuvfATELY 40 MpH, AT AlP OX 100 YDS IAWAY FROM TIS ACCIDENT SCENE, P-1 WHITE PLACED TBE i`HMOTTLE A M II*N`TO NEUTR�kL +JAiNyTTD�j.B'`'�E€:rAIN}'1 0 SLOW DOWN, '�-iTE I ' SLED A" OTIME . 75 YDS A-ND `txIAS S-'i`'.�.,I.. �'R.��T...LI�G 1A r�`4llh 10 �:0 15 tom,. P-i WHITE PLACED 'I IE THR.C'i"I'LE `0 REV`ER.SE TO SLOW "'IM PATROL I I BOAT DOWN AND REALIZED HIS ENGINE Sh=DOWN AND IM LOST POWER. W� : ,, WAS UNABLE j ITO COME TO A STOP. = BOW OF V-1 STRUCK V-2 (HOUSEBOAT) AT THE FLOOR LEVEL PO I RT NW ALE CAUSING ML40R DAMAGE TO `ZIF FIEE_IR GLASSAND WOODEN S7RUCTL OF V-2. i i j ;CAUSE: P-I (DEPL T'Y`Y TE) HAS LIMITED BOAT HA.N`I)LING EXPERIENCE, WHITE WAS NOT ' I F AIMMIAR WITH TITEZ OPERATION OF PA71 ROL 30AT 48422 AIND TFIA T AFTER,BEING RUN A""1UGH SPEEDS FOR A PROLONGED PERIOD OF ;Dv E, 71N1E ENGLNE COULD SOLI'?' DOWN. TATE CAUSE OF f 177-US ACCi'DENTT IS DO TO A COMBLNI ATION OF P-I (DEPTUTTY WHITEIS) OPERAT�J'R 1d, ERZENCE, I I (SPEED, AND EQUUMEN'T FAIT URE. I I IVI*114ATia$YIN As"I I IQ 10*8111 t tiYiiTl4ATi0 lY i$Me+.N"k) j li AiYiii R$YHitfia iY i i f z S�!7 CA rryr t++ I c'n ll�y rar+. cl } wry �✓� � � �-=� � ,; a �. 2 , �r •, #t g a `w�... ifs CLAIM BOARID rel SUPERVIS RS 0E CONTRA COSTA C-Qu n, CALIFoRNIA_ BOARD AO DECEMBER 19, 2000 Claim Against the County, or District Governed by � the Board of Supervisors, Routing Endorsements, } NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". f F; AMOUNT: e $10,000.00, Free Medical treatment• and CLAIMANT: CAROL JEAN HARRINGTON ATTORNEY: BATE RECEIVED: NOVEMBER 30, 2000 ADDRESS: 1780 CHESTER DR. , #204 BY DELIVERY TO CLERK. ON: NOVEMBER 30, 2000 PITTSBURG CA 94565-3997 BY MAIL POSTMARKED: NOVEMBER. 29, 2000 L FRONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BATCHELOR, Clerk NOVEMBER 30 __.. Dated: > 2000By: Deputy � Z fs H. FROM: County Counsel TO: Clerk of the Board of= upervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 410 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: ro� Dated: {� �•- f� By: eputy County Counsel III. FEtONL Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 411.3). TV 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: if/ ( /. p =` PHIL BATCHELOR, Clerk, By 4` ''` y , 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. AFMAVTT OF NiAlitlU-JNO I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By c �,�/-t / Deputy Clerk CC: County Counsel County Administrator n :.; ....:w;;r. •:::: ...............r :. :: :iiii:;;.; ;' E•' ;::.:..... :. ....::::::.:::.: .:c iii:::...... Ea>1:::i::33##i333i ::•::ii:::SiS:.2:'.......... ..; rr i. ........:.: ,f>:. t >< :::::::::::::::..... :. ......... .....:: Y: f: i.' t E: is is f' F: Claim to; BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY �. MDNT A. Claims relating t causes of action for death or for injury to person or to personal property orgro"Ming crops and which accrue on or before Decemliber 31, 1987, meat be presented not later than t1h0" dry after the accrial of the cause of action, Claims relating to causes of action for death:or for injury t person or to personal property or growing crops and which accrue on or mer January 1, 1-9883 must b presented not later than six € onths mer the accrual of+the cause of action. Claims relating to any other cause of actionmust be presented not later than one year after the accrual of the cause of action, (Gov't Code 9111.) , Claims must be filed with the :ler the Board of Supervisors at its office in Room it 06, County, d inistrat wi Building, 55" Pine met;, .�artb az, CA 9A553. Ce If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should he filed in. f� , I the claim is against more than one public entity, separate claims must he filed against each public entity, j °d, See penalty for fraudulent claims, Penal Coda Sec, 72 at the end of this form. : Chains By Reserved for Clerk's filing states :�.._ . Against the County of Cont€a Costa or � to .x ..� District) (Fill in name The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum u: and in � t o this cia; re rese is as Io s. 1. When did the damage or injury occur (Give enact date 'r Whore did the damage or injury occur? (Lnclude city and county) 3. or tnu ry-.cur? (Give full details;use extra paper ifrequired) What partioular act or omission r the part of coon or district officers, servants, Or eM PlOYees Caused the ir'ury or damage? 5, Wt are the names of countyor district Officers, servants, or eray s causing th e damage or Lniu `� . What damage or injuries do you claim resulted? (Giga all event of injuries or damages claimed, Aftach two est Mates for auto d . 3� 7. How was the ount chinned above competed? (Include the estimated around any Prospect ° � 4 damage.) . Names and addresses of witnesses, doctors and hospitals. ''°b.® /+jam p�3.,1`' �. ' ' °"�vr/''�-, "U:E .�^"✓�.s' =f . List the expenditures you made on account V,this accident or mju , P IM IDME kT 1 r .P° y�9- �! tj�g✓49' ".✓ �1.+' �off' V�d bv93` h+' Gov, Code Sec. 910.2 i des"The claim mus,be signed by the claimant or by some person on his ahf" Name and Address of Attorney (61-e�m aTt ut Telephone No. - - - T ellephone No. �-NIOnCE Socfion 77 2 of the PmW Codeprovides: very person who,with intent to deftud,presents for allowance or the payment to any state bmrd or of floar,or to any Via,city }P s � -� d zt claini,bit,R. t, voucher,or wri ,is :akmb' either by imprisonment in&,e wanty tail for a period of not more thm t . one yew,by a fm.of n--b cxcerAgng one theumd{ 1,€00),or by bot such im.prisonment and Vie,or by imprisomn ,in the r prison,by a fine of not exceading=thoumdday ( 10,x ),or by both sueh imprmnment and Vie. CONTRA COSTA REGIONAL MEDICAL T CONTRA COSTA L` H CENSERS 17-98W M-9 PA MW WE PIATIENT COMPLAINTIGRIEVANCE o Psi r' ENT NAMEz DATE 05 8Rypc � on such r o , E What actor. are You a sir ? ;d� 'Z7 47 { P y�♦ Vt a + subq?ttnqg 0 W ° d ampicysa oto fon'r? If 0!hw than;peflor°, nftateo albr"s€ip: YOUR COMPLAINT WILL BE THOROUGHLY INVESTIGATED AND YOU WILL RECEIVE AN ANSWER WITHIN THIRTY DAYS. THANK'VOU FOP, BRINGING THIS TO OUR ATTENTION. WE STRIVE TO PROVIDEQUAD CARE. tir a V4 k 4— v"% <�; ✓ � C� !' �-r'r.��+�—�' "'���� ,"!e� ,0..m�{ �� ��°'�'' •`- '% t'�,���`'��"� �i'� �� ,�'/;d6 ,�.*-• �� �{ ,!- '�'! i.�r / 7� �"- t"'^�'lo-j 3"'P tri. ti �,Jb'�. J ZC % a , ° 1 `s,6:moi, e� ,v 4 x a�`2`�;'rs f� �'.��a'r: 't� �b3� E���" ,� f � �� C� �S✓�o-" ..�` ` --�� ; � ' �- ;: �'Pte-�" .� ° fµ fi ''yam ge e /1V {��. � t�_t�4> P+i dsw;f �,Fz„c. /2S• �'a.+T D'.S A �°.91 �e�'�"''.&/✓'�' 9 �� e A `�.7,1 ��,.'.,r,.�•.' ® (6 " /��'y', .p'�.l- J rib,d„ ��' f o y/� 1.J d5J ( at A./Aa-A� doh /�`� .IL! 5 5�. f � d g� Z? Y{ rY `q..k S r '..r�° y n. a q "'d p !yam ✓ tJ •f P jp 3,��a• .�»�ir 8 �� �� 'bi p'+� E eL./' .`.^�y t i,._.,I �.6` —4 • "� :`�-�,: � .`�9 ,�-� �) fff ��4e�'� Cd'` .7�`l ra»�/ � ,.�3 d'�. � 'r-a ��ryry 1 tea _ 164- el r we �x - ` - { e� CIALM BOARD OF S��' R�ISOR� O� �t7�"I'�A +�CISTA �C}�TI'V�'T'Y CAL_IFORN A BOARD-AO DEC BER 19, 0C Claim Against the County, or District Governed by � the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. all Section references are to } The copy of this document railed to you is your California Government Codes. I notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given pursuant to Government Code Section 913 and 918.4. Please note all "'Warnings". AMOUNT: $290.00 CLAIMANT: PAT'TIE J. LEW ATTORNEY: DATE RECEIVED: NCVLNBER 30, 2000 ADDRESS: 701 KIPIING CT. BY DELIVERY TO CLERK. ON: NOVEIBER 30, 2000 EL SOBRANTE CA 94503 NOBER 29 2000 BY MAIL POSTMARKED: 9 L FRONL° Clerk of the Board of Supervisors TO: County Counsel Attached is a ropy of the above-noted claim. PHIL BATCHELOR, Clerk. NOVO BER 30 2000 Dated: 3 By: Deputy H. FROM[: County Counsel TO: Clerk of the Board of pervisors (This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( Other: Dated: By: '%{ �'✓ ` . Deputy County Counsel MF FROM- Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. PHIL BATCHELOR Clerk B 5 y �& - , y . , Deputy Clerk Dated: j WARNING (Gov. code section-91-3)-- Subject ection913)Subject to certain exceptions, you have only six (6) months from the elate 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 MIAELI NG I declare under penalty of perjury that I aan 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 fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. it P Dated: __- '%� 1, By: PHIL BATCHELORBy ti p y -.e- „� ��-- - De ut Clerk CC: County Counsel, County Administrator Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to 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 t, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2.) B. Claims roust be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez, CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be fillet!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 E 4 Against the County of Contra Costa 3rd;a n or y District (Fill in Name The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S `' ��; and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact tate and Hour) 2. Where dill the damage or injury occur? (Include City and county oil,,-dad_ bus ,ra ,-? - t 1r) ' Y � evao-A�, 3. How did the damage lir injury oCt `� (Give full details;use extra paper if required) 'a"Ohfit i�hr16 a V S t+taa�ec P ic,tt-,.�S e10- got-��e i 4�-MYVI; +#Ce 're Baia r� q tr t e5s i. s i»ac. dis t " n h" t� 6 4. What particular act or omission on the part of county or district officers, servants, or employees caZW W� `3 s4*8) injury or damage? i ' -liy eS i`dy'l 4`1c,&cW/!)5 tt.yhk t 5, 'What are the names of county or district officers,servants,or employees causing the damage or injury? ,; r tr rbra ` f�Aa' S �, s t=„fid es-r a a�gc Yr z *e-) d,,:,-e I-C rel ���� fir° shc,�.ts ------------------------------------------------------------------------------------- 6. 'What damages or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 047' a� fit” v (-,��,�1 4- �X�eeec4yle Ftp 11 ;g." R,Sk- , �S fi `*tet (`a Yvt ? �j € � P C afwts 0s� dal 5�,x� ea ` d : ��` i �ff�. 7. How was the above claimed amount computed? (include the estimated amount of any prospective injury or damage.) atm mil -______-_n________________..__________r__m_r_________-_________..___________w___-______ 8. Names and addresses of witnesses,doctors,and hospitals. -______ 9. Dist the expenditures you made on account of this accident or injury; _ DA'T'E ITEM AMOUNT c& dWeaJr)1,rmi -1 i 1(11* Gov. Code Sec.910.2 provides; "The claim must be signed by the claimant SAND NOTICES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney _ 2j_er Effie,JN'p (Claimant's Signature) ( Address) f <` I` Telephone No. � '� d ® Telephone No.L 2 .. �� �`�t eiteJa . NOTICE Section 72 of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account,voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand dollars (51,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars (S10,000), or by both such imprisonment and fine. IE/ ,7�g"3 Answer to question #3: I was parked on Olinda Road in El Sobrante on 10/4/04, where there were absolutely no signs posted that prohibited parking (see enclosed pictures A,B,& Q. Notice in the pictures there are other cars parked there too. I parked in front of the blue sedan in picture##A. When I casae back to my car at approximately 11:44 a , Contra Costa workers were in kont of and right next to my car paving the road and there was asphalt sprayed all over my car. They were paving right up to and in between cars/ (See enclosed pictures). I can't believe how careless they were in not posting parking prohibited signs, and then to pave the road right up to the parked cars (see pictures A&B). - :. ------------ f f: i . v ............::".......::.��:. + .:i ...j. ff S : ffr l a � P { f f e ' f d AFf lv f 4. G i f .. �A w f Auto Shine Auto Detailing Service SERVICE INVOICE 5050.Appian Way I Sobrante, CA 94803 510-222-0483 FOR., INVOICE NO. 73 70 g , DAT �d BILL TO: DATE SERE DESCRIPTIONAMOUNT ALI ! s S TOTAL DUE d MAKE CHECKS PAYABLE TO: Mel-n-Sims Paid y. Cash_Check Credit Card -/12%200.0 02.38 5102347302 PAS e1 "PlUb 12,42€gym $Ea`E bor'g Auto Body "G 24#h tt ids CA (Ole)234-120 (OSB zu-I"I Gava Type of Low Comprehensive sof Lv : 1440 cantad 00c IW SW payer .i€ ants Deductible, 6.1 # aei: MORGAN OR Ptr Lim i aiptfa*. 2000 iM A Oftsmv Ex vshkis psaaa€uctim We; ivm Body rftc VwWazz Dom*Train. 3AL€aq#Cyl 2M 2W ?i I$?*fK 67 T075 CA 0,2 OffWA T: A Search cads: C64 clutw CHAMPANE MET, AM-FM a CASSEM,D11=seL ENGINE,pMER RemM MIRKap VAN LWW emy finerpa l ryw t� Labor own Af e' T i a E3a its Put NwrAw Agwwd UWU REman TAR Offs WAY Exhdino � 42" 2 02+07 AWT COST SHOP MATERIALS 3 109M AgWONMENT DATE Y iia ia ' 40111h TARGET MINER ' a jttdsoment Item L Labot SUM44 10 Units Rste AnKwA– AnwUM ToWip it. 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