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HomeMy WebLinkAboutMINUTES - 02152000 - C19 I Ci" 1go,&U CCff S1TpXgnSM,.M MMA =TA QO[,'j1_!�''T' SAT TFMl'\_ UA ..JQA82. FEBRUARY 152 2000 Claim Against the County' or District Governed by the Board of 5�lpervisors, flouting Endorsements, � NOTICE TO CLAIMANT The copy of this document r and Board Action. All Section references are to 1 rrriied to you is your California Governmeni lodes. notice of the action taken on your claim by the and of Supervisors. (Paragraph IV belowl, given slant to Goverrmenrt Code Section 913 and , : < 15.4. mase rote all `11hrrtings". , . 4 ;# AMOUNT: Unknown ;�; � ursL MAR c.aCZ CALIF. CLAIMANT.* Debra Norton, Suezanne Norton, a minor, and Justin Norton, a minor ATTORNEY:c/o William J. Dullea DATE RECE V ED: January 24, 2000 Wo 'Theatre Square, Ste. 234 ADDRESS: 0rinda CA 94563 BY DELIVERY TO C1,M ON: janingryZ 4 2UOo _ BY MAIL POSTMARKED: 91 , 2QQQ,..� I FROM- Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. January 24, 2000 PHIL BATCHELO Clerk I}tted By: Deputy til. FRON County Counsel TO: Clerk of the Board of Supervisors ( Tbis claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are to Notifying claimant. The Board cannot act for 15 clays (Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated:, BY� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 9111.3). 1'V. BOARD ORDEN, By troanimous vote of the Supervisors present; This Claim is rejected in full. Other: - I certify th t this is a true and cagy of the Board`s Order entered in its minutes for this date. Dated: _PHIL BATcHEwR. Clerk. By Deputy Clerk I WART+tNG (Gov. code aecti 913) Subject to certain exceptions, you have only six (6) months from the date this roti-m was personally served or deposited in the mail to file a court action on this claim. See Government Code Sr) ti,:j 94S.6. 'nota day seek the advice of an attorney of your choice in connection with this matter. If you want to 40asult an sttornzi. ,ou should do to #mediately. *for Additional Warning Sege Reverse Side of This No*�iw. ` ;MAVIT OF MAIL11W I declare under penalty of perjury that I am now, and at all times herein mentioned, have bftn a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full-A prepaid a certified copy of this Board Order and Notice to Claimant, addr3ssed to the eminiant as shown above. Datedt2 / By: PHIL BAT"CHI LOIt By -�~~ Deputy Clark M. Cmmty Counsel 'Wi 'tt,,; �prator 1 William J. Dullea (Bar #74342) Two Theatre Square, Suite 234 2 Orinda, CA 94563 (925) 258-0060 pCC �) 3 GC EI V ED 4 Attorney for the Claimants DEBRA NORTON, SUEZANNE NORTON and JUSTIN NORTON JAN L 5 6 t gpAtiD OF SUP 7 8 DEBRA. NORTON, SUEZANNE NORTON, 9 a minor, by Debra Norton, her CLAIM AGAINST A PUBLIC ENTITY guardian ad litem, and JUSTIN 10 NORTON, a minor, by Debra Norton, his guardian ad litem, 11 12 Claimants, 13 vs. 14 CONTRA COSTA COUNTY ANIMAL SERVICES DEPARTMENT, 15 Respondent . 16 17 18 1 . The address of Claimants is as follows : 1853 Overhill 19 Road, Concord, California 94520 . 20 2 . The address to which the Claimants desire notice of this 21 claim to be sent is as follows . William J. Dullea, Two Theatre 22 Square, Suite 234 , Orinda, California 94563 . 23 3 . On September 22, 23 , and 24 , 1999, Claimant DEBRA NORTON 24 visited the Martinez Animal Shelter and was exposed to rabies . On 25 September 24 , 1999, Claimants SUEZANNE NORTON and JUSTIN NORTON 26 visited the Martinez Animal Shelter and were exposed to rabies . 27 4 . Claimants were required to undergo a series of painful 28 injections . In addition, they have suffered, and continue to Claim Against a Public Entity - 1 t c�° 1 suffer, from emotional distress caused by not knowing if they will 2 contract rabies . 3 5 . The name of the public employee (s) causing the injury is 4 unknown. 5 6 . The amount of damages are unknown to Claimants at this 6 time . 7 8 9 Dated: c!( illiam J. Dullea, attorney for 10 Claimants 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Claim Against a Public Entity 2 . 41-V/2 � o » c) > 7m m o A3A f ® e. ? � �Q r � m � AR m p knnn � Ln t k § o f (D / ^ ? / / M (D A 4 0 0c\/\ Lo H rt 0 � � \ � � 0 � m ® ! � | � l � � • � \ 0 \ @ , � . . . / � � CLAIM Y.OA D OF MaN M— DF CC}' MA cmTA =11SIM CAIIFQB-N'IA FEBRUARY 15, 2000 _01 FEBRiMBY 221 ,r Against the County, or District Governed by 1 NOTICE TO CLAIMANT die Board of Supervisors, Routing Endorsements, and Board Action. All Section references are to The copy of this dont maned to you is your California Government Codes, Notice of the action taken on your claim by the Board of Supervisors. (Pregraph IV belnwi, liven ys 1scant to Government CodeSection913 and 5.4. I� rote all "Yi pings"r AMOUNT: None Stated ' 3Njy COUNSEL CLAIMANT: Shair Ali ATTORNEY: DATE RFS: January 20, 2000 ADDRESS: Ironwood State prison BY DEL:tVERY TO CLERK ON: ,�,_January 20, 2000 P. 0. Box 2199 Blythe CA 92226 BY MAIL POSTAMARMG:D: , Jan larv,l8,, 2000 L FROM Clerk of the Board of Supervisors 'T+O: County Counsel Attached is a copy of the above-noted claim. PHIL BATSKMCIR. Cle Dated: January 21, 2000 By: Deputy- 1L eputyDL FRONL County Counsel TO. Clerk of the Board of Supervi s ( ) This claim complies substantially with Sections 910 and 910.3. (tThis claim FAILS to comply substantially with Sections 910 and 910.3, 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 &round that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 91 13). ( Other: Dated: /�, By: '% Deputy County Counsel IDL FROM: Clerk of the Board TQ C*mty Can Wal (1) County Administrator (3) ( ) Claim was returned as untimely with notice to claimant (Section 911,3). TV BOARD tiIZDEFt: 8y unanimous vote of the Supervisors t: Ibis Claim is rejected in full. ( j 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$ATC1fELiR. Clerk, By912i=� Deputy Clerk WARNING (Gov. code .$*-Won 9I3) Sub lout to certain exceptions, you have only six (6) months from the date this ;otic: a personally served or dep in the mail to file a court action on this claim. See Government Code S ion 945,15. You array seek the advice a attorney of your choice in connection with this matter. If you want to mast It sn attorney, you should do so immediately. *For Additional Warning See Reverse Side of 7kis Nodvv. AFFJ;1?AV'TI OF MAIIxis I declare under powalty of penury that I am now, and at all times berain mentioned, have ben a citizen of the Ur States, over age 18; and that today I deposited in the United !states Postal Service in Nurtinez. California, postag, Prepaid a certified copy of this Board Carder and Notice to Claimant, addressed to the claimant as shown above. Dated-sABy: PHIL BATCHELOR By J)X _Deputy Clerk M: C&Mty Coxmset Qministmior A4- VICTOR J.WESTMAN DEPUTIES: COUNTY COUNSEL ANICE L.AMENTAALTHOFP NORA G.BARLOW B.REBECCA BYRNES SILVAN4 B.MA i*dHE51DY CONTRA C0STA��1.NTY ANDREA COOPER MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL hC �{i 'i�p� �yi,�t�a VICKIE L.DAWES OFFICE OF,THE COUP OUNSEL MARKES.ESTIS SHARON L.ANDERSON Vf MIC�aELD.�ARR C1Yf31v(INISTFtafIC7f 1, U#tJ i {4 ., LILLIAN T.FUJI I w ' N RAVES ASSISTANT COUNTY COUNSEL JANET L.HOLMES GREGORY C.HARVEY MAgTiN Za CFALIF6 # 53=1229 KEVINT.KERR BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUF4IZ VALERIE J.RANCHE OFFICE MANAGER STEVEN P.RETTIG DAVID F.SCHMIDT DIANA J.SILVER PHONE t925}335-1800 NOTICE OF INSUFFICIENCYBARBARA .SU TUFPE FAX(925)8461-1078 AND/QR JACQUELINEY.WOODS NON-ACCEPTANCE OF CLAIM TO: Shair Ali Ironwood State Prison P.O. Box 2199 Blythe, CA 92226 RE: CLAIM Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ 11. The claim fails to state the name and post office address of the claimant. [ ] 2. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. X 13. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [X] 4. The claim fails to state the name(s)of the public employee(s) causing the injury, damage, or loss, if known. [X 15. The claire fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation,the estimated amount of any prospective injury, damage or loss so far as known,or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. Page 1 �t [X 7. Other: The claim fails to describe any duty or obligation of the public entity and any action giving rise to the claim. VICTOR J. WESTMAN COUNTY COUNSEL By: :Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,scaled and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: January 24,2000,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§410,910.2,920.4,920.&) Page 2 el!lI t i i RE- JAN 2 0 2000 CLERK BOARD OF S' _ 3 / . ' tea- .2/597 A i j _ - I ! !� I i /b f��,ha Ste'= C c�.v SetL T" . .. ..4'.rtJ L� 1e.'�=�✓/C'� ��' � _ z Z 17-e , � �.^� ,� r.,�% a�r✓'L �r 7-S klIvL.19 r l e),,J /3 r .2/ �GI.T,�`t C//�L CeSJ,•t1 C�=�✓t! /�Ar'�'?"1 ,$" . . • �11N t�L Vic'', ' I z3 i G1 7-o lx)Hcvl X 7- rj t /LG.t 14 C iillL RIC6,9 7-S �C�.rrJ�'G•�lrrtl/" S€} L4 ,47 i/vtS J f"le0,1/ 67,om/e-7' �tvl�! .�tc7`h��S' G,'/4 Z/47daOx/ V"I1L=�t1"C l�l ,✓.c1 ;z? .2). f�.- 1-0/-GCC-- _ 1 ./ r « . �y /moi .+ 'T/. tC•- 3 "�" ✓tJ' r�7rt� /C'• 'rL !7`a!�> - /4 ,4AIZ 07,--Ae,- e -�t tt b t C'/�� t�ev'c''�, N P,09/c' 1L G'.''$T rtf'/SG�9r. 11" P�r�r/t Trv� .n'J.� 7-6 _ Ir 1Iz L /��XlyR --2 -- .5-aZ.7' li-'t 7•�y P.�l�'� r� /- T J" .-9 T tc t•'1 C 1 ewi Ok_ a,7 4i ' , 1-z. 126 sg67,oYR11VC Floes 67,,ViceJ407W , Jr re g 4,e" s'LA5W1GG= p t-AFD Z;tl ..z`, J'p. air 7"-W-���`�4 40G' 10 daol . .:7-lj4 C3) t r'!L1 P RQQ F Q SERYICE,BY ti(_-�_n Code Civ. Proc. Penal Code Fess Rules of Civil Proc. 1 1012, 1011(a),2015.5 Rule S. (b) 3 I Y declare that 4 I am over the age of 18,an t a citim of the United States,am a resideat cif Rj r/ County,and not a party to the within cause...My address is: P o.._ 8w* 'Al 21. S C4 92,x..2— 6 t— ! I fixriher declare that I placed a true and correct copy of the attached; e:�aa 7 -' 12eA s 9 in an envelopes) and served a true copy upon the following,by addressing said envelope(s) as 10 follows; 11 I? Q. aew I� f-C' � . 15 16o 19 20 941-3-2 ?1 2Z I ttr•her declare that the envalope;s j were thea. sealed , pcs:age prepaid and placid into the otn marl<ed"L;.S. Mail"... V-.r A �46'r;.91 M,914 I declare that the aforementioned is true and correct ender the penalty of perjury... 25 .�fitr executed in California, county of '01wi.9-& �, 26 27 Dated : This E day of ' in the year 's 23 � fr Declarant a 1 L fir 7�t P �CAJt _ Ln m LY) tit - - �P4�i ri+F+lso rt'►M 44 r - CLAIM RQAjW OF SUPF-RUOR5 of CO-NMLA COSTA CQUIS Y. CAL IEM-NI BOARD A00FEBRUARY 15, 2000 Beim 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 railed to you is your California Govermtent Codes. ) route of the action taken on your d6m by the Guard of Supervisors. (Paragraph IV Woo, given pmant to Government Code Section 913 and 815.4. Piaase rote all 'Nhrnings". AMOUNT: None Stated CLAIMANT: Shair Ali, P57502 ATTORNEY: DATE RF:CP:TM: January 24, 2000 A1717RES5: Ironwood State Prison BY DELIVERY TG CLERy, ON: January 24, 2600 P. 0. Box 2199 Blythe CA 92226 BY MAEL POSTMNtM; January20. 2000 Y lROK Clerk of the Board of Supervisors 711 County Counsel Attached is a copy of the above-noted claim. PHIL BATCNELo& ae# Dated: January 24, 2000 By: Deputy — -t FROM County Counsel TO. Clerk of the Board of Superviso s { ) "Phis claim complies substantially with Sections 914 and 914.2. ( ) This claim FAILS to comply substantially with Sections 914 and 914.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 914.11). { ) 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 SII. ]PROK Clerk of the Board T0: County Counsel (1) County Adrninismor (2) { ) Claim was returned as untimely with notice to claimant (Section 911.3). W BSD MDBR: By unanimous vote of the Supervisors ( } Tbis Claim is rejected in full { ) Ocher: I oeertify that this is a true and correct copy of the Board`s Order yes wW in its minutes for this date. Dated: PAIL BATCHELL& Clerk, By Deputy Clerk WAIt.'NTNG (Gov. code section 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally Served or deposhk in the mail to file a court action on this claim. See Government Code Section 9416. You may seek the advice of an attorney of your choice in connection with this matter. if you want to con*uh a:r attortaey, you should do to immediately. *For Additional Warning See Reverse Side of This Notion. AFS' Ma OF M+kTLIIVG I declare under penalty of perjury that I ant now, and at all times herein mentioned. have bm a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: t t By: PHIL BA7CLOR By Deputy clerk `: maty caumse} Cmtn.rY Adminimtor l RECEIVED i J 7. ox 2199 JAN 2 4 2000 G f./ h/ c._ A QCs CLERK BO RD OF VVEMORS CONTRA COSTA CO. 7 I } 7— IS' VD7 of-/plYoL®CIS .rSS`a6 JJ i /�i 1�L E`i► S'= t^,C AJ S a4 7- , .. ,4AI b i 7--1,0itJ .. I i ,.2/ GlZj t Cl/F L C dJC L ,�°.itJ / /2?r 5� . . . tt.r�15 } i 2-3 rs .�a, .�V I rs lits tit ..1I �vr,1C LNtvrZ. Wl e suf r P1,0Z.47,��.�co /.cJ IC-7 or,, � L- r •vim �"�r��L 14L .reJb 1 cA�94 C.v G6:'�/V P.92%/,'=-S ,, hf S 7;�I-1 I I� /V4r —7-A/ c CA,97-k4 C©SI 1 �-- o L ucyc si 7h-W7- Y�u2 L c�•s,L L 'f.�. G',•��- SrrL 7` ✓,9 SI�VCC 7'111S �-� �i`f� C.5`-SG-=.S .s'�•Pl�crS�.. �' J ,yv/��"" , ®.2/� ``'''q-r' e Gr _ _ � , + _ +C'�T��=� �, l,.c-�,� t�JIL L ✓y���' h��'/5t+^�"//tl� �/c'�'3/�'l �` C�G7�"ff '. .2 c7 G, l ZaL <3` t3 �1 Alf P-RO E QE-.X B Ai Code Civ. Proc. Penal Code Fed Rules of Civil Proc. 1 1012, 1011(x),2015.5 Rule 5. (b) 2 ` 3 I 'S declare that: I am over the age of 18,am a citizen of the United States,am a resident of t v' County,and not a party to the within.cause...My address is: �� 5 — C-4 9.2.E 6 I fuer declare that I placed a true and correct copy ofthe attached; + , 8 9 in an envelopes) and served a true copy upon the following, by addressing said envelope(s) as 10 follows; I-? 16 CC 12 19 20 21 2- 1 Lnher declare that the envelopes) were then sealed . postage prepaid and placed into the hir marked""U.S. Mail"... X, s'. ,r? Z4%,94 A4414 2` 1 declare that the aforementioned is true and correct ander the penalty of perjury... ex ,Iuted inCalifornia, county of ?6 4(x� 7 Dated : This --- day of � in the year t� 2 � f � 29 s� �r ,may Declarant .rev iC4 C. 4yc,. A:. 47`" X..91. /::'. CN � � i C_7 5. What are the names of county or district officers,servants,or employees causing the damage or injury? '--- ��or� _` ���-j_a_A]-__ -pct -#-- =-- ----------------- 6. What damages or injuries do you claim resulted? (Give still extent of injuries or damaYea led. Attach two estimates for auto damage.) -------------------------------------------------------------c----------------------- 7. How was the above claimed amount computed? (Include the estimated amount of any prospective injury or damage.) w e� • � r -- --- �_--- --_ L-fu- -------------------- ----��3., �----------- 8. Names and;a dresses 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 NOTICES TO: (Attorney) or by a person on his behalf." Name and Address of Attorney I (Cl mant's Signature) U 4N {Address) Telephone No. Ic� — L173 — ��(0Telephone No. � � `Z 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 ($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. CLAJIM IRO& f) OF SLURNISORS OF CC7►'iMA COSTA ML2aLCAlORNIA � Mfi= FEBRUA Y 15, 2000 ClaimAgainst the C�xmty, or district Governed by the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT and Board Action All Section referewes are to l The tM of this dotsment rresiled to you is your California Government Codes. } ttot'tce of tt a action taken on your dairn by the Board of pervisorL (P regraph IV belov4, Oven ` ,� �, purscreni to Government Code Section 913 and , 3 915.4. Pww note all Wrings". AMOUNT: $5,000.00 C-AIMANr: LA Mar Anderson ()UNMAR�E�Z"ALIFI ATTORNEY: DATE RECEVED: January 11, 2000 (4 PM) ADDRESS: 206 Edward Avenue BY DELrvERY TO am ON: January 11, 2000 Pittsburg CA 94565 January 10, 2000 BY MAIL POSTMARKED: L FROIM: Clerk of the Board of Supervisors Tt. County Counsel Attached is a copy of the above-acted cin. January 12� 2000 PHIL BA R. DatedByDeputy , YIP-IT FRONL County Counsel TO: Clerk of the Board of Supervi rs (This claim complies substantially with Sections 410 and 410.2. This claim FAILS to comply substantially with Sections 410 and 410.2. and we are so notifying claimant. The Board cannot act for 15 days (Section 410.6). Claim is not timely filed. The Clerk should return claim on ground that it was fired late and send warning of Claimant's right to apply for leave to present a late claim (Section 411.3). Other: Dated: By: '' - L.-- Deputy County Counsel UL yR014Y: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was retw mod as untimely with notice to claimant (Section 411.3). TV BOARD CRDEFt By unanimo a vatae of the Supervisors present: This Claim is njected in full. ��1�I�II�Ywii11��111i11111f1�Y�iil - 11 MriWbY_Y®YY�f1lY� If�gl�slblYi�M1 i�� I certify that this is a true and correct dopy of the Board's Order prod in its minutes for this date. PHIL BATCHELOR, Clark. By deputy Clerk WARNING (Gov. code section 413) 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 4+15.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional 'Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the 'United States, over age 16; and that today I deposited in the United States Postal Service in Martinez, California, postage full, prepaid a.�certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: � „ �, By: PHIL BATCHELOR By e" Deputy Clerk y.W.�• Y4.h1.JYMk1 :wlwlr.S , _.._... ..,�.._..�.....�_ A/)el CC)WTR,A CC7STA +CCD�ITWrr'y I:)ETENTIC.7Tq EA+CILIT'Y- { ) INMATE REQUEST FOR INFORMATION ( ) MEDICAL REQUEST To. From:_�..�` orf i.% Bkg # :. tDoe1 , ;? —> Date: ! l! t' Housing Assignment: Check One: ( } Request ( levance { ) Appeal { ) Other Request: r f r !r s r nAt—: > {p S t K. r K' Date Recd: ! ! Rec'd By: Routed To: ANSWER: { ) APPROVED ( ) DENIED-(state reason) By: Date: ! Z Pink:Kept by Inmate Yellow:Reply to Inmate White:to Booking 6E7 024.FRNI 1/2191 .�. `✓I.J�T�� C;�r�T.ri �✓C�►rtT�"''Y` 1 I ►ETENTIC N F'.AC:ILIMY ( ) INMATE REQUEST FOR INFORMATION ( ) MEDICAL REQUEST To: Bkg Date: ?' /- Housing Assignment: Check One: ( ):Request ( } Grievance ( ) Apppeeall { ) Other Request. L - oe f: J• f r r Date Rec'd: ! ! Rec'd By: t Joseph Canc amilla Supervisor,Dikrict V Contra Costa County 915 Fast Leland Road Pittsburg,CA 94565 (925)427-8198 Fax(925)427-8142 E-Mail jcanc@bos.co.contra-costa.ca.us Toll Fret?from Far Nast County(925)634-5915 k t 4 ,y .r r» �d � E t CLAIM B QARD OF ST TPx 33 S M OF M�� MS TA 0013"t'Y'. ALLFMM A .8ABD A= FEBRUARY--15, 2000 Clem Against the County, or District Governed by NOTICE TO CLAIMANT ftte Board of Supervisors, Routing Endormnents, end Burd Action All Section references are to � The co" of this document mruled to you is your California Got�ermiertt Codes. t notice of action taken on your claim by the Board of Supervisors. (Paragraph IV below, given r pursuant to Government Code Section 913 and 915.4. Pma tate all "Warnings". AMOK: None Stated CLAIMANT: p A;Ct31 Z CAL11 Robert Bethke, et al of Cesari, Werner and Mori%gory 11, 2000 AT'T'ORNEY: c/o Ian Fraser-Thomson/ DATE 360 Post St. , Fifth Floor Januar 11 2000 ADDRESS: San Francisco CA 94108-4908 BY DELIVERY TO � : y BY MAL POSTMARKED: January 7, 2000 L FRO ft Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PHIL BA EID& Clerk January 12, 2000 Dated By: Deputy V. FROM. County Counsel TO: Clerk of the Board of Supervis rs (This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are to 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: LLzaad County Counsel M. PROM Clerk of the Board TO: County Camel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). BOARD ORDER: By unanimous vote of the Supervisors present: . This Claim is rejected in full. O tomer: I certify that this is a true and correct copy of the Board's Order amtwtd in its minutes for this date. ?t)ated: 1` ' PwL BATCHELOR. Clerk, By Q � , , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (b) months from the date this notice was personally served or deposits b the mail to file a wurt action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do so immediately. 'For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING - - I declare under penalty of perjury that I am now, and at all times herein mentioned, have ban a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full, prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated' 6 By: PHIL BATCHELOR By ....Deputy Clerk LAW OFFICES OF DENNIS F. MORIARTY 4JFrSA.FZI,WERNER ERNER.l3 ND MOIRI.A.IRTY JAMES 8. WERNER CHARLES P. SHEA A PROFESSIONAL CORPORAMON (1929.19813) IAN FRASER-THOMSON 3450 POST STREET-FIFTH FLOOR D. RALPH CESA Ri PAUL N. CESARI SAN FRA:':CISCO,CALIFORNIA 04108-4908 fREnRED> ANDREW S. WERNER TELEPHONE(4151301-1113 STEPHEN L. DAHM SAMUEL SORT Fax 141b)391-402e EDWARD 1. BLOOM JOSE A. MONTALVO WRITERS E-MAIL ADDRESS: LLOYD BERNSTEIN EMAIL SEAN P. MORIARTY JAMES J. PATRICK January 7, 2000 RECEIVED ,JAN 11200 Mr. Phil Batcher CLERK BOAR OF SUPERVISORS Clerk of the Board of Supervivors CONTRA COSTA CO 651 Pine Street, Rm 106 Martinez, CA 94555--1293 Re: Triche v. Bethke Our File No: 3394-5-10 File Number Dear Mr. Batchelor: On October 8, 1999, defendant BETHKE served on City Counsel for Contra Costa two separate Claims for Indemnification and or Apportionment of Fault as a Result of a Personal Injury Incident . Both of these Claims were returned because the claims allegedly "were not presented within six months of the event or occurrence as required by law."' Defendant BETHKE respectfully disagrees with this decision. Attached are two Amended Claims with attached Proposed Claims . Please inform of the County' s decision to accept or reject these Amended Claims, so that we may take the appropriate steps to serve Late Claims if necessary. The following is a synopsis of defendant BETHKE' s position with respect to both claims for your convenience in reviewing: 1 . Oami lda v. Bethke, No. C99•-02736 The Complaint for this matter was not filed. with Contra Costa Superior until July 16, 1999 . The Notice of Claim and Claim for Indemnification and/or Apportionment of Fault was served on County Counsel for Contra Costa on October 8, 1999 . Government Code Section 901 states that the accrual date for a case of action for equitable indemnity or partial equitable indemnity is the date upon which a defendant is served with the complaint. The service of the Claim for Indemnity on Contra Costa was not only within 6 months of service but also within 6 Months of the actual filing of the complaint, therefore, service of the Claim for Indemnity was timely and proper. / d% January 7, 2000 Page 2 2 . Triche v. Bethke, No. C99-00594 Defendant Bethke, who was residing in Texas at the time service was attempted in this matter, was not properly served pursuant to CCP 415. 40, because plaintiff did not send to defendant Bethke or personally retain proof of receipt. The Proof of Service form for the Summons and Complaint is signed and dated April 22, 1999 . The date of service as calculated by when the Summons and Complaint was mailed is approximately April 10, 1999, (as stated above, this date is not known for certain because plaintiff' s attorney did not retain the necessary proof) . Government Code Section 901 states that the accrual date for a cause of action for equitable indemnity or partial equitable indemnity is the date upon which a defendant is served with the complaint . The service of the Claim for Indemnity on Contra Costa on October 8, 1999, was within 6 months of both the signed date on the proof of service form and the approximated date of service by defendant Bethke. Thank you for your attention to this matter. Very truly yours, CBSARI�,, WERNER AND MORIARTY IAN FRASER--THOMSON IFT. spm RECEIVED A 1 IAN FRASER-THOMSON (BAR NO. 73526) AN 11200 STEPHEN L. DAHM (BAR NO. 114745) =+ 2 CE ARI, WERNER AND MORIARTY UERK )ARD SSUI#I RVISORS 360 Post Street, Fifth Floor C 7RA OSTA C 3 San Francisco, CA 94108-4908 Telephone: (415) 391-1113 4 Facsimile: (415) 391-4626 3394-5-10 5 Attorneys for Defendant, ROBERT BETHKE 6 7 8 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA 9 IN AND FOR THE COUNTY OF CONTRA COSTA 10 11 ELVIN OAMILDA; EDILBERTO ) No. C99-02736 OAMILDA, ) 12 ) NOTICE OF AMENDED CLAIM AND AMENDED CLAIM FOR 13 Plaintiffs, INDEMNIFICATION AND/OR APPORTIONMENT OF.FAULT AS A 14 vs. ) RESULT OF A PERSONAL INJURY 15 ROBERT BETHKE, et al. } INCIDENT 16 Defendants. ) 17 18 TO CONTRA COSTA COUNTY AND DOES 1 THROUGH 50, INCLUSIVE: 19 DEFENDANT ROBERT WADE BETHKE hereby presents this amended claim.for 20 indemnification and apportionment of fault to CONTRA COSTA COUNTY pursuant to, but 21 not limited to, Sections 901 and 911.2 of the California Government Code. The Complaint 22 of the above-captioned matter was filed with the Court on July 16, 1999 [Exhibit A], and 23 served on defendant BETHKE thereafter. Defendant BETHKE's Notice of Claim and Claim 24 for Indemnification was served on County Counsel for Contra Costa on October 8, 1999; 25 [Exhibit B] therefore the original Notice of Claim and Claim was timely served within six 26 months. (Government Code Section 901 and 911.2). 27 Defendant BETHKE's claims for indemnification and apportionment of fault include 28 the following: 1 If defendant BETHKE is found in some manner responsible to plaintiffs or to anyone 2 else as a result of the incidents and occurrences described below, defendant BETHKE'S 3 liability would be based solely on a derivative form of liability not resulting from defendant 4 Bethke's conduct, but only from an obligation imposed upon defendant BETHKE by law; 5 therefore defendant Bethke would be entitled to complete indemnity from CONTRA COSTA 6 COUNTY and any cross-defendants. 7 Defendant BETHKE further claims that Contra Costa County and each cross- 8 defendant should be required to pay a share of plaintiffs'judgment which is in proportion to 9 the comparative negligence of that party and/or cross-defendant in causing plaintiffs' 10 damages, and to reimburse defendant BETHKE for any payments defendant BETHKE makes 11 to plaintiffs in excess of defendant BETHK.E's proportional share of all damages as asserted 12 hereinafter. 13 1. CLAIMANT: Robert Wade Bethke 1809 S. 47 Street 14 Temple, TX 76504 15 bate of Birth: 10-14-68 16 2. SEND NOTICE TO: IAN FRASER-THOMSON Cesari, Werner& Moriarty 17 360 Post St.,Fifth Floor 18 San Francisco, CA 94108-4908 19 3. DATE OF INJURY: July 21, 1998 20 21 4. LOCATION OF INJURY/INCIDENT: Intersection of Marsh Creek 22 Road eastbound and Camino Diablo in an unincorporated portion of Contra 23 Costa County,CA on a public roadway designed by, constructed by, and 24 maintained by Contra Costa County. 25 5. HOW THE INCIDENT/INJURY OCCURRED: On July 21, 1998, at 26 approximately 12:30 a.m, two vehicles were involved in a collision which 27 allegedly caused injuries to four individuals,resulting in the death of one 28 individual. Claimant, Robert W. Bethke, was traveling westbound on Camino Diablo. Mr. Bethke stopped at the stop sign on Camino Diablo before _2_ Ca f� I entering the westbound lane of Marsh Creek Road. A second vehicle driven 2 by Elvin Tabon Qamilda was traveling eastbound on Marsh Creek Road 3 towards Mr. Bethke. The two vehicles collided. The incident occurred at a 4 portion of Marsh Creek Road where the design, configuration, construction, 5 and maintenance of the roadway is such that motorists proceeding eastbound 6 on Marsh Creek Road and westbound on Camino Diablo face a situation 7 where, by the time an oncoming car is seen, it is too late to take evasive action 8 and a head-on collision is inevitable. Camino Diablo at its entrance to Marsh 9 Creek Road has become a major route with traffic having to cross the Marsh 10 Creek Road eastbound lane to travel westbound on Camino Diablo. No traffic 11 signals or stop signs govern the course of travel of motorists proceeding 12 eastbound on Marsh Creek Road. 13 6. INJURIES/DAMAGES: Plaintiffs' injuries, wage loss figures, medical 14 expenses, burial and miscellaneous expenses, and potential general damage 15 recovery will be established according to proof during the course of 16 discovery. 17 18 19 DATED: January 7, 2000 20 CESA.RI, WERNER AND MORIARTY 21 22 ,F � BY 23 IAN F'RASER-THOMSON 24 Attorneys for Defendant RCIBERT BETHKE 25 26 27 28 o3- A EY OR PARTY WITHOUT ATTORN� tiNAME AND ADDRESS): T'EW 4A VE: FOR COURT USE ONLY LAW OFFTC:E OF MELANIE DARLING (51{0) 464-8098 Jahn Franklin, Esq. SBN 100737 1300 Clay Strut, Suite 600 Oakland, CA 94612 Frit ? � ATTORNEY FOR (NAME): Plaintiffs pert name of count,Judicial dishict or bnunch comet.if",and post off m and street addraaa: CONTRA COSTA COUNTY SUPERIOR COURT _ 'L (b A 725 Court. Sheet Martinez, CA 94553-1233 - � PLAINTIFF: ELVIN OAMILDA; EDILBERTO CAMILDA DEFENDANT: ROBERT WADE BETHKE; COUNTY OF CONTRA COSTA PER LOCAL RULE 5 THIS CASE IS Ass ED x0 DEPT M DOES 1 TO 20 CASE NUMBER: COMPLAINT µ Personal Injury,Property Damage,Wrongful Death C3 MOTOR VEHICLE ❑ OTHER(spisciy): Q Property Damage M Wrongful Death C 99 - 02736 Personal Injury Q O&er Damages(sped: 1.This pleading,including attachments and exhibits,consists of the following number of pages: „ 6 2. a. Each plaintiff named above is a competent adult C3 Except plaintiff (name): L3 a corporation qualified to do business in California (3 an unincorporated an* (disswitle): L3 a public entity (descnbe): C3 a minor L3 an adult Q for whom a guwdm or conservator of the estate or a guardian ad Idem has been appointed L3 other(specify): C3 other(specify): L3 Except plaintiff (name): L3 a corporation quavied to do business in California an unincorporated entity ('describe): (� a public entity (desc nbe): C3 a minor Ll an add L3 for whom a guardians or conservator of the estate or a guardian ad r"dem has been appointed other(specify): C3 other(specify): b. L3 Plaintiff (nerve): is doing business under the fictitious name of (specify): and has complied with the mus business name Iowa. c. 0 information about additional plaintiffs who are not competent adults is shown in Complaint- Attachment omplaintAttachment 2c. (Continued) ForJudicial" "undo" by"" COMPLAINT-Personal Injury, Property Damage, Effective January 1,1982 Rut*021 �_�_, Wrongful Death CC'P42S12 r OCT o 8 1999 1 IAN FRASER-THOMSON (BAR NO. 73526) (-;UUNSEL STEPHEN L. DAHM (BAR NO. 114745) MARTINEZ,CALIF. 2 CESARI, WERNER AND MORIARTY 360 Post Street, Fifth Floor 3 San Francisco, CA 94108-4908 '"''" Telephone: (415) 391-1113 ' 4 Facsimile: (415) 391-4626 ' i 3394-5-10 5 Attorneys for Defendant, r 1 ROBERT BETHKE (yC 6 E7 Cid�*�'vt7t3OR� cow 8 IN THE SUPERIOR COURT OF THE STATE OF CAL ORNIA 9 IN AND FOR THE COUNTY OF CONTRA COSTA 10 11 ELVIN OAMILDA, EDILBERTO ) No. C99-02736 OAMILDA, 12 NOTICE OF CLAIM AND CLAIM FOR INDEMNIFICATION ANDIOR 13 Plaintiffs, ) APPORTIONMENT OF FAULT AS A RESULT OF A PERSONAL INJURY 14 vs. ) INCIDENT 15 ROBERT BETHKE, et al. )} ) 16 ) Defendants. 17 TO CONTRA COSTA COUNTY AND DOES 1 THROUGH 50, INCLUSIVE: 18 DEFENDANT ROBERT WADE BETHKE hereby presents this claim for indemnification 19 and apportionment of fault to CONTRA COSTA COUNTY pursuant to Section 910 of the .20 California Government Code. The Complaint of the above-captioned matter was filed with 21 the Court on July 16, 1999, and served on defendant BETHKE thereafter,therefore this 22 Notice is timely served within six months. (Government Code Section 911.4 and 945.5). 23 Defendant BETHKE's claims for indemnification and apportionment of fault include 24 the following: 25 If defendant BETHKE is found in some manner responsible to plaintiffs or to anyone 26 else as a result of the incidents and occurrences described below, defendant BETHKE'S 27 liability would be based solely on a derivative form of liability not resulting from.defendant 28 Bethke's conduct, but only from an obligation imposed upon defendant BETHKE by lave: -Z- r . I therefore defendant Bethke would be entitled to complete indemnity from CONTRA COSTA 2 COUNTY and any cross-defendants. 3 Defendant BETHKE further claims that Contra Costa County and each cross- 4 defendant should be required to pay a share of plaintiffs'judgment which is in proportion to 5 the comparative negligence of that party and/or cross-defendant in causing plaintiffs' 6 damages, and to reimburse defendant BETHKE for any payments defendant BETHKE makes 7 to plaintiffs in excess of defendant BETHKE's proportional share of all damages as asserted 8 hereinafter. 9 1. CLAIMANT: Robert Wade Bethke 10 1809 S. 47 Street Temple,TX 76504 11 Date of Birth: 10-14-68 12 2. SEND NOTICE TO: IAN FRASER-THOMSON 13 Cesari,Werner& Moriarty 360 Post St.,Fifth Floor 14 San Francisco,CA 94108-4908 15 3. DATE OF INJURY: July 21, 1998 16 17 4. LOCATION OF INJURY/INCIDENT: Intersection of Marsh Creek 18 Road eastbound and Camino Diablo in an unincorporated portion of Contra 19 Costa County, CA on a public roadway designed by, constructed by, and 20 maintained by Contra Costa County. 21 5. HOW THE INCIDENT/INJURY OCCURRED: On July 21, 1998, at 22 approximately 12:30 a.m.two vehicles were involved in a collision which 23 allegedly caused injuries to four individuals,resulting in the death of one 24 individual. Claimant, Robert W. Bethke,was traveling westbound on Camino 25 Diablo. Mr. Bethke stopped at the stop sign on Camino Diablo before 26 entering the westbound lane of Marsh Creek Road. A second vehicle driven 27 by Elvin Tabon Oamilda was traveling eastbound on Marsh Creek Road 28 towards Mr. Bethke. The two vehicles collided. The incident occurred at a portion of Marsh Creek Road where the design, configuration, construction, _7_ 1 and maintenance of the roadway is such that motorists proceeding eastbound 2 on Marsh Creek Road and westbound on Camino Diablo face a situation. 3 where, by the time an oncoming car is seen, it is too late to take evasive action 4 and a head-on collision is inevitable. Camino Diablo at its entrance to Marsh 5 Creek Road has become a major route with'7affic having to cross the Marsh 6 Creek Road eastbound lane to travel westbound on Camino Diablo. No traffic 7 signals or stop signs govern the course of travel of motorists proceeding 8 eastbound on Marsh Creek Road. 9 6. INJURIES/DAMAGES: Plaintiffs' injuries,wage loss figures,medical 10 expenses, burial and miscellaneous expenses, and potential general damage 11 recovery will be established according to proof during the course of 12 discovery. 13 14 15 DATED: 10-4-99 16 CESARI, WERNER AN MORIARTY 17 18 19 BY IAN FRASER-THOMSON 20 Attorneys for Defendant ROBERT BETHKE 21, 22 23 24 25 26 27 28 -3- PAR TV vIt n1'U-T'�'nP�!VE"y(ICamrt And CESARI , •WERNER & MORIARTY "`"" "" 415-391- 1 1 13eJf ATTORNEYS AT LAW 360 POST ST 5th FLOOR SAN FRANCISCO, CA 94108 Pot,No.CfFasyo. AT'7`GAN0 7vrf t?`Jama!; 00212548.01 t insert name c?court and narne of judicial district branch tour..if ariv. CONTRA COSTA SUPERIOR COURT,MARTINEZ MARTINEZ, CA 94553-0000 SHOAT']%E,OF CASE i OAMILDA vs BETHKE DATE; 't'YE: :Ii_p7 OiV,i CAS;�vtREA PROOF OF SERVICE C 99 02736 I served the : ; 2 NOTICE OF CLAIM AND CLAIM FOR INDEMNIFICATION AND/OR APPORTIONMENT OF FAULT AS A RESULT OF A PERSONAL IN..jURY INCIDENT as follows : Name: CONTRA COSTA COUNTY Person Served. GAYLE MUGGLI AUTHORIZED To ACCEPT SERVICE Date of Service. 10/08/99 Time of Service: 02:50pm Place of Service. 691 PINE ST. (Business) MARTINEZ, CA Manner of Service: Personal Service - By personally delivering copies . 5, Person Serving,: RICHARD SNELL a, r-ee for Service: $75.00 D i.a C;Al �I i��"iC��, i�C. b. Regiss*e ed Caiifnrnia ur^cess se;' cr. r .t-ki k T L*lOye9 1. ^e" ger:' "ate. .. -4 k " ;I -t _ � .;3r, s 438 San Francisco s 10/ 12/99 :. Office of the County Counset Contra Costa Cou ty 681 Pine Street, 9th Floor 'hone: 335- 00 Martinez, CA 94583 Fax:646.1078 Date: October 8, 1999 To: ANN M. CERVELLI, CLERK OF THE B AFS From: Victor J. Westman, County Counsal �_�-/ B Oreo C. Ha By Gregory Harvey.Assistant C nty{Coun Subj: Claims for indemnity by Robert Bethke Attached for treatment in the normal course are two separate claims (two copies of each) for indemnity hypoperly served on our office on October 8, 1999 on behalf of Robert Bethke. Please treat each of these claims as a government tort claim and handle in your normal course. Because this claim has already been referred to outside counsel, I am directing copies to risk management for transmission to counsel cc: Ron Harvey, Assistant Risk Manager (With copies of attachments) CONFIDENTIAL.ATTORNEY CLIENT COMMUNICATION PROOF OF SERVICE 1 2 I am a resident of the State of California,over the age of 18 years,and not a party to the 3 within action. My business address is CESARI,WERNER.AND MORIAR.TYY, 360 Post Street, Fifth Floor, San Francisco, California,94108. Can Jamar 7,2000,I served the within document: 4 Notice of Amended Claim and Claim for Indemnification and/or Apportionment ofF&Wt as 5 a Result of a Personal Injury Incident 6 7 ❑ by transmitting via facsimile the doc wnwt(s)listed above to the fax number(s)set forth below on this date before 5:00 pm 8 s by placing the document(s)listed above in a sealed envelope with postage prepaid, in the United States mail San Francisco,California addressed as follows. 10 11 ❑ by causing personal delivery by of the document(s)listed above to 12 the person(s)at the address(es) set forth below. 13 b personally delivering the document(s)s listed above to the person(s)at the ® YP Y 8 ) � � ( ) 14 address(es) set forth below. CONTRA COSTA HOARD OF SUPERVISORS 15 Mr.Phil Batchelor 651 Pine Street,Room 106 16 Martinez,CA 94553-1293 17 18 1 am familiar with the firm's practice of processing mail. Under that practice it would be 19 deposited with the U.S. Postal Service on that day,with postage thereon prepaid in the ordinary 20 course of business. I am aware that on motion of the party served, service is presumed invalid if 21 postal cancellation date/postage meter date is more than one day after date of deposit for mailing 22 in affidavit. 23 24 I declare under penalty of perjury that the above is true and correct. 25 26 Executed on January 7,2000,at San Francisco,California. 27 28 ce� SEAN M©RIARTY t ppyy „{�tl' 3 -10RIARTY FLOOR 94106.4908 + its _i re U.S. 7tlr';c , r Mr. Phil Batcher Clerk of the Beard of Supervivors 651 Pine Street, atm 106 Martinez, CA 94553-1293 CLAIM BoAgp OF 5Upr_g j5 S OF CC3M.A` COSTA nrtistNM C'AI TF012NIA BOARD ACT= FEBRUARY 15, 2000 Claim Against the County, or Dstrict Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The ropy of this document mailed to you is your California Government Codes. , , notice of the action taken on your dairn by the Board of Supervisors. {Paragraph IV belovO, liven suant to Goverment Code Section 513 and A N 15.4. Pfaase note all "Warnings". CCU 9 COUNScI AMOUNT: JURISDICTION OF SUPERIOR COU'AtO+ TIVNEZ CALtF. CLAIMANT: DOUGLAS AND PAMELA CUNNINGHAM ATTORNEY: c/o CURTIS L. JOHNSON DATE RBCVVED: JANUARY 6, 2000 CURTIS L. JOHNSON & ASSOCIATES JANUARY 6, 2000 ADDRESS: 2225 BUCHANAN ROAD, STE. C BY DELIVERY Tri 0MX ON: ANTIOCH, CA 94509 HAND DELIVERED BY MAILPDS"'1"l�Sh�: L FROM: Clerk of the Board of Supervisors 70. County Camel Attached is a copy of the above-noted claim. JANUARY 10 2000 PHIL BAT R, Clerk Dated: By: Deputy IL7-- County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 9I1.3). ( ) Other: Dated: / By: uty County Counsel III. FROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). ,TV, BOARD ORDER By u na dmous vote of the Supervisors present: Tbis Claim is rejected in hull. ( Ckher. I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BAT'CHEI.AR, Cleric, By Deputy Clerk WARTIING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or depositet 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 to immediately. •For Additional Warning See Reverse Side of This Notice. AFF DAYI'T OF MAILING - I declare under penalty of perjury that I am now, and at all tunes herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States postal Service in Martinez, California, postage full; prepaid 6-04 -4- copy of this Board Order and Notice to Claimant, addressed to the claimant as shovm above. ��-- Dated: 1' /6i By: PHIL BATCHELOR By ' Deputy Clerk +VJ V.AS00 V 8.LN V3 SV0 IAajdns eo �jvSNH310 F f 03I38 URS L. JOHNSON & ASSOCIATES ��C ATTORNEYS AT LAW JM 200 Contin Costa County CL-&a c/o Risk-Management COV, OFS` 2534 midDdvc,Suite 140 ` . "ACO, OR Martinez, CA 44.533 TO CON-IRA COSTA COUNTY: Mas and Pamela Cunningham hereby males clvm against Contra Casts Cour4y and makes,the following staterntmts in support of the claim: I. Claimants' post office address is P.O.Box 935,Bethel Island.California,94511. . Notices concerning the claim should be sent to CURTIS L. JOHNSON AND ASSOCIATES,2225 Buchanan Road,Suite C,Antioch,California 94509. 3. The date and place of the occurrenva Sivivtg rise to this claire are October 16, 1999 on Bethel Island Road,approximately 200 feet north of E. Cypress Road. 4. The circumstances giving rise to this claim am as follow*:at the above time and place,an automobile crashed into a utility pole. C)aimazft' daughter,Sarah Cunningham,was a passenger in the autornobdle with her sister Melissa, b&lisaa survived. Howver,Saith suffered a right femur fratture and a skull frau which duvaby caused her death at the scene of the accident 'This accident,and thereby Sarah's wrozefui death,occurred because of Contra Costa County's sets or omissions that allowed dangerous conditiou on dais portion of the road,mWesrlying design defects,and irtsuf i`icieat wartrictgs of the dangers thereof- Com CostCounty knew or should of known of the dangerous conditions.the design def"ft,and the warning immfRciewies by reason of numerous,similar accidents at this place that predated this,occurrence. 5. Claimants injuries stem fi nm the wrcmgf4f loath of their daughter, Sarah. Thereby,claimants have-darmW3 includin&but net limited to,pecuniary loss resulting from the loss of the society,comfort,anandou,servica g,and support of Sarah in addition to her funeral and burial expenses. 6. The names of the public employees causin�the claimant's Wuries arc unl mown. 7. My claim as ofthe date of this claim is in an a amou:rtlftW would place it within the jurisdiction of the superior court. The claim based i�jur%cs,damage,and lass in an amount to be proved later. DATM: January 3,2000 TIS L. bJ for CKs TELEPHONE(9251779-4 Z0.�0'd 10W :NS I�! J�.!_� ti15Cl0 ti�`l.l.�t]� Z 0•=S'c 4t—Wr L.i.iAIM BOA CIF S UPFRNM O S OF C''!t1`ti"TR 4 COSTA CO 1h`"I'Y. CAI FO>:th'i A BOARD-A00 FEBRUARY '1.5, 2000 Claim Against the County, or District Governed by y the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT &W Board Action. All Section references we to The copy of this dowmt meiled to you is your California Government Codes. 7FP 2c, notice of the eon taken on your daim by the 8aard of Supervisors. (Paragraph lV.belDvo, given A _ ;s.a wsuant to Government Code flection 913 and 815.4. Please nate all 'Warnings". COLINTY COUNSEL AMOUNT: JURISDICTION OF SUPERIOR COUR AIT3NcZ CALIF. C1.AIM++ANT: MELISSA CUNNINGHAM ATTORNEY: c/o CURTIS L. JOHNSON DATE RECEIVED: JANUARY 6) 2000 CURTIS L. JOHNSON & ASSOCIATES ADDRESS: 2225 BUCHANAN ROAD, STE C By DELTMy To C3.M ON: JANUARY 6, 2000 ANTIOCH CA 94509 BY MAIL YOSTMApjCM. Hand-Delivered L FROK- Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-notod claim. Dated: JANUARY 6, 2000 PHIL BA R. Clerk By: Deputy FRONL County Counsel TO. Clerk of the Board of Supervis s ('his claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are to notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated:, I "" By: Deputy County Counsel M. PROK 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 tlR.DIX 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:_= �� ,i;�,!'HIL BATCTR, Clerk, By.�LDeputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you Gave only six (6) months from the date this notice was personally served or depositer 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 r+m attorney. you should do to immediately. *For Additional Warning See Reverse Side of This Notice. AFMAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full prepaid asy certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated- "„t' By: PHIL BATCHELOR By !-- 0147a2L Deputy Clerk CURTIS L. JOHNSON & ASSOCIATES ATTORNEYS AT LAW Contra Costa County RECEIVED c/o Risk Management 2530 Arnold.Drive, Suite 140 JAN Opp I Martinez, CA 94553 ,00 , CLERK BOARD OF SUPERVI^ , TO CONTRA COSTA COUNTY: CONTRA co CD. Melissa Cunningham hereby makes claim against Contra Costa County and makes the following statements in support of the claim: 1. Claimant's post office address is P.O. Box 935,Bethel Island, California, 94511. 2. Notices concerning the claim should be sent to CUR.TIS L. JOHNSON AND ASSOCIATES, 2225 Buchanan Road, Suite C,Antioch, California 94509. 3. The date and place of the occurrence giving rise to this claim are October 16, 1999 on Bethel Island Road, approximately 200 feet north of E. Cypress Road, 4. The circumstances giving rise to this claim are as follows: at the above time and place, an automobile crashed into a utility pole. Claimant and her sister were passengers in the automobile. Claimant's sister, who was sitting where claimant could see her, died in the crash. Claimant suffered serious physical and emotional injuries as a result of the crash and witnessing her sister's death. This accident, and thereby claimant's injuries, occurred because of Contra Costa County's acts or omissions that allowed dangerous conditions on this portion of the road, underlying design defects, and insufficient warnings of the dangers thereof. Contra Costa County knew or should of known of the dangerous conditions, the design defects, and the warning insufficiencies by reason of numerous, similar accidents that predated this occurrence. 5. Claimant's injuries are a fractured right femur, related physical injuries, emotional trauma, and mental distress because of her own injuries and the witnessing of her sister's death. 6. The names of the public employees causing the claimant`s injuries are unknown. 7. My claim as of the date of this claim is,/in an mount that would place it within the jurisdiction of the superior court. The claim is ba-"-d on injuries, damage, and loss in an amount to be proved later. DATED: January 3, 2000 rZomnAey "rClaimant J�?III [SON 2225 BUCHANAN ROAD,SUITE C TELEPHONE (925) 779-9458 ANTIOCH,CALIFORIA 94509 FACSIMILE: (925) 779-1973 CLALM RQAED OF S ERN71SORS DE affil A CY TS► Cf7►L�,"TY. CALEMENTA .JOARD AMOU FEBRUARY 15, 2000 Claim Against the County, or District Governed by f #11e Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to N any of this 6mment Wed to you is your California Governrnent Codes. notice of the action taken on your deirn by the y�rl and of Supervisors. (Paragraph !V beloo, liven `°~ suant to Governrnent Code Section 913 and JA ' 5.4. Phase note all "Werninos". COUNTY OUNO-L AMOUNT: $1,815.91 MART1,14EZ cAL.�z. CLAIMANT:Alice Evenson (nee Hardesty) ATTOP14EY: DA"T"E RECEAW: January 10, 2000 ADDRESS: 77 Laguna Circle BY DELIVERY TO CLERK ON: Jan Hary 10. 2 Pittsburg CA 94565 BY MAIL POSTMARKM. January 7. 2000 L PROM Clerk of the Board of Supervisors TDt County Counsel Attached is a copy of the above-noted claim. PHIL BATS"' R. Clexk -- Dated:_ January 10, 2000 .,,.... By: Deputy„,_„ — 11 FROM Courcy Counsel TO. Clerk of the Board of Supervisor (0 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: / -� S_` 8y: deputy County Counsel IM PRML Clerk of the Board TC. ammty Counsel (1) Comfy Administrator (2) ( ) +Claim was returned as untimely with notice to claimant (Section 911.3). 3'V' ROAM MDER: By unanimous vote of the Supervisors present (-/ 'Phis Claim is rejected in full. ( } Other I certify that this is a true and correct copy of the Board's Order entergd in its minutes for this date. Elated: �f PHIL BATCHELOR., Clerk„ By � i"�-�` � Deputy Clerk WARNING (Go7 evade section 913} Subject to certain exceptions, you bave only six (6) months from the date this notice was personally served or deposite in the mail to file a court action an this claim. See Government Cade Section 94y.,4. you may seek the advice of an attorney of your choice in connectionwith this nutter. if you want to consult an attorney, you should do to immediately. *For Additional Warning Sear Reverse Side of This Notice. II►.IcMA'V T OF MAW G- I declare under penalty of perjury that I am now, and at all times herein Mentioned have bena citizen of the `United Statex, over age 18; and that today i deposited in the United States Postal Service in Martinet„ California, postage full, prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. y Dated:- ��'." � �� aE By: PHIL bATCHEL.OR By, :_-'04 y Deputy Clerk en ,Clkim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code§911.2. B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one nublic 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 Alice Evenson (nee Hardesty) Against the County of Contra Costa RVE or District (Fill in Name) CLFgE co-- The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of$1,815 . 91 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) Period of July 12 , 1999 through September 12, 1999 ---------------------- ---------------------------------------------------------- 2. Where did the damage or injury occur? (Include City and County) 77 Laguna Circle, Pittsburg, Contra Costa County - ----------------------------------------------------------- -------- 3. How did the damage or injury occur? (Give fiffl details;use extra paper If required)----------------- Marcel Jordan, an inmate incarcerated at Byron Boys Ranch, made collect phone calls to my residence, to minor''s telephone number. This inmate was quite obviously not supervised given the number of phone calls made and jffjgth of time of most of;these calls-. - ------------- ----------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 1, I was. told by Byron Boys Ranch that per policy, inmates are only allowed to make phone calls to immediate family members . 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Calling Card Calls •Billed an Behalf of ATN COMMUNICATIONS Bate Time Place and Number Called T Elate Minutes Amount 4. u pm CONCORD CA 925 692-2745 __ aY�reY d-'._._._ ve . — ca led from CONCORD CA 925 680-6052 Questions or disputes for charges on this portion of your bili should be directed to ZPDI, P.O. Box 29442, San Antonio, TX 78229 -4698 at 1-886-507-0734. Customers not satisfied with the resolution may register a complaint with the California Public Utilities Commission (CPUC) or the PCC. (See back of page 1 for address and telephone number.) Advertisements are paid for by Zero Plus Dialing. Pacific Bell has no affiliation with Zero Plus Dialing and cannot endorse, recommend or warrant any products or services described herein. 10 6500 8A01 1A 9264323371 305 946650000 ��'it�'�' '� •�`hYf`.tiri+t�+� 4`�` X�s '' i�i'+t�Ni'f ...e.�:`.i,•.rQ�`ktnf:+,y�yQ1 'l'�3 IlJ e Residence Flet !tats Sery Account Number Statement Date ALICE E HARDESTY Raga f 925 432-3321 305 N 5167 Sep 20, 1888 77 LAGUNA CIR PITTSBURG CA 94565-6027 Previous Xmount of lastbill1275.22 Charges .._ ._ .�_.� Unpaid Balance. Please pay now (please deduct if paid) 1275.22 Current Psolfie Bell - Page 2767.51 Charges iVIIdCarm� - - - - pie - 9 fi �4 erb rue D1a1in _ _ 10..__. Current Charges due by qct 20, 1999 771.37 Total to Due LATE CHARGE REMINDER. A late charge may apply on Oct 22 If your payment has not been received. (See Reverse) Whom to Racific Bell - Customer service; _ � _800-310-BELL or 800-310-2355 Call Far questions about other company charges, see company page. For three months your bill reflected late payment charges. This Is because your payment, In full, has not reached our office In time. You can avoid the late payment charge by making sure we receive your payment In full by next month's DUE BY date. . . . . . . . . . . . . . . . ' DET-ACH &RETURN THIS POR77ON-V ITH PAYMENT . . . . . . . , . . . . . . . . . Statement !late Sep 20, 1999 A000unt Number 925 432 3321 305 167 N 5 Payment Due Oct 20, 1999 Total Due $2046.59 Eater Amount Raid > > > $ El El M El D D � Maks Check Payable to Pacific Bell. w 7446.20.630.162243 2 AV 0.463 EB�EX (�r�rrr�rrlr�r�rr��rrrtr�rr��rr��rrrrr�r��rrr�rrrr��rrr�rr�r�r �rrl�rrr�rl�r�rrrlr�rrrl�rl�rrrrrllr� ALICE HARDESTY PACIFIC BELL E 77 LE E H CDR PAYMENT CENTER PITTSBURG CA SAC CA 95887-0001 94565-6027 109 4523321 305 425 167 0000127522 303 119077 0000204659 Lf PAYING & UNDERSTANDING YOUR BILL �. .....p,.t How to pay your bili When to pay your bili You can mail your payment, pay electronically through Your payment is due when you receive your bill. If we our Automatic Payment Service, or pay at one of the don't receive payment for your local and long distance Authorized Payment Locations. When mailing your charges by the DUE BY' Date, your account will become payment, write the amount paid in the boxes on past due. If we disconnect your service for non-payment, the remittance stub., Also, write your area code You must pay the past due amount and a charge to and telephone number on your check. Enclose your reconnect your service. You may also be required to pay check and remittance stub in the return envelope a deposit and mail to: Late payment charger Sern (�jtt; Pacific Bell, Payment Center, If we do not receive your payment by the date shown in acramento, CA 95887-0001 the "Late Payment Charge Reminder section, we will add 1p Squthsrtt �iiLqnia: Pacific Bell, Payment Center, a late payment charge of: Van Nuys, CA 91388-0001 Exchange Services - 1.6%, calculated monthly, of your total unpaid balance when the Billing for other than basic telephone service unpaid balance is $20.00 or more Pacific Bell bills for other telephone service providers Dedicated Services - 1.6% per month, calculated daily, Including long distance companies, and information of your total unpaid balance serviceproviders. There is no connection between Pacific The late payment charge is a penalty charge and does Bell and thess companies. not relieve you of the obi#ggation to pa the total If You dispute an 376, 900 or 700 Information Service amount due by the "DUE BY" date. The late payment Y p Y date will be at least 22 days from the date of mailing. Charge, you may be entitled to a credit. You must request this credit by ca#ling or writing Pacific Bell within Cluaaticns about your b#ii 60 days from receipt of the bill. Pending review, you maylf st haus questions about our bill, please call us at withhold payment of the dispi#ted amount and collection Y Y, of those charges will be suspended. You have a right not the numbers own on your bill or write to us at P.O. Box to be billed for interstate 900 calls which violate federal 9039, South San Francisco, CA 94083-9039 for ca,sidga law. You may request blocking of 900 and 976 services. and P.O. Box 78230, San Francisco, CA 94107-8230 You may be blacked from calling 900 Delta for failure to for If you are not satisfied after Provider legitimate 900 call charges and the Information recelving an exp enation, ask to speak with a manager. Provider may seek collection of these charges. Your basic Pacfic Bell will investigate and notify you with the results, service will not be disconnected for non-payment of 900 If you still disagree: and 976 charges or other information services, such as • You first must pay the amount to Pacific voice mail, electronic mail, voice store and forward, fax Bell by the 'DUE BY" Date, store and forward, directory advertising and inside wire i You must file a claim with t e California Public Utilities installation that may be included in the `Total Due." Commission (CPUC) within 7 calendar days after we Please call the number on your bill if you have any have notified you of the results of our investigation. questions about your charges. This will avoid possible interruption of your service. Call type and rate information To fila a claim with the CPUC: The codas that appear in rite "T a" and"Rate"columna describe your calla. " You mtiS# sendan Of your Claim and a Tho Type column describes the Typa or.1411, the "Rate" column describes#Ira check for the di iijad amount to the CPUC, to be rate period for the call. T�u"nna■ held as a deposit. �ui•1I[perator-Assisted Third-Party Billed TTY CLaf art�fiod TTY user Rata ` The CPUC only accepts deposits for matters which Anncmt 9001978 Announcement Service TTYRat Certified TTY User Rate relate to the accuracy of the bill. This does not Bsyin# Busy Interrupt Call Return Include directory advertising. Bsyvfy Busy verify • The CPUC will review your claim and distribute the Card Calling Caid (tut funds, based on its investigation. Chariot Channel Usage sy ay ClBack Call Back Dayr Day Multi-Rate Consumer Affairs Branch, 505 Van Ness Con Operator-Assisted Collect Ducat Discount venue sen Francisco, CA 94102. Telephone number Conf Conference Econ fconomy , Direct Direct Dialed Eve Evoning 1-800-649-7570. Local Local Toll Eve+ Evening Multi O+s_i�r Operator Assisted LNi lit Late Night Network Access for Interstate Lalling Pccs11 Person C=sue.l LNgi« La#aN;gtMat#i If you have questions about charges for 'Network Access Person Parson-to-Person N' it Night " PSD Public switched Digital NOiit+ Night Muft€-Rata for Interstate Calling imposed by the Federal Rechrg Recharged Peak Peak Communications Commission, or Charges for calla to Return Call Return (—*.private number) Oft Off Peak another state that you are unable to resolve with your S13rd system Assisted Third Party Billed OtPk+ Off Peak Multi-Rano long distance carrier, you should Consumer S)Coll System-Assisted Collect Peak+ Peak Multi-Rata p ShipRL Ship Radio Link std Standard Complaints - Enforcement Division, Common Carrier Bureau, S1 dessa recibir asta Informaci n an aspanol, Federal Communications Commission, 445 12th St. S.W., consults las pagglnas de la Guia Para EF Washington, D.C. 20554; or call: 1-888-CALLFCC. Clients an su cNectorio de Pacific Bell. M 1 VVV;r y��i5� Account Number Statement Data Page 2 925 432-3321 305 N 5167 Sep 20, 1999 Questions about your Pacific Bell bili? 800-310-2355 Summary of Pacific Bell Current Charges This summa for for informationaI .purposes only.::.:•:,:.::::: ::: .:•:.,•.•:: :.::,,•:.::•. :::::.::,•,•:.: ::•,:.. ::::::::.:::•::::::::. TA fi'> ..: a �"� k�Pl; .,:;;;.. :. .... .. .. .. .... ..:... . . .M��•�*ilii:i<::i� i<;>it:<'•i�`%�si� ii'; a�l�!� �;��J� i7i;i Pacific Bell Monthly Charges •Sarvicels} D*ScrlptionO - -- - - Amount _..} _...eResidence Flat Rate���i��ry 2. -90M76 lockcing_... 3. Your Listing Is Not Published 4. -Number Portably-y—SVE rfi�orge ._._. ._fie_ S. �re ro C_ " usfom ca ng Services:S. Cell Screen 13.40 7. _Cali Ae urn — 11-'46- 8. Caller �_.s.�_....�._�..® - SD7 9. �Prio It Ringing �. _ 3 4D 11. Selig Ca I Forwarding_`� �__� - - —i� �.�� 12. �ell�_Wc__ti Waiting, - — - __ 13. - Call o� �wsrc3T `�__._ - .____ _ _ �...___,l_- 14. —�yCailinn _ Monthly Servlo* Sep 20, 1999 thru Oct 19, 1999 50.19 •Monthly Discounts D*scrription LineNumber O Cho as Discount Amount fib.-Tfia Worrks Saver�'s.._cic—�i�)=eaturas _..._ � =��2�.�.."._3'T.1� 5 3'0 Directory Assistance Call Charges DescriptionCalla Amount Directory - __. 1.3 -__.. -Direc ory AsiTita-iic—e Allowance 17. Directory Assislence ar es a a ' 2.00 •Sarvlce Charges Date Description Amount ll1 hep' Lateiarrge on`�.$127� _ _._�� _SITE Unpaid Balance as of Sep 23, 1999 Additions & Changes i •Activity an 925 432.3321 *Order 00000000 •Change In Monthly Rate from Jun 30, 1999 thru Sep 19, 1999 _Desertton - _qty Pro-hated . One-'Trow Amount I 19. Rate Change 1 11..58en 1.58ea I Access for Interstate Calling Non-Primary Residence .60 Per Month ocntinues 10 5492 8089 1F 92654323321 306 946668821 0022 RTEN i Account Nuinber Statement Date Page 3 925 432-3321 306 N 5167 Sep 20, 1999 Questions about your Pacific Bell bill? 800-310-2355 Additions & Changes *Activity on 926 432-3321 (continued) *Order 00000000 *Account Activity from Jul 30, 1999 thru Sep 19, 1999 Description . MY Pro-Rated One-Time, Amount 1. Debit Applied for 1.2121 Late Payment Charge credit in error or Late Payment Charge not billed on your June bill Total for 925 432-3321 1.58CR 1.21 .37cR it Pacific Bell Direct Dialed Calls -Local Calls (Zones 1 and 2) All Local Calls made are included in your Flat Rate Service. -Zone 3 Calls Data Time Place and Number Called Tye Rata Minutes Amount 2. u 23 9:44amTTREZ-69-92 28-6879___Y 'T M -D rect Day 1 .0 3. ug 13:6_7pffi­_D_AW1UE CA §25_b2"- 957 Direct Day 5 .13 Express Call Completion .35 4. ��uqg7_ 29pla DANV 1 9 .20 -CA 92"20- Direct y 5. 2:2-9 ---W� _pT__ ay is. `hep 2 4T:25am MWA-CM ey 1 .07-- 7. 9 ep 1 .07 8. ,_S6_n__6__12:10pm WALNOT--CRKCX--92"3'6--MI-DFr'e-ct-Day 9. Day .10 1.13 -Local Tall Calls Data Time Place and Number Called peto Minutes Amount 1ug 0. A2l :2%Kt�jj --ff.A_­N­__CA 415 861-2727 D rect 19 t1 -.6'6- 11. Aug 15:29pm WEASANTOWK-6-2-S-M-4-2-ff Direct -Night 4 .2 12. Aug22 5. m 4_0_8_43_3_Vf2_Y_ Direct Ni 13. A 22 - 5,51 CA 51 6-2-8-63-2- irect I ht 1 .66- 14. Au 23 10:1 CA 510 839- 15. A6g2 m TONCA -92"9 P-0-2-U-0-irect-N-e 16. AuU24 9- m -R-TtHM-0ND­-ZA---5`l-02-3S--Wq erect ve 17. 2: SPIP --tA--5"F03S7--27 fi--V Fe-ct ay 1 1a 18. -A 2" ecfF-- 19, -Au 22 5: m HAYWA U 0 78 --GI 597 D t Eve 1 20. Aq925 9: m_n __HMYYWVAK C 1 .0v 21. k6 2 On— _FfAYWAff15__C_A_ 10 784_-OS4��irect Eve 1- .08 m N 22. _A6 R---U _g26 8:47p p_Tm 23. AuE126 8:02pm 24. 25. a-- m 26. Au 27 _8_,._j,I _ 27. -AAgl 9.51 "v 28. Au9261.j6 I Fit AGL�9­1�46 t t 1 :06 m ht 4 30. AL .26-- 31. 4 .20 31. AuE[28 �_F:4_ 3 __A_ : 0 2. u L;�6--2-:4 UTDR-A g25--361--5696-Dii-ec-t---Night 1 .067 33. _amu§29_6:53pm ASANTWCA-_10-25 6V-2-641- Direct NIG --f__.0 6- 34. Au928 10:13pm -PfEAS-ANTOUCW---626-269---264�--Uii0ic-t-Ni _T ,6_6_ 35. ug2V-8--27i�r- PLEAgANTONCA-62!5 X09 2643- -i�"f)irect Night 1 .06 36, AuU30 3:57pm SAN 'FRAN-tA­"i -861-U-64--Diiect---Day 2 _Aff__ 37. d6Enj___PL_gLSAWT0NCA__6_25*__26V-2641--Direct Day I continues 10 6492 SC68 1F 9264323321 306 946666027 0022 RTEN ........... ... ­....--o--...............................­,_­....',....... ........ ........................ Account Number Statement rate Page 4 925 432-3321 305 N 5157 Sep 20, 1998 Questions about your Pacific 8911 bili? 800-310-2335 Pacific Sell Direct Dialed Calls *Local 'Toll Galls (continued) Date Tim* Place and Number Called Two Rate Minutes Amount _t_: Se ,l®_11 OR -PLEAEANTORCA----M-2 �-I�s4�� rec ay -Amount 1. 2. ._._..t ern"�CEAbrAFITC1r3TGi�C_._..� s 1�i= S C 3tect NN 3. -si��p3 �:�,..m Ersr�RxTr�1r�� ��#r� =ter rsr�� D�- � _ a3 4. 9 4 1 am"r?i GFil�tSrltT --s'fti` 5_62Ci_ Direct Night 5. ``5o, 44- Q S��S..-►n,._R T�1���fi��_�A.-._.�1��8=���-� Recur`n-lVi-fiT_...'._n.�,.__.....,i 6. a 4-'fi 2a�prri EL ERNTPFiL , � �Si?f 8 7i8'li7 N3#re"e -"`Mghf 7. gp 5-mirect_ Night 8. --se5_ A:2 a5' _K1_CR ItSRD___GA• i -723"- irre`c g8 ..___..._ 9. S fT 2 am t EF FJTPFfCG7� �s'rtS 'SB Q"? Dire cTNi 10. am-`-ELrfRNtPNCA�� i3ttl i �Clcf -`Nifi __ _ _ 6_M 11. �S_9_-5 3:2i�._.m ._.L RMURE i Q�S fig 774 -.,._ irec� 2- .1 V, 12. ep1T-�;48amriixLSr6 _515=1�2t57 13. -se 1.T_...1 :Q sin. R r # `1i 1 5X257 - -C)rsct Night- 2- _ _ A 6" 14. `aP11 1:0012-M`1TTT�F�tt3Nl5 ��C��i�X35-�2CfT.._...,.__CSlrec rght _ 15. �5epTT__.....-.2;T4pm-LIVERfIORE--CA�23-443=28Oi Direr hrie_._,___`.®._ 16. e Ti -3 24 mTr�t3PR17CHCA25-24 -Zi3i CSrrecir __ 11_. 17. ��p 211 50aERMORE__CA__ M-51A..M6._..__....__.._Cf1rebt - N 18. �STv�fi. m `�Ti~iSPRNFrGJ �E25aT-74Q`- "- rec -05a fi _ 8� 20. at) 55 m`VR1CRM0ND-- A_..._.T5�# Tt17_.._..�.__-i�irec-.�Eve a- 20 21. 8ep1TT_ ""its;2�am"--1w 1VERr►Tt3RE �i125fifiR=moi races ` Say` �� Tis_ 22. iso 1 T'r 12a.._m..._P�L'EASAI�`t}�CA-- 025-B'2-""96 _..._.Dlrec1 _-e Da V 23. 5ep1725i.in..._ AKC7iFiIS`_. A._`.` 'fQ-352= 55w.�. _lSr9 t5a_y d T �_..i . 24. e 17" 2:52p --4t3Ai�L-AND-_6A.-.--Ti6 T-0471 _._-D#reat Day.`- 5.31 t; + < Pacific Sell Operator and System-Assisted Calls Dots Time Place and Number Carted T 6 Rate Minutes Amount isXYTtrN__W. -- Co lit - �. :E3 26. u i _ 8 rriGCA'Ti3Fr._..__C C_..`_ 25 43_ . _.._DoiiDa 27. -Au i8�i:48am LC`7T�N_.. A� S E72 i�i34 Call m - ay 2 -4:59"" 28, ` : 4 m--CLlAY'TDN- CA 925 V"- '64 Coll Day - _ _..i.$ 29. is .1-1 FT ccA�rTTarr_._.__Ca 7 lr � Coll �D 30. �g6`_STp�i:ANT0N_._6A.__."925 4..--- Cori `Do 31. Au T8�:42 rn____ 'AYTON._...._CA.._.__925-UM-0043 . ._ Coll $ 32. Auqu 6 '7::5Epiri�C-AYTTON _`_...CA"._._92.5_.V2-'#0-42..._`__..__.`t olr`--Eye 33. -A-U916- 3pmCLYTt1N� A25 'f2 Qtrdoti Eve �_- �:6� 34. -A.Uq'T#' 1C:NS i�--CL-AYT� .. '_CA W2 't2-W42._�.-"o va ,.__..._5 35. ugf7 $ 2pnn4� AYTOR- CA__...�25 E7'2-C 1T2 Co._.11_.._�. ay 36, 17V� am LAYTON�CA`-$'mss 13Y2 3 712. Co-ff---" tay _3. . 37. -Au1T` :iSamL�CYTt)T __..C'A572=0712--____Cofl..__..'.�� _ s....._ .... _ 2;94 38. -Au i7�16QSam___ L�iYTtSN.___._C �$25 ST2- 11 5 Cor�.._..___.DaD�Y 39, �A7 5dami.7�YTtSR " 725 =5iy"``foil 40. -tu8i7 �i3E8airti `rrCAYTCfF1A 587 =�C37 `i Col rDay `3:5 41, 7--418pm CL-AYT 42. T7�ffi: am'-CLAYTtSN_.._CA_. 5 X72- t43.__.._`__C_=.rr. _.._`_Day 43. �uDi'T :2E_prri-CL�AYTtSl4_..__CV-79M 972 4 .`_'.-'_C'oil_...._._CSe_y ;SS 440 _Aii CL ---OWV2-- 0-43..__..__.Carr_..__ Da + 4.72 45. _Augfi7�3:d7m� C1LYT{114�'. 7� 5 �T2Cr42....._...__.Ccll` E ff 46. Au 17:.._..5 Eve . 5._ .. 3.611 u 47. - 7. - #sLnn- CL7�YT 1�... 25�872tSd3 . Coli. _Eve �.1C _ x.38__ 48. AuQ17`11-10m CLAYTi R----C C 925-972_4039' U011 Eva 2 49. Au T7`8:52prri "GLAYTCSN 7L 2 872-1�t543 -mall Eve --fig- _ -3.84._ 50, �Au T7 _�3t5�m_ G�'YTt1N_._.."CA_ 023 87T--913 3 o va _ 81A- 51. � �j .� : _m_ �roYTtSN �, � r+rr� 52. -Au i 8' 6t#pmCLAYTON CA43 Coil Eve 4 _ 53. 1Au1fl...__ 845�m7_C_ L�AYT��___-CA " _8125_#72.-W4j-�_.___Colr Eve 1.8._".�.._...,.��v 54. Au_ 18 _4:27pip CLAYTC1Ff_..-CA--825•`.'*07"M...__,- .'Cull _ ve -...84,_...__-kou- 55. -i4u-8ii"8 4arn--CCAYT 672-9043- Coll OR 7 _"V aontfnues 10 6482 8C6V 1F 9264323321 306 648666027 0022 RTEN 2,119 Account Number Statement Date Page 5 925 432-3321 305 N 5167 Sap 20, 1999 Questions about your Pacific Bell bill? 800-310-2355 Pacific Bell Operator and System-Assisted Calls (continued) Data Time Placa and Number Coiled Two Rata Minutes Amount 1.. Au_ 19 �?dam COIL lTf5F1 � 9 �i 2-9 a`` ��`t oll l7a 9 2. ���_�������gg�19 fo-24a-m- -CCAYT-ON---CA 92-`6"7-2-D -4F-Coil`--�iay - 39 so9ii 3. Aug19 11 0aY__ 4. y 7 Au 1s 11:o�am CAYT N �C71" 9 72=9c�44� crf1 "�CSa4 5. Aug19 4mCAY7(SN_" A�-762�5'9�-2`80'44_.`.`.`_ 011..__ _CSay 0 3s` 6, _Au f9 39 rrs CAI'T�1N- A- x`25- 7 -803s golf Eva 0 3. 6 7 19�:1 �m-OCAYCfSiT� A-92�6�`2-9038 -`-" o1i-�`Tve 58 6,.24 8 Au 19 8:2+pm CAYTfSNf '"-X25 672 st339-- oii"` -� va 5 3.06^ 19 : 59 m 10. kugT9.'._9:55pm__iCAYTZIiT_."".."._CA 11. AuX20,_�2a`a-mCAYTUff -`_6A-.'-82 `J2-§43...- `".-�aCC 12. �Au20 �b;26arndYTSi�"`- OA S2a672 91}+#4oll � ay � 'S d.Ofi 13. `KU.026-80 prri-OCAYTt�N"�-0A9 9' 5 72-9043 oi`r �ve� 8 3.12 14, ?�217`8d0 m twZAY€ lt`...... A 2s 672=91143 -... o1T_ `_eve.._e�_._..__....�0 3 .. 15. Aug20 $:53m" CAYTfl�"--071--v 92372 8i� 3 0e0 5 16 16, -Aug-21`-$:37am- LAiYYtN� 0A g2a ?2=60 3 oTr-' hii �it� i2 2.66 17. g21 9:06amC�1YTZSl�T- CA92s7`2$028� o€i I~liht 9 3.25 18. Au^21 1126arriOLAYTbN_...'.'_6. _ `2 97' 042..-.___UalT "_N1gftt`__._._....-.-,e..`i1 3:37 19. � __i 43am CA1'TtfN-'-�OA 82S"_9 -643 -OoT#- �N19h't a 2:955 20. 821 �s 3aprri" CC�iY1 OltilJ- -- 2 072-9 - o1i ItDht 15 3,61 21. VAug21 8:12_pm"`t:CfiYTC►N" ti 925 ti72- ci3i9 �-` doll_ _._Night ` - }1�` 3.37Y 22. -Aug21 6:43�m CCAYT�SN- t26,7�=90 Coir Night `23 4:ti9- 23. ug2140s�rm-- CAYTtTt4�`"- A-""9262-9043 CoIT'���Nights t.ti1 24. ��821$:29m OC�SY7(7FI� -CA X23 + 72 9f1 - o(r-- - Ni ht 42. 5.23 25. Au�22 8t48 tam ECSBFitTl�1dLAyfit3 2`22=086,7 CoT� ht 8 26. _ug22 1 25prri OCA?T-()7- C11 925 672 8839 Coif �i phi 27. Au22 5:22�rrr CCAS�TtIT Ci��--�25 672 80a3 Call Night -?- 3:13 28. Aug22 i~55:41prrri Ct�YTON�Ot� 926 672 8043 m Coil Night 13 3 4s 29. 23 ?4larri�CCAVTON � A- 9257 91144` OiCI Ili ht 4 2 f15 30. 31. Aug23�1i:1 :14� 32. Aug23 10 34amCAYTC)N CA-"�25 ?2-8043 Carl�`""" Gay �` 8 3.j12 33. Au923 12.19pm__CC�YTI9N-"`�OA"92 61'2 9144 `- -Coif"-`�`-` Clay 34. __Xu 1:10 M OCAYT�?N OA� 02s� G72 9043 Goll"- '�l7`ay 3� 3.02 35. __Aug23?1:49p_m_ IwC98RN1`PNCOA 61`0 222-16,82_. C-01_.._._._Day 36, Au 23 a:56p_m_,- [AY'ftSfl A"�25- 702-9043 __ Coii -_ 37. �Aug23 v 23m CCAYTOI ` GA - 825�7G- l43 Coli Eve 38. -t�ug2 a�$ irt` C�AI'TiSFI-"' C 920 st;72-904 Coli -'-iWve8 .74� 39. -Aug23 6:22rrtCCAYTOIT-"-`CA�26�72 9Gtdoii �ve 6 3 12 40. Au 23 6;41 rr_i I71YT1�tN_�-CA " 92 72 9 39 OIT"�- -lWve _ 2� _4_.6 2 41. 23 -736pnm CCAYTUff____CA 925 72 9038 CollV ve 22 4 08 42. Au 23 9;i0�r-,--c N A`825 72 8b43 Coll �- � ve 33 -` 4.74 43. ��23�9:49pm CC1�Y7`t�N-� A 926972 6x44` CoIT`-"- -gve - 42_ 5:28 44. Aug24� 13:06 s_rrr CCAYTfiN�`-C� 82b672 8i3_ -� o�li -11ay 2 2.88 45. )�u_g2i14 41pm� LAYTt�t1""�CA82�672X044 Ccsl1� -15ay 3 2.66- 46, Au924m11:39 rti CAYTISN Z ` �925�+ 72-9€!a4 _ Collve 47. �Au 24 --8-:55pm CLbYTt71�T� C7 �25�72 0391--"' --Goff eve __ 2.94 48. Aug24�9;3 �i�CCA`tTONCA 8266672-9043 Coil ve -`2 -"' - 4;14- 49. Au 24 9 56,pm CC1►YT0 "-Cli- 1257 Coli "eve 36 4 86" 50. 25_ 9:05am CCSYTOW �CA- 82a�672-9� Coll ��l�ay 3 2.66 51. �?iug25ay_ 6� 3:92ry 52. A`u�2�s`10,25a`ii�i"CCA'YTt51Tu�l� _ 53. Aug25�i _59em`GCAYTONCA� 9 5x6729043 Cola i5a -'S6 7 20 _Y... 54. -Aug25 12`37prei C`CiiYTtSN"`C7i a25 X72-`si43 Coll - Day 6 3ry12� ! 55. "Aug25� _03piir`CCAYTON-CA 92 '72-9043 C011 bay - 56, Au�25 d 52prri CCAYT6l�i CA-`-- 2672 9044 -Goll` �-L5� � 6 3 2t3� 57. Aug25 5,08prn C_AYT('lla-"-Cid s5 672 9ft_43 all_-`___eva 9 3 24 58. Aug25 5-.-:46pm CLAYTON - A 92 672 90x3 CoH v® 5 _ 3.60 59, Aug25_7µ65p_m CCAYT1Sl3 GA-"'9'5-0`i2 x0`43 Coil I:ye 2 2.82 60. �Aug25 9:Oa rri CLAYI6N A' 925 671-9643 CoI1- Go - 4 2.94-- 61. .9 --61. ?ug25 _W33pm CCAYTON --CA-"�92 67 0d3 Coir 6v`e 38 4:91 ' 62. "A������u�g26 12:226m CL - A-�"'"-#2` 7T-gi541 `Coll°`- a ` �55 _ 3.12- 63. Au 26--16'09prn -CC7CY1'�fN-`-tnA'�26�72 913� lT ve - 3. 64. Aug26 106pmLAYTlN" A2572=9tt37� `CotT Eve 1 x.76 continues 10 6492 BC68 1F 9264323321 306 946665027 0022 RTEN 0 00 Account Number Statement Date Page 6 925 432-3321 305 N 5167 Sep 20, 1999 fluestions about your Pacific Bart bill? 800-310-2355 Pacific Bell Operator and System-Assisted Calls (continued) Data, Time Phar and Number Called Ty e___ Rate _ _ Minutes Amount L-iYT-0jj--C+��2V8�' 8 2 _ _coir CSa.� � � __ _ �:�4 2. _WU27 12'� i__,.. L-AYT't}�T�-A-92+ 7�Wo-43--`��rl ..�`._ 3. "_WU_ 2 2:ri CL7iY"tCit�iCA� 2567 =T1�43- rr --Cay 3.12 4. �i u IT-118pm MAYT0R__.`CA.__.-92!V-#72Za44 Corl..__._._._CS.a 4:6 u� p�T:kYTf3R � __..._f2 '?2= i14 _ rr. 1y_+ _ _ 3:74- S. 6. Aug275:"T0 m '.. L7 9Tt3iV_..' A B B 72��43 ...-,_ orf live _ 2___ 2.82- 7. - Au 7----S Tm - -sem -- rr �►$ - _ _ 5.16' 8. Yu7 �. t7 rrTr w_��..a..._ _ �A 3c� a:5o . 9. -"Au 27__8:2�m�..�tYT�R_'..- i� i32 2 63ilt 1=.v.e. 2 __ 2'.82 - 10 .82_ 10. -Au "fy�"B S7 rri L Tt3N�TaA 2 fl7`2� 3 __ � _eve ---- -17 - 3:72 - 11. U9 9: pm C CYTfi}R_. TrA �2��7'2- fi4J.__..___ orT....__..._.Trv® _ 37 - 4§Y, 4.69 13. --Au 28 i7p m CLAYT�#FT.._-_.-CA-_- 28-72='0043-._�.-_.C61- --}�II�-l�_� �.7 __ 3.07 14. -A 928 :0Aprr ..a. IAYT t3R� i 825-67 -�it5337-�. -oil---__l�1i 17ft_�� 25 _ 4A S 15. Au 2 ` 58 m`.._�LAY�oR_..__ A X25 872� �T3._ ..___coir - Nr ht d.21- 16. Au b_ 4:57pm�L7 Y7DR.-.__..`._TiX._.`.8 5-572 i'T43....� ori �tl h 5 _ 2:0s 17. �uO2g x:34 M__C �A 82�-872= 43_..____.._ oll NTgfit- _ � 8 _ __ _ 3 18 18. `w"u_28-��7�YT0W-.._t�C__.."§2+5--#72'W43 __ o ._.-.___Nfi h_t _ __ 2�__ 4:08 19. _A`ug2ll_ 8:' a48 m CLAYT't3Tl_.__-_.CA�" �3-1#72= US Coll_`._'_._Nlgr t _ _ _.._ ._.__ '-2.71 20, Aug2W..._�56am CL"AYTtI.R___.`..CA�..._MgF-872--06.1 -Colt_. -Ni�� ... 1 _ 3.73 21. - u 29-fi-� ��„ YroR- A-� 5 2=tea+ rr� Nr _ _ 3.01 22. -AuS2tfi1laTcYTrA77oT1 - --Nrgf _ _ .o 23. ug 12:0 5 rri 24. �-ug28- 24�m. T:AYT OR�- C 25-07orr Ni 64T___...__Cght 25, '-Aug2§__16.,_T m 4.03 26. -Aug ''0 12:4Apm-CLAYTON- 27. pm CAYTt1R�_CA_"'��5 1#720 0 -Day � __ __._ 2.86 28. - Aug30 ."._4:4T r: YTTiFT t�-25 -24daw____.._. Coll _�_Elay 4 20. AuS3ti -67T2f.+m -CLAYTr3R--TA�25_M-0043-_.`.____._ 611 ___.eve 7 3,1?_. 30, �;uS30 10;06 m_`_CLAVT0N__�_..�5_.872 C4 _ _ _Co __ _ .____.__..23 __ _ 4:08_. 31, Aug 32. �3fi � �5amT:AYT r31ir__'. C-A` "..$2572Y __.,.'_ orr - Eve~ �s5 _ _x_80 33. --Sip fi�2;27pm ZCAYTC3Fr__..___.Tr.A._ 572-6 C olT TSey 12 3.08 34. _ 0 1_ S:fi1Lttm` CAYY7CR._-._ 7C__�_I 2+3 572=8 43 "`.._. _C4rT v _Eve _ 4 351 -8e �� 5:37pm 0LAYT0W ___CX_�25 - 3���Corr�� ve __T _ _ 3 42 36. -Sep 1 ...1008 m CL"AYTTfRC�_ 112 8T2= tfddtorr.._-.,._.._Eve 27 4:32 37. "�sspp- aCAYTOF(_'_..__.0;� 5-r#?2- 3 .r-.-...._. .rlT - -Tfy �r8 4.24 38. _15iin 4i01fie�n�CCAYTiSN ____C 8�5 872w T+13..� oTi rSay ,� _- r#.0d... 39. �£ep 2"43 mL�CYI`DR_.._.._CA.._....85--87r2- t34. _ moll. day __ �._.13 _.__ ._3.76- 40, `so i- '�:filpm�CAYTDR'_.`CJ�__625 X72=80d�'__'.°..Carr_-`.'._Day+-- - 1$ ___- -4:0e_. 41, -Sep 2�STS mCL7iYTbN� 01-_i25"672ti4iC ._ 42. __Ve 2 515pYTCr 43. __8 44. ` Si 2�i� 8 rn-_OT:�TYTf3N -C7�-8 372= 43 o(r _ v ._ 3 42 45. _Eek 3_ T 4 m LAY" QR'�A I .+ 213643 �CoTT.�._._ l'#l�T_it 4 2 8§ - 46, --Sip 373m CL7�YTCfR_._._C7�_.._825�672-6043'-._.__-__CoIT_ __T�rrSht _�.�__�_ _ 283_. 47. --Sip 7 34a_._m.....CL-AYT0W_'_CA____&2 872-W4J7_.._.-Carr __Nr�tit W ---11 - ... .w 3.3 f . 48, a m_.".�LAYT0ff` CK _"H3-1372-843`.`043----C6 F_,..`T�Tlghf --_ 7--' '-'-_ 3.07 49. V'ap" 47am `�L-AYTCSR_-. _CA`._'S2"7"- 043.._._...__coil ..-,___._.Day_ 1 -2:80 50. _8ep iµfii 5 a0_ _.._Ct AYTT A��i25 #7 -�a3 ._..____C-Tr..�...- a _- _ .23-_._.._ 4.56- 511 -9-0 .55- 51. -��i fi217"pm�CAYTTfR� A� "T325v8T2=6�F43.� Cali _ Clams _ _ � 7.02 52, _8e 4:28►m GLAYTa"R._..._.CA�21-972- 44-..�...`__CO ._-�Sa + _ 34 5.38 53. a 37pve 54. �Se 1Cfi5pm tAYTiFRA- 12'372=T3t343 _ all _1«ve __ _ 10 _... . 3184 55. Sep 4 1i;fi3eri CCXYTtJK-...#325 S7wi44 _CoTr� rTri _ _ 5 _ 2:95.. 56. Sed 4 _1 fi �aam CLAY°r C � �25�672®�04 _CcsrC.� __NrSh - - 42 5.fit . 57, Se �....___.1 2'rprri CCICYTZIN_..`._.. A..___.._3257fi044_ C9Ti1__. 58. a 4 1:5m CLAYTCFR- 59. �p 31piim---CL71YTON---CW" 2f-'6T2=o-CF44---Corr Ii 60. " ep�d 1 :C5pm-CCAYTCSfl'_--CA_._-925`87'2--3CF44-'.r.__Co`Il___ � 61. Sip s� -Bn 37a " CL-AYTOTU --ZV "T}25-'672-5044-` ""Cote`__ 62. �'e���fi'C:56am�C.J'�+'Tt3F1���A-'_1�25__87237"��011_.._���_..�.. B 3.1.3... 63, hep ' �:'d3aL7tYTT3FI� A._"_.625 6243_. _ oTrMl __. 2.80.. il 84. fi 1 e4...in._` 'r:AYTtFFr....._C X35- 7 63 � Colr� `7rI ht "r-­­3107.."' continues 10 6492 BC69 1F 9264323321 306 946666027 0022 RTEN �7y1 i..f ly W �Y't✓�.r x3/'i Account Numbor Statement Date Page 7 925 432-3321 305 N 5,67 Sep 20, 1999 Cluestions about your Pacific Boll bill? 500-310-2355 Pacific Bell Operator and System-Assisted Oils (continued) Date Time Place and Number Called T Poo Rate Minutes Amount 1. a t;'1-3: 8�arms-CLAYTOR y CA 92 -9 Colt "�`_ NIT ht 3.§Y 2. -. .._.__54o mCdY1`tSN_ `til 825- 0'4_x._ _.'._ oTf eve 3. ��p 7cAYTfi -_ 7� 4. -S i 9:57 m--CEX TON�.A_.`X25"+57 ...v. oll...�._._.Irye "2 ..__...-_._.4.02- 5. Se 7 9:�CAITOA�.._CSC, ._`_925- 721..4 "._". ciTf. .._Eve __... '...-._."....".'... $e 6. -6e-�1010:01rPpm_ CUA�?�"OR-- 7C_ 92"72-9th o ve 7. ` etip 8` �i:27a c'-AYT0�i._...."_.CA.."._025- 72-9043 c� ay 5 .._."__6.32 8. S__e-p�_8_ 2�fi p_m _ CAPTON--t-A----923 672-9043� Coll may 9. Sem ,0.2 m cAYTDNi ; 9 5 �2-00 3 Ca1fv Eve 16�-"--�3.66 10. ­8ep9-4_: 4p�m AY 043"�-�of •-�•-C1ay+ s 3 6 11. gip-9- 1 1p_rri CcA`7MW-' CA `925 67-2--­15044 CollEve 20 12. Se 10 10: am CLAYTON----C 92 -9046 Col ay "-42 -- f38 13. --S 0 0: bpmC[kYTON-0`025-6 44-- --col Eve fig 1184 g 14. e I-S: 4a-C_ LAYTON__.-0"A`--Q-1"7-2- 0 3 �"roti...®__TIi Tit __.__'__ _t.3-_._.-._•,.3.4 15. - 1-1--� 10: ,aCm _C LA TfSNCAA`._0-2-"7"- 0�'�_to_ll.._ . N19 t_ .�._. 16. Sed 1 1 •0 pm_ _CLA Z)N CA 925 672-9044 Coif ^1�7i9_ _ _ 13 17. -S"-8pl 1 x'22 m CLAYTtSN- -CoV -9-2s 972 0 o ht 56 - S.Sfi- 18. e 11 T6-.1 pprn A�TM--CA x}26 9-72-0 3 o ig t 9 3.1-V 19. ` p���2--i'2:28 m tMT75 72*90�3 -�x foil `�-Ni Fit 20, Se 1�`CLAYTON_._C.A�5- 2-9043Ni ht- 3. 21. -Se 12 a 3. cA'TONCA 25�729��ant - 22. Sep 2 10:20pm- CMT-0 CA 925 672-9043 Coll Night 14- 3.`d6 Pacific Bell Calling Card Calls Data Time Place and Number Called TM Rata Minutes Amount 2'3.'d Jul3t0 7.:_19pm'`�L�A6;�1��b�?�`��5"13631i2k12`v`�ard "_t5_ay 1 `:�0 Called from ANT I OCH CA 925 757-9533 24. --Tdf30--- :3-1p-m -FL SANTORC•A 0 " -92Card ay f 7 Called from ANT I OCH CA 925 757-9833 25. -ug , 6:"18pm COffCO1[17._....• A 25 f�2-2"45...._.___.._ a -Nig t 1 30 Called from CONCORD CA 925 680-6052 26, Aug-1 6:2p7-"m-C}NCOFf6---CA 92 `-2'T4 ar Night 1 -716- Called from CONCORD CA 925 680-6052 27. '�Cug f-6 m`CON OITD C 2Card Night Called from CONCORD CA 925 680-6052 28. mug 1- 66 pm CONCORD---C-A- Sn- 14 Caril Night Called from CONCORD CA 925 680-6052 29. -Au--L ps�.m_Pl��"I`�tERG1 A���93 CardEve ._2 ...__..�• 85 Called from PITTSBURG CA 925 439-9842 30. �Cug 34 5.0 a�-m Pi -0$59 Card ig t 1'- � 10 Called from PITTSBURG CA 925 439-9727 31. u� 3: 9prri SAi� ItAiCA.._ 4fi5 86 -C4O4.-_.�..._ ard Called from PITTSBURG CA 925 439-9744 32. Augl2 1: bpm ANTI CH CA 02" 3-1604 Card Day Called_ from PITTSBURG CA 925 439-9808 33. -AugU' 1:58pm"P -TT-90W6`.Z-1C--Q3 76- a Carday Called from PITTSBURG CA 925 439-9508 34. Augl2 2: pm T'58U tG' CA 925 a-'� r-d- ay Called from PITTSBURG CA 925 439-9906 -A-ug 2" :i rT7SB - 05 535. Card ay 8 Called from PITTSBURG CA 925 439-9906 36. ._Aug12 . v_`2Op_,ci _..plIT1R ..C7i02573 , Card ay 7 Called from PITTSBURG CA 925 439-9906 37. -TAug1-2-2:2^4pm ANTIOCH CA 92"W-1-604--Card Day Called from PITTSBURG CA 925 439-9906 38. -�Cug18-12 26pm F'f'rTSSRRZ CA 92 3-1146 Caraay �0 Called from P ITTSBURGWCA 925 458-1048 continues 10 6492 BC66 1P 9264323321 306 946666027 CO22 RTEN Account Number Statement Date page 11 925 4323321 305 N 5167 Sap 20, 9999 auestions about your pacific 8911 bili? 800-310-2355 Pacific Bell Calling Card Calls (continued) Date Time Placa and Number Called 7 0 Hate Minutes Amount -1-Xigi77 ID: #pm PI TTHBI�RZf..-tA—`125-4'7Y=7".�f.40ward _ �....`... __. Called from PITTSBURG CA 925 439-9806 Taxes & Surcharges Desc_tlon _ Amount -2.`—CharOesTr I it—w-or Access ` or n 9—r9fafe i 4TI ni"}g, - 8 Imposed by_Paderal Communications Commission 3, —�:A Hfa most Fund urc aria =�1 - 4. -taUo-r-n a e eeconnecfi`Fu-nif- urc are S� 5. "'-Uffversa-Ufeifne'TaT done`-- ery ce urc arae e. �1aie urc are �` - - erica 7. iafei emu ator es 8. `-C �� 9ry c�-ir and ommun ce ons e`vices acids - - 9, ua Access e—cove ry T� �. i� :�>::•:' :i''y%: i;'i� .'•i�'ii�35i��>i�5Ss�i�i�5:">s S>iii ri��,!�.'•i� ;Si�i�s�:i;i%;r�'ii�i:i:i;'?�i+'s'?:;�> �i�i�;i;:; ;i,:i=.`•s�^i2�i�i;�i�i�i�'i� i�i•+.' ;:i? ;it;i;%:Si»5:...__e_.e.._ 10 6492" BC69 IF 9264323321 305 946666027 0022 HTEN Account Number Statement Date Page 9 925 432-3321 305 N 5167 Sap 20, 1999 Questions about your bill? 800-310-2355 MCI WORLDCOM. `data >:lu� n Monthly Charges Desai tion Amount oat un u cc arge 2. _ ntvlJ r a1 Il the eTep-fione Service Surcharge a 3, ax: wed: —..05 9�1 �1� oca : N Galls •Domestic Date Time Place and Number Called Ty a Rata Minutes Amount ep 0 :�9am -F'`T7TSSCIT#� 7 9�s�d s 19 -� Day . � ;.: 1 t 10 6492 OC68 1F 9264323321 306 946666027 0022 RTEN y �ve-r+•s'�KW Account Number Statement Dat* Page 10 928 432-3321 305 N 5167 Sep 20, 1895 Questions about your bill? 1-888-507-0734 ..:..:.::....::. ::: l>rir< itat �rloi�r i• 9: Monthly Charges Description _ Amount -I LA T41µTi os uncd 9-urcc arge"= -..._� .�... __ - ..�7_ _ ._ .07 2. ®. ra ver-eaT- el nfn:e:— rie Sarvlce uic r e - _ .00 3. -"Iex: a. "_____� �C: Hifi._ Loc,._al_� ._ __.� ____.. .67 Calling Card Cells •Billed on Behalf of ATN COMMUNICATIONS Date Time Place and Number Called Type hate Minutes Amount _ .. epfi#"1fiprrmTA�SPIINL`I ,tJ`+T �_`....hard _ 1:86 Called from PITTSBURG CA 925 439-9789 a I f I N 10 6482 BC69 1F 9264323321 205 946666027 0022 RTEN s # s :. - l 'r r. { x LL J W 100 10 Clerk of the Board of Super- '° visors Room 106 ;� ❑ County Administration Bldg. 651 Fine Street City of Pittsburg © Martinez; CA 94553 ' LL � S Je i. h N f d f �,2 �. ` v lv � .�a .. z 7 < 7.y`` z„'�^.� wti S+S�t >dc✓%a ... .,.,.'.. .-..-,—.-.rfL.,N.�.:.,...' ';::zcarf�'a:::l;�L�Yi.acrr. .'. :. _.. .. �. r..=: . :+.c�:..•�.Ss.. .. __...�_ ..__,..__. CLALM BOARD QF SIMER1 R5 DE CMM CY)STA cQUMg CALTFQRnA #!GOBI) AM FEBRUARY 15, 2000 Crim Against the CwVy, or District Governed by 1 the Board of Supervisors, Routing Endarsemerrts, � NOTICE rG CLAIMANT and Board Action. All Section references are to 1 7be to; of the document rreiled to you is your California Goverment Codes. ) Mice of the action taken on your claim by the Board of Supenrisars. {Paragraph IV bef ovrl, given Wscant to Govement Code Section 913 and 915.4. wase mote 1111 'Warnings". AMOUNT: UNKNOWN CLAIMANT. MANOANJIIA MAHARAJ ATTORNZY: Law Offices of Steven James DATE RFCErM: January 24, 2000 Choi - Attn Kelly January 25, 2000 ADDRESS: 1999 Harrison St. , Ste. 1990 BY DELIVERY TO CLERK ON:, Oakland CA 94612 January 20, 2000 BY MAIL POSTMARKED: L P'ROIK: Clerk of the Board of Supervisors TO: County C,ouasel Attached is a copy of the above-noted claire. Januar 25 2000 PHIL$A R. Clerk Dated: y By: Deputy =- FROINL County Counsel TO. Clerk of the Board of Superviscifs 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 to 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 11L PROM Clerk of the Bond TQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 3V. BOARD O RD13b By unanimous mote of the Supervisors present This Claim is rejected in full. y Other: I certify that this is a true and correct copy of the Board's Order uterruid in its minutes for this date. J Dated: 111 PHIL BATChIELOR, Clerk. By � Lrr Deputy Clark WARNING (Gov. code section 913) Subject to certain exception's, you have only six (6) months from the date this notice was personally served or deposits b the mail to file a court action on this claim. flee Oovermnent 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 to immrsdiately. '*For Additional Warning, See Reverse Side of This Notice. AFMAVIT OF MAWG 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 fuV prepaid a certifie— d copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: J� By: PMLBATCHELOR By ?""-' Deputy Clark I AUX This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period-within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims dict. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY rNSTR„u,�.�TIONS To c�,A .M�.,�,.ANT 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 1000" day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988,must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov#. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553.. C. If Claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. RE: Claim by ) Reserved for Clerk's Filing Stamp M1 k � . } RECEIVED Against the County of Contra Costa JAN 2 4 2000 or CLERK BOARD OF SUPERVISORS District CONTRA COSTA Co, (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of$ IS'OM + and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Bate and Hour) --..-abev 2. Where did the damage or injury occur? (include City and County) 3. flow did the damage or injury occur? (Gtve'ri,n details;use extra paper If required) t -ale efonlavrt s� rA - A- did? , (i��tafd cAWo;nu iN�'� vv h � gt�& Me cftl'mo tt lherf X g'm Ilea Gl li 'h'1�'C f` Y1Lv eff A> lc 1 . a 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? F,cU�urr +0 avrt gv�I f✓a Wl1 (Over) 5. What are the names of county or district officers,servants,or employees causing the damage or injury? r------------------------ ------------------------------------------- What damages or injuries do you claim resulted? {give fall extent of injuries or damages claimed. Attach two estimates auto damage.) ___. '�! _ f► II'i}Pd' _? fi_ n r_, L ------------------------------------------- How was the above claimed amount computed? {Include the estimated amount of any prospective Injury or damage.) -.Y--------------------------------------------------------------------�---- 8. Names and aUddresses of witnesses,doctors,and hospitals. wftc es Pep Ai q01 /Vevi`e 4WAv ', ---_--_-__-..------------------------------------------------------------------------- 9. . List the expenditures you made on account of this accident or injury: DA`PE1 TQM MA OUN F ik Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICES TO. (Attorney) or by some person on his behalf." Name and Address of Attorney c L Aus .- Steven-Jarn6 Ckai (Claimant's Signature ,eft ru rel(� -,g&je—te nke J`qq 1990 (Address) 7 TelephoneNo. ( 7_ Telephone No. * ,� a a a * � a * a x a x * * s * * a * � * x * � * * * * a * * * * * ;� ,� * * � * a * * ,s � a * ar * * � �•�r � NOTICE Section 72 of the Penal Code provides. "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill, account,voucher,or writing,is punishable either by imprisonmtrnt 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($10,000), or by both such imprisonment and fine. 41'11� JRICH Md N I �� /� 3150 HILLTOP MALL ROAD RICHMOND, CA 94808 510.839.4300 PERSONAL INJURY ATTORNEYS SAN FRANCISCO OFFICE ONE SANSOME STREET, SUITE 2000 SAN FRANCISCO, CA 94104 415.777.4878 LAKE MERRITT NhfiUa �dA OSTREET, SUITE 1990, OAKLAND, CA 94612 + TEL 510.444.48`76 + FAX 510.444.44".42 + E-MAIL CHOI40DNAI.COM Clerk of the Board of Supervisors County Administration Building �, �-- 551 Pine Street, Room 106 Martinez, CA 94553 JAN 2 4 2000 Re: Our Client: Manoanjila Maharaj FCLERKOARD r ER�lfSORS Your Insured: Martinez court house iRA; Claire No.: Unknown Gate of Accident: October 26, 1999 Dear Clerk of the Board of Supervisors: Cour office represents Manoanjila Maharaj with respect to the above claim. Please note we are making a claim for money damages and that legal action may be taken in the event this matter is not resolved. Please advise in writing if this notice of claim has been sent to the wrong person or is insufficient in any respect. 1. Adiuster and Claim! Number: Please advise us of the adjuster and claim number of this case. Please forward all documents needing execution. li. Bodily Iniur_v: Our clients were injured in this accident and will be making a claim for personal injuries. Ill. Authorization: Please find enclosed an Authorization pursuant to Section 2695.2 of the California Insurance Code. Please direct all communications to the undersigned. IV". Medical Authorization: If you wish to obtain the medical records yourself, please forward an authorization within 15 days. If we send an authorization you must request the medical records as soon as possible so as not to delay the resolution of this case! Thank you for your courtesy and cooperation. Very truly yours, Kelly Tsai Law Office of Steven James Choi Authorization 1. Authorization to Obtain Records: The undersigned hereby authorizes the Law Office of Steven James Choi, and the following insurance company: to inspect and make copies of the followin records: police reports, medical records, employment records, which relate to my accident dated: October 26, 1999. This authorization is limited to records that relate to the above-referenced accidentl A photocopy of thisggeneral authorization shall be considered as valid as the origInal. This general authorization shall expire when all claims arising from the above accident are resolved. 11. Authorization To Handle Insurance Ctalm: Pursuant to Section 2695.2 of the California Insurance Code, I hereby authorize the Law Office of Steven James Choi to handle my insurance claim arising out of the accident dated: October 26, 1999. This authorization is valid for one year from the date set forth below unless otherwise revoked or renewed in writing by the undersigned. All prior authorizations are hereby revoked. A photocopy of this authorization shall be construed as effective and valid as the original. Dated: l- � - " X anoanjila Maharsk t \ % . , � - uj w , , � . o ® ■ q � , O � a ■ ■ � _ ■ ■ i � ■ � o � � ! & . 0 � \ . . \ . \���� � CLAIM C? RU bF SLM SORS OF COM . STA==, CALMORNIA .8QARa. Q{ FEBRUARY 15, 2000 ClaimAgainst the Ctl�trrtyt a tistrict Governed by the Btrard 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 3: �a7 and of Supervisors. {PareeraSectiobelos a riven 11 scant to Govermtant Coli JA 14 2 : €} 15.4. � note all "Warnings". 1_; AMOUNT: None Stated COUNTY COUNSEL MARTINEZ CALIF, C1YXMANYT. Tam V. Nguyen ATTOP EY: DATE P ErVED: January 14, 2000 ADDRESS: 1195 Arch Ct. BY DELIVERY TO C E M' ON: JaM;Agy 14. ,2000 Concord CA 94519 . BY MAIL POSTMARKED: J,anuM_v, 13. 2000,0 E PROM: Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL B!�AR. Cler Dated: January 14. 2000, $Y: Deputy FRONL County Counsel 'I'O: Clerk of the Board of Supe tors ( ) This claim complies substantially with Sections 910 and 910.2. 4 t bis claim FAILS to comply substantially with Sections 910 and 910.2, and we are to 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: --_ ted Jay:(� BY: �� LLIEkg- Y per' County Counsel M. WOK Clerk of the Board 7* County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. BOARD ORDEFL By unanimous vote of the Supervisors present: Ibis 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:&�Lt,(tk,4 BATMI LC1R, Clap„ By �� � �' �� Deputy Clerk WARXrNG (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►. flee 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 Sett ReverseSideofThiiisNotice, A rA I OF ML I declare under penalty of perjury that I am now, and at all times bersin mentioned, have berm a citizen of the United Mates, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated::' By: PHIL BATCMLOR By, + Z7t`�peputy Clerk Ulyl�i.iiq - I�YIIIY�.IIIIIIIIII II�IYIIWYiI��IY�Y -- 1C`'C; C.oumy K`*"�:esct •.: .",V A,,Lri j;» ,ruor VICTOR J.WESTIVIAN DEPUTIES. ALTHOFF COUNTY COUNSELn ICIEL.AMENTA NORA G,BARLOW B.REBECCA BYRNES SILVANO B.MARCHESI CONTRA COSIT{� O.W_ '\/ ANDREA W.CASSiDY dr ��F /1 1✓ t4 L �Y.I � MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL VICKiE L.DAWES OFFIC tJFTHEGQ 1 eQUNSEL MARKES.ESTIS SHARON L.ANDERSON MICHAEL D.FARR N74 tlUpyl$TRAT1f J.` Ut4 LILLIAN T.FUJI[ ASSISTANT COUNTY COUNSEL *Itif:Rie 4, DENNISC.GRAVES + JANET L.HOLMES GREGORY C.HARVEY MARTA, , /#1 IF1229 KEVINT KERR BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU A GAYLE MUGGLI PAUL AN R.MUF41ZNIZ VALERIE J.RANCHE OFFICE MANAGER STEVEN R RETTIG DAVID F SCHMIDT PHONE(925)395-1800 BARBARA N.SUTLIFFE FAX(925)646-1078 NOTICE OF INSUFFICIENCY JACQUELINE Y.WOODS AND/OR NON-ACCEPTANCE OF CLAIM TO: Tam Nguyen 1195 Arch Ct. Concord, CA 94519 Please Take Notice as Follows: The claim you presented against the County of Contra Costa or District governed by the Board of Supervisors fails to comply substantially with the requirements of California Government Code Section 910 and 910.2, or is otherwise insufficient for the reasons checked below: [ 11. The claim fails to state the name and post office address of the claimant. [ 12. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [ X ] 3. The claim fails to state the date,place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s)of the public employee(s) causing the injury, damage, or loss, if known. [ X] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000),the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: The claim fails to describe any duty or obligation of the public entity and any action giving rise to the claim. Page 1 VICTOR J. WESTMAN COUNTY COUNSEL By: _ Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P.§§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: January 19,2000,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 Craim to. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 ' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year alter the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or District) (Fill in n me) ) � ,CA 4 � The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) 2. Where ///f,1did 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)111,7- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? ne5 1,",9 S. What^are the names of county or district 'officers, servants, or employees caussiinj(g� the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages clai . Attach 7 two estimates for auto damage,) �/ Lv, ✓`2 /� �,. 7. How was the amount claimed above computed? (Include the estimated.amount of any pros ctive it ul y or damage.) 8. Nalnes and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE AM-QM Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf." SaND N TI E Name and Address of Attorney ) (Claimant's Signature) (Address) Ile t ) o � -- G Telephone 1' .26- Telephone No. NOTICE Section 72 of the Kenai Cade provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any aunty,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. a t- JL r tri V � 7 � ♦♦ l X11 V I� CLAIM IRQAED E SIMERYISMS DE ,COMA C*OSTd Mrr►'T"1', CAr )RI'a A Y. MQU1*'EBRUAARY 15, 2000 ClaimAgainst the Couty, or District Governed by 1 the Board of Supervisors, Routing EndorsermInts, NOTICE TO CLAIMANT end Board Action. Ali Section referemes are to The copy of this dlxwwt mauled to you is your California Government Cedes. I wtice of the action taken on your dah by the Board of Supervisors. f Para reph IV belouu�, liven pursuant to Governrr eM a Section 913 and 915,4. Haase ante aiI "Warnings". JAN 1 1-41 22,000 AMOUNT: $50,000.00 C(3UW,s i� UNSEL MARTINEZ CALIF. CLAIMA s7: 'dam V. Nguyen ATTORNEY: DATE RECErWD: January 14, 2000 ADDRESS: 11.95 Arch Court BY DEI.TYERY TO CII.ERK ON: Jaul ry 14 2000 Concord CA 94519 BY MAIL PDS'TMARM:_„ dM ax�,Y 2000 „ I. 1 ROK Clerk of the Baud of Supervisors TO: County Counsel Attached is a copy of the above-noted alaim. PHIL BA R. Clerk . Dated: anuYar14, 2000 YY By: Deputy '.-Y IL FRO&i: County Counsel TO. Clerk of the Board of Supervis rs (Vis claim complies substantially with Sections 910 and 910.2. } This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 1$ days {Section 910.9). } 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: .f � '' By; D eoury County Counsel IML YROK Clerk of the Board TO: County Counsel (1) County Administrator (2) ( } Claim was returned as untimely with notice to claimant (Section 911.3). IY $OARD ORDElL• By unanimous vote of the Supervisors Present ?his Claim is rojectsd in full. C } Other: I certify that this is a true and correct copy of the Board's Carder entered in its,,minutes for this date. Dated: PHIL BATCHELOR. Clerk, By �, - _ ., .L� � 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 94.5.6. You may seek the advice of ren 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 SideofThis Notice. AFMAVIT PFisAIIG I IY YYFYYYM1IiiiilY�YYYY�rYI�YII 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 16; and that today I deposited in the United States Postal Service in Martinez„ California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. DatedK,4 By: PHIL BATCHELOR By Deputy Clerk Yt4... Crim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY rJ INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100,' day after the accrual of the cause of action Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 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 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 'lam' ) RECEIED Against the County of Contra Costa or ) JAN 14 2000 District) CLERK 10ARb OF SUP RVISORS (Fill in name) } TA The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: 1. When did the damage or injury occur?(Give exact date and hour) 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 ��u11 / / � CLAIM BOARD-Ano FEBRUARY°"1.51 2400 geim Against the County, or District Governed by 1 the Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT end Board Action All Section references we to N copy of this docur wt railed to you is your California Government Codes. 1 notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belovvl, Oven pursuant to Government Cade Section 913 and 15.4. Phase note alt "Warnings". Moo AMOUNT: $10,000.00 4?tY co7UJNSEL. CLAIMANT: JOSE PASTRANA �.�,t,�'�i�ExcAL�t+. ATTORNEY: c/o Law Offices of John Diaz DATE RECEWW: January 20, 2000 Coker January 20, 2000 ADDRESS: 525 Marina Blvd. BY DEi.JVERY TO CIM ON: Pittsburg CA 94565 Unreadable BY MAIL POSTMAR) ED: L PROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. January 21, 2000 PHIL BA '"+ Clerk J Dated• By: Deputy...._,. IL 'FRC?hi County Counsel TO Clerk of the Board of Supervis (This claim complies substantially with Sections 910 and 910.2. This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 1$ days (Section 910.8). ( 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). ( tither. Dated f By: Deputy County Counsel .. .. 11L PROM: Clerk of the Board TO. Canty Counsel (1) County Administrator (2) ( Claim was returned as untimely with notice to claimant (Section '911.3). 3y, BOARD ORDEW By unanimous vote of the Supervisors present: This Claim is rejected in fall. Other: I certify that this is a true and correct Copy of the Board's Order entered in its minutes for this date. Dated: ) Ikputy 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 nutter. If you want to consult an attorney, you should do so immediately. *For Additional Warning Sae Reverse Side of This Notice. ...�,,.,.._.Y....... _, ... - ....�AFMAVIT OF hunIN - I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: r-54-. By: PHIL BATCHELOR By Ekputy Clerk : C. uffly rounscl C✓vc iiy Aftivi for - JOHN DIAZ COKER ATTORNEY--ABOGADO Of Counsel A. ARACELI RAMIREZ RHONDA WILSON RICE Clerk, Board of Supervisors b tt �r r� Centra Costa County RECEI V El 651 Pine Street Martinez, CA 94553 JAN 2 0 2000 CLERK BOARD OF SUPERu1S01l N A OSTA c0. January 19, 2000 RE: Claim of Jose Pastrana Dear Clerk, Please file the original of the claim on behalf of Mr. Pastrana and return the copy, marked with your received stamp, to our office in the envelope provided. Thank you. Sincerely, Secretary ° me Enclosures 525 MARINA BOULEVARD • PITTSBURG, CALIFORNIA 94565 (925)432-7373 CLAIM AGAINST CONTRA COSTA COUNTY �+ �t AND ITS AGENTS AND EMPLOYEES RECEIVED JAN 2 0 2000 ADDRESS OF CLAIMANT: CLERK BOARD Of SUPERVISORS Vose Pastrana C NTRA STA 0. 4956 Teakwood Oakley, CA 94561 ADDRESS TO WHICH NOTICES SHOULD BE SENT: Jose Pastrana c/o Law Offices of John Diaz Coker 525 Marina Boulevard Pittsburg, CA 94565 DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE: On December 29, 1999 Claimant' s son Shawn Pastrana was a victim of an attack by four Hispanic males who stabbed Shawn twice, apparently with a screwdriver. These same assailants vandalized Claimant' s vehicle by breaking all the windows out and then also took the car and drove away. Claimant got his damaged vehicle back the next day. These events occurred at San Hill Road near Oakley, Contra Costa County, State of California. Claimant immediately reported the incidents to the Contra Costa Sheriff' s office. Several deputies responded to where the victim, Shawn Pastrana, and his brother, Joseph Pastrana, were waiting. Claimant arrived while the deputies were talking with Shawn and Joseph. While Claimant was there speaking with the deputies, the deputies told Claimant there was nothing they could do about the incident. After Claimant had been present speaking with the deputies for about five minutes, a Sergeant from the Contra Costa Sheriff' s office arrived and told his deputies "Let' s go. " The deputies and their Sergeant left without explanation. One of the deputies evidently called the California Highway Patrol (CHP) before departing, but Claimant and his two sons were left alone at the scene to wait for the CHP, even though this exposed the three to danger from the same assailants if they chose to return. Claimant and his two sons waited for the CHP for approximately 30 minutes. When the CHP officer arrived he was very surprised that the Sheriff' s deputies had left and informed Claimant that the proper procedure would have been for the Sheriff' s deputies to take a report and to wait for the arrival of the CHP officer. Later that evening the Sheriff' s deputies did take a report, but only at the insistence of the CHP officer. PARTIES RESPONSIBLE: County of Contra Costa, and unknown agents of the County of Contra Costa. 1 c� 19 A�-3 AMOUNT OF CLAIM: $10, 000 . 00 against County of Contra Costa and its agents and employees; $10, 000. 00 in punitive damages against unknown individual agents/employees of the County of Contra Costa GENERAL DESCRIPTION OF INJURIES ANIS BASIS OF COMPUTATION OF DAMAGES. Compensatory damages are based on the unnecessary costs associated with the attempt by Claimant to gain redress of his grievance against Respondents, including but not limited to attorneys fees and costs; damages associated with the anxiety, nervousness, embarrassment, humiliation, vexation and distress caused by the conduct of the agents and employees of the County of Contra Costa. Compensatory damages are further based on the deprivation of Claimant' s civil and constitutional rights arising out of both the Federal and California Constitutions and both Federal and California Civil Rights statutes, including, but not limited to the right to the right to due process, and the right to equal protection of the laws. Punitive damages are based on the outrageous and intentional conduct of agents and employees of the County of Contra Costa which amounted to malice, fraud and oppression within the meaning of California Civil Code Section 3294, all of which where based on improper motivation, including retaliation against Claimant and his son Shawn, for prior disputes with the Contra Costa County Sheriff' s office, including prior and/or pending personnel complaints and governmental claims against that office. Dated: January _, 2000 JOSE PASTRANA 2 vi w i N .D r ('3 (`1 CD O d f (+ t I t + CD ,gyp tU 0 M R7 LnLn M iw �• 1 � r C'V THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on February 15, 2000 by the following vote: AYES: SUPERVISORS GIOIA, UILKEMA, DESAULNIER, CANCIAMILLA AND GERBER NOES: NONE Resolution of Intention to Establish Underground Utility ABSENT: NONE District leo. 28 ABSTAIN: NONE RESOLUTION NO. 2000/82 SUBJECT: Fix March 14, 2000 at 9:00 a.m. for a public hearing to discuss establishing Underground Utility District No.28, Parker Avenue, Rodeo Area. Project No. 0676-6P1094 The Board of Supervisors of Contra Costa County RESOLVES that: The Board of Supervisors of Contra Costa County has adopted Ordinance No. 68-10 (Ord. C. 1008-2.002 et seq.)which provides for the establishment of Underground Utility Districts in those areas of the County where the public health, safety, or welfare requires the removal of the overhead distribution system from the public streets, alleys or ways, and the replacement thereof with an underground system. Parker Avenue is the downtown commercial district for Rodeo, and a major travel route for the area, providing sub-regional north-south circulation. Therefore, it is the intention of this Board to conduct a public hearing to ascertain whether it is in the interest of thepublic health, safety, or welfare to underground the overhead distribution system from the public street, alleys or ways of the unincorporatedarea along Parker Avenue in the Rodeo area, as shown on the attached map and legal description marked Exhibit "A". At 9:00 a.m., on March 14, 2000, in the Chambers of the Board of Supervisors, County Administration Buildin , Martinez, California, this Board will conduct the saidpublichearing on the proposed establishment of Underground Utility District No. 28 in the area hereinabove described and at that time will hear the testimony of all interested persons for or against the establishment of this zone. The Clerk is directed to notify all affected property owners, as shown on the last equalized assessment rolls, and utilities concerned, by mail, of the time and place of such hearing at least ten (10) days prior to that date. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the JY:Je G:kGrpbatatTransEng\2000\Bo-Ta1801uu28.doc Board of Supervisors on the date shown. Originator: Public Works(TIE) Contact: Joe Yee,Tet.(925)313-2298 cc: County Administrator Auditor/Controller y� Community Development,G.Slusher ATTESTED: February 2 2000 4n�Districts,riices C..SSaiwgren viaPA✓! PHIL BATCHELOR, Clerk of the Board of Supervisors California Highway Patrol Property Owners(see list) and County Administrator PG&E(via PW) Paottic Bell(via PW) Viacom(via PW) By fia Deputy 67 RESOLUTION NO. 2000/82 The Board of Supervisors �� � _/31-'1r tPhil Batchelor Clerk of the Board and County Administration Building Cost. County Administrator 651 Pine Street, Room 106 (925)335-1900 Martinez, California 94553-1293 County John Gioia, 1st District `J Gayle Uilkema,2nd District e Donna Gerber,3rd District r, Mark Desaulnier,4th District Joe Canciamilla,5th District , e+d: February 15, 2000 Proposed Parker Avenue Underground Utility District#28, Rodeo Area Dear Property Owner: On February 15, 2000, the Board of Supervisors set March 14, 2000, at 9:00 a.m. as the time for a public hearing on the creation of an underground utility district along Parker Avenue (from 7t Street north to San Pablo Avenue and on San Pablo Avenue from Rodeo Avenue to about 400' west of Railroad Avenue). Under Rule 20-A for utility conversions, the proposed district will pay for all costs related to the installation of the underground system. The underground district will also provide 30.5 meter (100 feet) of lateral trenching and conduits, if needed, from the underground district's main service trench to the foot of the building wall where the utility service box is attached, at no cost to the property owner. The property owner, however, will be responsible for the conversion of their utility service box to receive underground service, and any lateral trenching and conduit in excess of 30.5 meters (100 feet). If the property owner already receives underground service no further action is necessary. At the public hearing, the Board of Supervisors will ascertain whether the public health, safety, or welfare requires the removal of utility poles, overhead wires and associated overhead structures within the designated district area. If the Board of Supervisors approves the creation of the district you will be notified of the time schedules for the conversion of your overhead service to underground service. Very truly yours, Phil Batchelor, Clerk of the Board of Supervisors and County Administrator By: An Cervelli,"Chief Clerk PB:JY:Je G:1GrpD®telTransEngL20001TEtParkerAveUU28notice.doc CLALM u. ,� OF rrtPFu�nenC OF rtYt'ti"fR4 Ct?5TA["Y►i T "i"Y. .� TI c) ' _A FEBRUARY 15, 2000 J 0 Crim Against the Cotity, or District Governed by the Board of Supervisors, Routing Endorsements, � NOTICE TO CLAIMANT Board Action. All Section references are to �AN 0 2Q00 The copy of this document mailed to you is your California Gwarnmern Codes. COUNTY COUNSEL notice of the action takers on your claim by the MARTINEZ,CALIF, Board of Supervisors. (Paragraph IV below?, given ppuurrsuant to Government Code Section 913 and 515.4. Please note all "Warnings". AMOUNT: $50,000-00 CLAIMANT: DORIS SILVIERA ATTORNEY: c/o MARTIN T. GONSALVES DATE . January 20, 2000 Attorney at Law, SBN 111552 January 20,___2000 ADDRESS: 511 West Third Street BY DEL VERY TO CLERK ON: „ Antioch CA 94509 BY MAIL POSTMARKED: Nand-Delivered by Server Toy 7espi e L FROPr3: Clerk of the Board of Supervisors 70t County Counsel Attached is a copy of the above-noted claim. January 20, 2000 PML BA R, Cler lh Dated: By: Deputy IL FRONL County Counsel TO. Clerk of the Board of Supervis s ( This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are to 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 911.0. { ) Other: - Dated: �'�"/ 0 By' Depute' County Counsel EEL PROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). TV. BOARD ORDEIL By unanimous vote of the Supervisors present: (- This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board`s Order entered in its minutes for this date. Dated: ( '" PHIL BATCHELOR, Clerk„ By &21ZDeputy 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 depositec 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 W attorney. you should do to immediately. *For Additional Warning Sae Reverse Side of This Notice. AFFIDAVIT OF bMUMG I declare tinder penalty of perjury that I am novo. and at all times herein mentioned. have bean a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated- � By: PHIL BATCHELOR By +�" s�=�fi�__ .Ll Deputy Clerk 5.t,,e 1 MARTIN T. GONSALVES Attorney at Law, SBN 111552 RECEIVED 2 511 West Third Street Antioch, CA 94509 3 (925) 757-8300 JAN 2 0 2000 4 Attorney for Claimant CLERK BOARD OF SUPERVISORS DORIS SILVIERA CONTRACOSTACO. 5 6 7 8 9 10 11 In the Matter of the Claim of ) CLAIM AGAINST PUBLIC 12 DORIS SILVIERA ENTITY 13 against [Gov. C. §§ 905, 905.2, 910, 910.2] 14 CONTRA COSTA COUNTY, CONTRA COSTA COUNTY HEALTH 15 SERVICES DEPARTMENT, BRENTWOOD HEALTH CENTER, PITTSBURG 16 HEALTH CENTER PHARMACY and DOES 1 to 50 17 18 TO: CONTRA COSTA COUNTY, CONTRA COSTA COUNTY HEALTH SERVICES 19 DEPARTMENT, BRENTWOOD HEALTH CENTER and PITTSBURG HEALTH CENTER 20 PHARMACY: 21 DORIS SILVIERA, hereby makes claim against CONTRA COSTA COUNTY, CONTRA 22 COSTA COUNTY HEALTH SERVICES DEPARTMENT, BRENTWOOD HEALTH CENTER 23 and PITTSBURG HEALTH CENTER PHARMACY, for the sum of$50,000.00 and makes the 24 following statements in support of the claim: 25 1. Claimant's post office address is c/o Law Office of Martin T. Gonsalves, 511 26 West Third Street, Antioch, CA 94509. 27 2. Notices concerning the claim should be sent to claimants in care of their attorney 28 Martin T. Gonsalves, 511 West Third Street, Antioch, CA 94509. Silviera vs. Contra Costa County Health Center 1 Claim Against Public Entity V vi 1 3. The date and place of the personal injury giving rise to this claim are August 17, 2 1999, at Brentwood, Contra Costa County, California. 3 4. The circumstances giving rise to this claim are as follows: 4 On or about August 17, 1999, DORIS SILVIERA went to the BRENTWOOD 5 HEALTH CENTER to have a prescription for Depakene, brand name "Tegretol", re-filled as 6 prescribed by Dr. Greta Perez, of the BRENTWOOD HEALTH CENTER. BRENTWOOD 7 HEALTH CENTER had DORIS SILVIERA'S prescription for Depakene (Valproic acid) filled 8 by the PITTSBURG HEALTH CENTER pharmacy. DORIS SILVIERA had been taking 9 Depakene, for over ten years for the treatment of seizures related to a brain tumor surgery of 10 1979. Upon picking up the prescription on August 18, 1999, she began giving herself the 11 Depakene medication" at the prescribed dosage, 1 tablet daily, 4 times a day, as prescribed 12 by her doctor and in accordance with the label on the bottle. 13 Over the following week and one-half of taking the "Depakene"from the newly 14 filled bottle, she began to experience increased headaches and shakiness. She experienced 15 extreme and constant frontal headaches from about August 25, 1999 to August 28, 1999. On 16 August 28, 1999, she began to feel very shaky and as though she was going to have a 17 seizure. 18 On August 28, 1993, DORIS SILVIERA was taken by ambulance to the nearest 19 hospital, Sutter Delta Medical Center for emergency evaluation and treatment. Laboratory 20 tests conducted at the hospital revealed a"subtherapeutic Valproic level". DORIS SILVIERA 21 was administered Toradol 33 mg. IV push, for her headache and instructed to take an extra 22 dose of Valproic acid ("Depakene") that night and the following day. 23 The following day, August 29, 1999, her symptoms did not improve. She 24 continued to feel "shaky", DORIS SILVIERA, returned to the Sutter Delta Medical Center 25 Emergency Room. The emergency room physician reviewed the laboratory tests of the 26 previous day and determined that the Tegretol level was low despite the continued use of 27 Tegretol. Poison Control was contacted to confirm that the pills in the Tegretol bottle were 28 truly Tegretol pills. The hospital was informed that they were not Tegretol pills and that they Silviera vs. Contra Costa County Health Center 2 Claim Against Public Entity 1 were possibly actually Verapamil. DORIS SILVIERA was released with instructions to take 2 two tablets of Valproic acid that night and one the following morning. She was also instructed 3 to go back to the Brentwood Clinic immediately the following day and have them refill the 4 prescription. Attached hereto as Exhibit "A" are the Sutter Delta Emergency Reports. 5 5. So far as is known at this time, said injuries to Claimant consisted of extreme 6 constant frontal headache and acute shakiness rendering her with the feeling that she was 7 going to have a seizure. Her adverse physical reaction to the wrong medication inflicted 8 undue emotional distress, because she thought that she was experiencing a life threatening 9 illness. In addition, she is uncertain what, if any, long-term complications may arise for the 10 lack of Valproic acid or the unnecessary exposure to Verapamil, which caused her extreme 11 and emotional distress. 12 The estimated costs to date for medical treatment rendered to DORIS SILVIERA 13 for treatment of the adverse reaction to the wrong medication amounts to$2,523.55. Attached 14 hereto as Exhibit "B" is the ambulance bill, the hospital bill, and the emergency room 15 physician's bill. 16 General Damages $50,000.00 17 Future Medical Treatment Costs $ Unknown 18 Total Claimed $ 50,000.+00 19 6. The names of the public employees causing the claimant's injuries are unknown 20 at this time. 21 7. Jurisdiction over this claim would rest in the Superior Court of California. The 22 claim is based on injury, damage and/or loss including but not limited to medical expenses 23 incurred to date, estimated future medical expenses, and neral damages in an amount to 24 be proved later. 25 DATED: January 12, 2000 f� SALVES, 26 Attorn y for Claimant, DRIS SILVIERA 27 28 5ilviera vs. Contra Costa County Health Center Claim Against Public Entity 3 Ct�a� lore -� SUTTER DELTA MEDICAL CENTER EMERGENCY ROOM REPORT EXHIBIT ffAff SUTTER DELTA MEDICAL CENTER 3901 Lone Tree Way . Antioch, CA 94509 (510) 979-7200 EMERGENCY ROOM REPORT PATIENT: SILVEIRA, DORIS 080965 DATE OF ER VISIT: 08/28/99 TIME OF EVALUATION: 20 :45 PHYSICIAN: MARY A. FITZSIMONS, M.D. CHIEF COMPLAINT: Headache and shakiness. HISTORY OF PRESENT ILLNESS : This is a 63-year-old female with a history of seizure disorder. She states she is worried she is going to have a seizure. She states that has had a frontal headache for the last three days, but all day today, she has been very shaky and feel as though,_she is experiencing the same symptoms as her prodromes before a seizure. She has been taking her Depakene as prescribed. Recently had Lasix started for pedal edema, but denies any other medication changes. She has had no fever. Describes a constant frontal headache with no associated nausea or vomiting. PAST MEDICAL HISTORY: Is positive for seizure disorder and recent diagnosis of pedal edema . MEDICATIONS : Lasix every other day. Depakene daily 4 times daily, 1. tablet . ALLERGIES: Codeine and Tegretol . SOCIAL HISTORY: Positive for cigarette use. REVIEW OF SYSTEMS: General - No fever. Gastrointestinal - No vomiting. Respiratory - No dyspnea. Cardiac -- No chest pressure. Integument - No rashes. Neurologic - Tremulousness, headache, see history of present illness. The remainder of the review of systems are negative. PHYSICAL EXAMINATION: GENERAL: Alert, very anxious female, slight tremulousness is noted. VITAL SIGNS : Blood pressure 136/67, pulse 94, respiratory rate 16, temperature 97 .7 orally. HEENT": Sclerae are anicteric. Conjunctivae are clear. Oral mucosa pink and , moist . Pupils equal, round, reactive to light, 2 mm in diameter. Discs sharp. Fundi without hemorrhages . Tympanic membranes are normal grat. NECK: Supple, no nuchal rigidity. No jugular venous distention. LUNGS: Clear to auscultation. throughout . No wheezes, rales or rhonchi . CARPIAC: Regular rate and rhythm. No click, rub, or murmur. ABDOMEN: Flat . Bowel sounds present . Normal active. Soft to deep I SDKC E11ERGENCY ROOM REPORT PATIENT: SILVEIRA, DORIS 080965 PAGE 2 palpation. No tenderness, masses or guarding. EXTREMITIES: Without clubbing, cyanosis, or edema. NEUROLOGIC: Cranial nerves intact. Deep tendon reflexes are 2+ and equal over the brachioradialis and patellar tendons. Sensation intact to light touch throughout. Mental status alert and oriented times four. MEDICAL DECISION MAKING: The patient presents with a frontal headache . No . evidence of meningismus or fecal neurologic deficit, ruling out meningitis or intracranial bleed. The patient has generalized tremulousness which may be related to anxiety, however the patient is on an anti-epileptic and therefore, this may represent a subtherapeutic or excessive drug level. In addition, the patient may be suffering from metabolic disturbance such as hypoglycemia or hyponatremia. The patient will be evaluated for possible anemia, causing her symptoms. LABORATORY DATA: Complete blood count is essentially normal . Shows a normal white count of 8, 600 with a normal differential . Hemoglobin normal at 13 .4, with a hematocrit of 40 .5 . Electrolyte panel within normal limits. BUN essentially normal at 28, with creatinine .9, glucose mildly elevated at 175 . Liver enzymes within normal limits . Valproic level, however, is subtherapeutic at 5. 7. EMERGENCY DEPARTMENT COURSE: The patient was given Toradol 30 mg IV push for her headache with marked improvement. IMPRESSION: Tremulousness due to subtherapeutic Valproic level . PLAN: Discharge home. Patient instructed to take an extra dose of Valproic acid tonight and tomorrow night . She is to follow-up with her neurologist in 48 hours by phone to discuss the drug level and possible chronic increase in Valproic Acid. The patient is to arrange for recheck of Valproic Acid level in about four to five days . DISCHARGE DIAGNOSIS : General shakiness, subtherapeutic Valproic Acid levels . MARY A. FITZ IMONS, D. c78 08/29/99 : 08/29/99 0 cc : i Pittsburgh Clinic t ,.ty REPORT . tIM£ ' d A 3NDITION ON DISCHARGE: C GOOD kTABLE U FAIR 0 SERIOUS C CRITICAL 0 EXPIRED C3 CORONER NOTIFIED C3 POLICE NOTIFIED I ADMIT C]TRAM FER 0 STABLE C]UNSTABLE :NATURE S4tt ► DeL 39Uf LONE TREE WAY Medical tom" ANTIOCH,CA"509 TIOCH,CA"509 Medical ta (5 0)779-7200 CIENT ACCOUNT V3. AUTHORIZATION NO. DAYS ADMIT DATE TIME MED,RECORD NO. 201451£32{, 08/28/99 2012 0080965 4TtENT NAME t PHON PAT ADDRESS 1100 VILLAGE-DR.—_ Y STATE,ZiP '8RE-NTWO_Obi CA 94513 W _ TAR NO. ADMIT CMF C'V THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on February 15, 2000 by the following vote: AYES: SUPERVISORS GIOIA, UILKEMA, DESAULNIER, CANCIAMILLA AND GERBER NOES: NONE Resolution of Intention to Establish Underground Utility ABSENT: NONE District leo. 28 ABSTAIN: NONE RESOLUTION NO. 2000/82 SUBJECT: Fix March 14, 2000 at 9:00 a.m. for a public hearing to discuss establishing Underground Utility District No.28, Parker Avenue, Rodeo Area. Project No. 0676-6P1094 The Board of Supervisors of Contra Costa County RESOLVES that: The Board of Supervisors of Contra Costa County has adopted Ordinance No. 68-10 (Ord. C. 1008-2.002 et seq.)which provides for the establishment of Underground Utility Districts in those areas of the County where the public health, safety, or welfare requires the removal of the overhead distribution system from the public streets, alleys or ways, and the replacement thereof with an underground system. Parker Avenue is the downtown commercial district for Rodeo, and a major travel route for the area, providing sub-regional north-south circulation. Therefore, it is the intention of this Board to conduct a public hearing to ascertain whether it is in the interest of thepublic health, safety, or welfare to underground the overhead distribution system from the public street, alleys or ways of the unincorporatedarea along Parker Avenue in the Rodeo area, as shown on the attached map and legal description marked Exhibit "A". At 9:00 a.m., on March 14, 2000, in the Chambers of the Board of Supervisors, County Administration Buildin , Martinez, California, this Board will conduct the saidpublichearing on the proposed establishment of Underground Utility District No. 28 in the area hereinabove described and at that time will hear the testimony of all interested persons for or against the establishment of this zone. The Clerk is directed to notify all affected property owners, as shown on the last equalized assessment rolls, and utilities concerned, by mail, of the time and place of such hearing at least ten (10) days prior to that date. I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the JY:Je G:kGrpbatatTransEng\2000\Bo-Ta1801uu28.doc Board of Supervisors on the date shown. Originator: Public Works(TIE) Contact: Joe Yee,Tet.(925)313-2298 cc: County Administrator Auditor/Controller y� Community Development,G.Slusher ATTESTED: February 2 2000 4n�Districts,riices C..SSaiwgren viaPA✓! PHIL BATCHELOR, Clerk of the Board of Supervisors California Highway Patrol Property Owners(see list) and County Administrator PG&E(via PW) Paottic Bell(via PW) Viacom(via PW) By fia Deputy 67 RESOLUTION NO. 2000/82 C'3 Rodeo-- Underground Utility District Boundry' EXHIBIT "A„ Real property in the unincorporated area of Contra Costa California being a portion of the Rancho El Pinole and the Map of Rodeo filed in Book D of Maps at page 91 described as follows: Beginning at the southwesterly comer of Lot 23, Block 4 of the "Subdivision of Block 1W"filed May 8, 1928 in Book 21 of Maps at Page 568; thence from said Point of Beginning along the northeasterly line of the "alley" as shown on said Subdivision map along blocks 4,3, and 2, north 10"52'west 1879.12 feet to the southwesterly comer of Lot 22, Block 1 of said subdivision (21 M 568) said point is also the southwesterly corner of parcel "B" of subdivision MS 115-76, filed January 27, 1978 in Book 62 of Parcel Maps at Page 47; thence along the boundary of Parcel B the following three courses (1) north 79"08' east 60.00 feet, (2) north 10°52' west 75.00 feet and (3) south 79"08' west 60.00 feet to the northeasterly line of the "alley" Block 1 (21 M 568); thence along said line north 10°52' west 475.00 feet to the northwesterly corner of Lot 1, Block 1 (21 M 568); thence crossing 70 feet in width Third Street to the southwesterly corner of Lot 4 Block 7W of the Map of Rodeo (D M 91); thence along the boundary of Lot 4 north 10052"west 125.00 feet; thence north 79008' east 37.00 feet to the southwesterly right of way line of Pacific Avenue; thence crossing 66 feet in width Pacific Avenue to the northeasterly right of way line; thence along said right of way line also being the boundary of Block 8W(D M 91) in a general northwesterly direction 245 feet to the westerly comer of Lot 10 Block 8W; thence crossing 70 feet in width Second Street to the southwesterly comer of Lot 5 Block 9W; thence along the boundary of said Lot and its northerly prolongation north 10°52' west 315.00 feet; thence north 69032' east 76.13 feet; thence north 10"52' west 135.00 feet to the southerly right of way line of 70 feet in width First Street; thence crossing said right of way to the southwesterly comer of Lot 2 Block 10W(D M 91); thence along the boundary of said Lot north 10"52`west 125.00 feet; thence south 69"32'west 203.00 feet to the easterly right of way line of Rodeo Avenue; thence along said right of way line and its northerly projection north 10"52' west 195.00 feet to the northerly right of way line of San Pablo Avenue; thence along said right way north 69"32' east 253.75 feet to the southwesterly corner of the DeMartile parcel of land recorded January 1, 1997 as series number 97-004543; thence along the boundary of said parcel north 10"41'30" west 60.25 feet; thence along the northwesterly boundary of said parcel and its northeasterly prolongation 1105 feet to the northerly corner of Parcel 'A' of Subdivision MS 71-67 filed November 29, 1967 in Book 50 of Licensed Surveyors Maps at page 14; thence along the northeasterly boundary of said Parcel 'A' and its southeasterly prolongation south 38"34'11"east 240 feet to the northeasterly comer of Lot 2 Block 37E (D M 91) said point is also on the westerly right of way line of Vaqueros Avenue; thence along said right of way line south 8"00' west 70 feet to the most southerly comer of said Lot; thence along the boundary of said Block 37E north 82° west 286.09 feet to the most westerly comer of Lot 12 Block 37E; thence crossing 70 feet in width San Pablo Avenue to the northeasterly comer of Lot 2 as shown on the"O ficial Map of Amended Map No. 2 of Block"A' and Amended Map of Blocks 'B' and '36E' in the Town of Rodeo"fined March 1, 1926 in Book 1 of Official Maps at Page 1; thence along the boundary of said Lot 2 south 8"00' west 130.00 feet; thence along the boundary of Lot 2 and Lot 1 north 82°00' west 82.26 feet to the easterly right of way line of Railroad Avenue; thence crossing 80 feet in width Railroad Avenue to the northerly corner of Lot 1 Block 5W(DM91); thence along the northerly boundary of Lots 1 thru 8 Block 5W, crossing 70 feet in width John Street (vacated) and the northerly line of Lots 1 thru 9 Block 6W, south 69"32' west 491.05 feet to the 1 northwesterly comer of Lot 9 Block 6W; thence along the westerly line of said lot south 10°52' east 125 feet; thence crossing 70 feet in width First Street to the northwesterly corner of Lot 36 Block 3W (DM91); thence north 69032' east 100 feet to the northeasterly corner of Lot 33 Block 3W; thence along said Lot south 10052' east 125 feet; thence south 69032' west 12.50 feet; thence south 10052' east 150 feet; thence south 69"32'west 37.50 feet; thence south 10"52' east 175 feet to the northerly right of way line of Second Street; thence crossing 70 feet in width Second Street to the northwesterly corner of Lot 23 Block 2W; thence along the boundary of said lot and its southerly prolongation south 10"52' east 175 feet; thence north 6932' east 110 feet to the westerly right of way line of 80 feet in width Railroad Avenue; thence along said westerly right of way line and its southerly prolongation south 800' west 400 feet to the southerly right of way line of Investment Street; thence along said southerly line south 82"0' east 172 feet to the westerly right of way line of the Rodeo Creek Flood Control Channel; thence along said right of way line in a general southeasterly direction 320 feet to the northerly line of Lot 4 Block B (1 OM 1); thence along said line south 79°07' west 90 feet; thence south 10"52' west 140 feet to 60 feet in width Fourth Street; thence crossing Fourth Street to the northeasterly comer of the Clover Trust parcel recorded April 7, 1997 as series number 97-057043; thence along the easterly line of said parcel south 10"52' east 160 feet; thence north 79"07' east 150 feet; thence south 10"52' east 100 feet; thence south 79"07' west 100 feet; thence south 10052' west 100 feet to the northerly line of Lot 8 Block B (1 OM 1); thence along said line north 79007' east 210 feet to the westerly right of way line of Vaqueros Avenue; thence along said right of way line south 10"52' east 800 feet to the southerly line of Lot 1 (1 OM 1); thence along said southerly line south 79"07' west 180 feet; thence south 10052' east 120 feet; thence north 79"07' east 180 feet to the westerly right of way line of Vaqueros Avenue; thence along said right of way line south 10052' east 380 feet to the northerly right of way line of Seventh Street, thence along said right of way line south 65"11' west 130 feet; thence north 10"52' west 175 feet; thence south 79"07' west 63 feet; thence south 10"52' east 187 feet to the northerly right of way line of said Seventh Street; thence along said line south 65"11' west 87 feet; thence north 10"52' west 100 feet; thence south 79007' west 75 feet; thence south 10052' east 120 feet to the right of way line of said Seventh Street; thence along said line south 65"11' west 55.00 feet to the easterly right of way line of Parker Avenue; thence in a general southeasterly direction 190 feet; thence south 65011' west 180 feet to the southeasterly corner of the Campbell parcel recorded May 2, 1986 in Book 12863 of Official Records at Page 539; thence along the southerly line of said parcel south 65"11' west 181.30 feet; thence north 24"49' west 129 feet to the southerly right of way line of Seventh Street; thence along said right of way line north 65"11' east 160 feet; thence crossing 60 feet in width Seventh Street to the Point of Beginning. This real property description has been prepared by me or under my direction, in conformance with the Professional Land Surveyors Act. 4 i t icq 1.AA1D Signature: Li used Land Surveyor Contra Costa County Public Works Exp. ` N0. s Date; OF C At-VI 11RWS15SHARDATA1GrpData\ClericaAF-XHIBITSV19981Rodeo-Undwgmund Utility Dist.doc Dammber 8,1998 2 0 j 00 3 v i i >. zda � $ all 43 Ft SAM p XNUIJ NN Q� ,n mof0 ran a p„ P h+ 00 07 OJ OJ M 's Ln 0 ST ST cc C] ST ZCS U W p jgSU��7l�l90) 1300 Q � C7 W {IS to ._3 N W €+"C _ "osA ST mcy � 'y c� co u> co r r4 r r n r� r• r� � � v �S 'T fo sr m 0. 0o v h. Y AVg ar O p D Ca tb ur. W W 0 -j � 0 c� Te aE O t 0 w v Ma L7 C> tx CLS M ,,, z ST u) tty tf5 �tl ca cp sp cD cp tD cfJ � a; a CL Ln �kV�ST NT sr 0 C, z < 0 0 0 31 �`' w � 0000 0 x p i -J (nu > i � �s crcr t� zoo 3v s >- O t7 0 w w !c t3 j.- t.- 3311 o 1* 040000 r U') In b 0 kTa. At ST CIL 0 is �� z r w t t� t w aes as 0 Li he Y �„ -jZ 2r- h w Wo011Q10 )->- «r us (6r-: 06ofo .= rin4 gyp} M1 pT zn r} to z) v It v It +t N C9 M � s v! 0) 4u'iroNwM0 .14N +h N 00 bTH ST NNNNNNNrryN7t*7M A. 6-TK ST ( �° w W A cr z LAi z z Y Cdl C z t � * "' c"rtz < z iz zt- J ' o ar � _ z +� * r� W CL IL s '� -- ® fiN st z 0 oa �? ca 3s z GSC O Q yc } Q w • t3 i!f 0 O 0 Cz7 Y F- CJ 0 vwM ! I * M a `i '� 0 ;°ir, immc0m -jmmm I . N Ki a� uy u6 r•. co a; �' ,49 15'-e5) BOARD OF SUPERVISORS , CONTRA COSTA COUNTY , CALIFORNIA AFFIDAVIT OF MAILING In the Matter of public hearing to discuss establishing Underground Utility District No. 28, Parker Avenue, Rodeo area. 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 copy of notice of hearinc,. to the following . See the attached list I declare under penalty of perjury that the foregoing is true and correct. Dated February 171 2000 at Martinez, California. epu t6l le--rF- 3 i 02/17/00 THU 09:38 FAX 928 313 2333 CCC PUBLIC WORKS COB IZO02 CARAT SORT**COOI CARAT SORT **CD06 CAR-kT SORT **C006 C14k 11, 357"1001 337 041013 357 041013 Current Resident Current Resident Current Eb;4ident 18 Parker Ages 371 Sart FtMo Ave#575 371 Senn Pablo Anes#375 Rodeo,ICA 94572 Rode%CA 94372 Roto,CA 94572 CAR-RT SORT **CO06 CAR-RT SORT **C006 CAR-RT SORT **0006 357 041 013 357 041 013 357 041 013 Currant RaWad Current Resident CurmA Resident 371 San Pablo Ave#373 571 Sen F%V*Arras 0575 371 San Pablo Ave 0575 Rodeo,CA 94572 Rodeo,CA 94512 Rodern,CA 94572 CAFE-RT SORT **good CARAT SORT*OCW t CARAT SORT ** 357041013 357 042 001 3:57042016 Cwt.R"kient Current Residad Current Rivident 571'Bantu Pubo Awes#575 1$0 Pee=Avec PIA W Avec CA 94572 Rode%CA 94572 Rodeo,CA CAR-RT SORT**C001 CAR-XT SMT**C001 CAR-RT(SORT**C001 357 042 017 337 042 018 357 042 019 tCu r res Curreeut Ressldent Current Resident 124 Parker Avec 130 PMkw Ave 134 Paster Ave Rodeo,CA 44572 Rodeo,CA 44572 Rodeo,CA 94372 CAR RT SORT* 1 CARRT SORT*'*Cool SRT SORT**Ml 357 042 020 337042021 357 042 t722 Current Rmidmat Current Resident Current PAvident 140 Parker Ave 160 Parker Ave 520 2Nd St Rodway CA 94572 Ptodao4,CCA 94572 Rodw,CA 94572 C;AMLT SMT ** CARAT SORT *"COOL CA AT SMT**COOI 35704202-1 337 051002 3570S1003 Ctxrent Resident C MTUA Resid" Current Re ddent Pfap4W Ave 205 Patio Ave#213 201 Pacific Ave Rodea,CA Rodeo,CA 94572 Rodeo,CA 94572 CARAT 3QR"T**CWI CAR-RT SORT**C001 CAR-RT SORT "COO1 357 0.51 044 357 052 001 357 081 001 Current Resident Carresrst Resident Current Resident 240 Paimer Ave 242 Parc Avv 3110 Parker Awes#320 Rodeo; GA 94572 Radars,CA 94572 Rode*.CA 94572 CAR-RT SORT **C1 l CARAT SORT"COO CARrRT SRT**Cool 357 081001 357 081002 337 081003 Currant Reddud Current Resident Current Resident 300 Parker Avec#320 330 Perrkw Ave 338 Puke Ave RadmN CA 94572 Rodeo,CA 94572 Rodeo,CA 94572 CARAT SORT**0001 CARAT Sgt's'* 1 CAR-RT SORT**Cool 357 081004 357 081006 S 57 081007 Cunant Resident Cwt Resident Cu nmmt Raddent 342 Parker Ave 362 Parka Ave 364 Parker Ave Rodeo,,CA 94372 Rodeo,CA 94572 Rode%CA 94572 CARAT SORT**C001 CAR-RT SORT**IC001 CARAT SMT**tO01 357 081 032 357 091038 357091029 CCu met Rodderut Cmrxe M Resident CAMMI hOWMA 386 Perim Ave 359 pwtw Avg 4014 PM1w Ave ReEueu;,ICA 94372 Rrsdees,CA 94372 Rte,CA 94572 02/17/00 TRU 09538 M $23 313 2333 CCC PUBLIC WONK t w-.-► COB Q003 ZARRT SORT**C001 CAI(-RT SORT ** CAR-RT BORT**C= C 357101001 357 101 002 357101 009 Ctfrrmt Resident Cwt Roddent Cent Resident 512 Porker Avec Parker Ave 586 Puter Ave boy,CA 9457.2 Rodv); CA Rodeo,CA 94572 CARS-RT SORT**C D06 CAR-RT T**=2 CAR RT SMT**CO02 357111 001 357111002 357111003 Current Resident currvat Resident Current Re Wont 520 61h St 610 Pmdw Ave 620 Pm tw Ave Radmi CA 94572 Rodeo,CA 94572 Rodeo,CA 44572 CAR-RT SORT**C002 CA"T SORT ** CAR-AT SRT"COW 337111 009 357111 010 337111 012 Current Raddent Gwent Ru ilderut Current Resident 686 Padua r Arne NO STREET NAME or NMWA 689 Rodto Ave Rodeo,CA 94372 Rodeo,CA Rodes CA 94572 CAR-AT SORT O*CO02 CARRT SMT ** CAR RT SORT**C002 357 111029 357111031 357111 033 Current Rmidea►t Cuava t'Resident 640 Pcater Ave Parim Arne 630 Pater r Ave Rodeo„CA 94572 Rcdoc�CA Rodeo,CA 94x'7. CAR-RT SORT**CDM CAR-IRT SORT*#CM GILT SMT**C017 357111033 357111033 357120 002 Currant Resident C**rnant Resident Current Resident 650 Pinter Ave: 650 Parker Ave 700 7M St Rodeo,CA 94572 Rode%CA 94572 RkhmorA CA 94801 C,A1t'.11tT SORT" +* CAR-AY$ORT ** CAR-RT SORT ** 357 132 WS 357132 013 337140 010 Current Resident Ourrent Resident Parker Am Parker Argo Parker Ava Rodeos,CA Rodeo,CA Rodeo,CA CAR-RT SORT**0101 CAR,.RT Sofff"cooI CAR-RT SORT**C001 357140011 357 140 03.2 357140 032 Current Resident Current Resident Current Resident 417 Poker Ave 551 P*IW Ave 331 Pwtw Ave Rodeo,CA 94572 Rodeo,CA 94572 Rodeo,CA 94372 CAR-RT SORT**C001 CAR-RT SORT**COOI CAR-RT SORT*''M1 357140033 357140 033 3571400.11 currentRosident Cent Awdent cumv lt R, t 545 Parker,Ave 545 Padcar Ave W Putm Ave Rade,CA %572 Rodeo,CA 94972 Rte,CA 94572 CAA-RT SCR'tT**tM1 C.ARRT SORT**Co01 CAR-RT ST**Ml 357140 034 3S7140035 357140 036 Current ReAdmt 335 Parim Ave 523 PWkw Ave 509 Paricer Ave Rodeo,CA 94= Rodo%CA 94572 Rode%CA 94572 CAWRT SORT**COOI C.AR-RT SORT" '"* CAR-RT SORT*"COD 1 357140 037 357140 038 357 140 039 C uervant ReddeM C t~ 507 Parker Ave Pe riror AveS 467 P*im r Ave kadvo,CA 94572 Rodeos CA Rodm CA 94372 02117/00 THU 09:59 FAX 923 313 2333 CCC PUBLIC WORKS COB W004 SRT SMT 0*1=1 SRT SORT**COOI CA RT SPURT OOM I 357 140 039 3.57140 039 357 140 039 Llu�t Raeddent C n4 t RoWeat C.*nve&Resident 467 Pew Ave 46.7 ffttw Ave 467 Parker Ave CA 94572 Rodeo,CA 94572 Rae$ao;,CA 94572 CART SORT**C001 CAR-RT SORT"**MI I AR-RT SORT**CW 357140 039 357140 039 357140 041 Current nt Resident coal ettt Reddent C:umat Resident 467 Pmtw Ave 467 Pwxkw Ave 411 barber Arra Rodeo,C.A. 94572 Rodeo,CA 94572 Rodear„CA 94572 C.ARr T SORT * I CAR RT SMT**MI CAPRT SMT ** 3.37140 043 33 7151002 357 151 oft cumint Resident Current RadAent Qm�Resident 407 Pteekw Ave#409 375 Part r Ave Purr Ave Rodaoe CA 94572 Rodeo,CA W72 Pwis%CA CAR,-RT SORT#*C001 SRT SCRT**C;OOI CAR-RT WRT**0001 357151014 35'7' 131020 3$7131032 C:*Tmt Resident cunvm Resident Current Resident 355 Pater Ave: 347 Ptetlaor Ave 363 Pwker Ave Rodau,CA 04572 Rodw� CA 94572 Rodeo,CA 94572. C:A"T SMT**COOI CAR-RT SMT's+'MI CARPRT SM* I 337151435 357151036 357151037 COMM Resident CurrentRevideot C I idan 341 Peer'lw Ave 339 Parker Ave 749 St Rodeo,CA 94572 ReYdv%CA %572 14:Awo�CA 94572 mit RT SMT ** CAR-RT SRT 0* CAXAr 6+tJR.T**Ml 357101001 357161 002 357161 006 Cuavat Resident C arrein Pte mid" cunvat R"WeEtt Rabroad Arne Re 1road Aran 201 Packer Avec P-066%CA R CA Rodeo,CA 94572 CAR-RT SORT**1001 CAR-RT SOICr**C0Ol CARrP.T SORT *� 357161013 357 171006 35717101 Curmnt Raddeat Ow"Reel UM Certo Rmsi&nt 223 Pati Ave I"Patar Ave Pyr Ave Rodeos CA 94!l"]"Z PjAe ,CA 94573 Rodeo,CA CARL-IT SORT**C001 CAR-RT SMT# 01 CAR-4r'SORT* 1 357171409 3$7171010 357171,019 C,turfolt Redd" Gsrxent Rakift comwat Reeideent 133 Parker Ave 113 P=kW Ave lar Purkor Ave RodaN CA 94572 Roa,CA W572 Rodm%CA 94572 CARRT SCAT**C006 CAR-XT SORT*"C006 CAR-RT SMT**CO06 357 231006 357131 009 35'7 181010 Current Resident Current Rmaldent Current Raffulact 1 Parker Ave 601 San P"Ave 25 Paei w Ave Rode%CA %572 Radm,CA M= Rode%CA. 91572 CAWRT SMT**C006 CAR-RT SORT**CO06 CARAT SORT**Ct106 357182 004 357 182 004 ,35718?W4 C;S *Rmklmt Cuirmt Rtelde n t Carrant Resident 6 Raikeed.Ave 6 R:kikaml Ave: 6 Radioed Avec Roadc%CSA 94572 R CA 94572 Radio,CA W72 02/17/00 THU 09:40 PAX 923 313 2333 CCC PIMLIC W0RKS -r-r. COB woos AWRT SORT**C,006 CARAT SRT**£O06 CARAT SMT**C,f0C 357182004 357 1$2 004 357182 010 Durtad Raddent Cuff**Resided Current ReMident 5 R,nl"od Ave 6 Raiftoad Arne 655 San 1'"Ave Rte.CA 94372 Radom CA 94572 R06M CA 94572 CARAT SMT**OW CARAT SORT**CM CAR-RT SORT* CO06 357 162 011 357183 001 357183 001 Chuerant Resident Cum o RoAdent QuTwl Resided 547 Seen'Pablo Ave 15 Ra Urnsd Ave 13 R*ilrood Ave Rte,CA 94572 Rode%CA 74572 Radom CA 94572 CARAT SMT**C006 C,A,RrKT SMT **C00d CAR-RT SORT **C006 357123 001 337 185 001 357 115 001 cuff"t Rpt C mvd Raddea Cumw F, +t 15 Rsllmad Ave 701 Son PtUa Ave 0705 701 Sm Pablo Ave#705 RodooR CA 74372 Radom CA 94572 Rodoa�CA 94372 CARAT SORT **C006 CARAT SORT **C006 CARAT SORT **CM 357185 001 357185 0101 357 185 001 Cwt Rtsldem Cmecart Resided Current Resided 701 Baa Ma Ave#705 701 Sas Pablo Ave#705 701 San P"Ave#705 Radom CA 94572 Rte►CA 945772 Rodv%CA 94572 CARAT SORT**CO06 CARAT SORT**CM CAR-RT SORT* 3571S6002 537186 004 337186 003 ttiat,q tTusulflut current Rent Caa rwd Raeeitlent 700 San Pablo Ave 670&w?"Ave 678 San Pablo Ave Rado%CA 94572 Radam CA 945'12 Rem CA 94572 CARR,I 1WRT*00M CA16RT g(W ** CARAT SORT** 3571$6140 357186012 357186013 CUMMAMINA Cumnt Raided Currant Resided 551)Sm Ave Sea Pablo Ave 706 Scat P"Ave Radw,CA 94572 Radom CA Radom CA 94572 CARAT SMT**C0i'16 CAR-RT SORT** 357126 014 357196015 Cunvat Resident CvrraCrt R w4wt 7012 Son Pablo Aver 650 Sim Pablo Ave Radon,CA 94572 Rodw,CA 94572 The Board of Supervisors �� � _/31-'1r tPhil Batchelor Clerk of the Board and County Administration Building Cost. County Administrator 651 Pine Street, Room 106 (925)335-1900 Martinez, California 94553-1293 County John Gioia, 1st District `J Gayle Uilkema,2nd District e Donna Gerber,3rd District r, Mark Desaulnier,4th District Joe Canciamilla,5th District , e+d: February 15, 2000 Proposed Parker Avenue Underground Utility District#28, Rodeo Area Dear Property Owner: On February 15, 2000, the Board of Supervisors set March 14, 2000, at 9:00 a.m. as the time for a public hearing on the creation of an underground utility district along Parker Avenue (from 7t Street north to San Pablo Avenue and on San Pablo Avenue from Rodeo Avenue to about 400' west of Railroad Avenue). Under Rule 20-A for utility conversions, the proposed district will pay for all costs related to the installation of the underground system. The underground district will also provide 30.5 meter (100 feet) of lateral trenching and conduits, if needed, from the underground district's main service trench to the foot of the building wall where the utility service box is attached, at no cost to the property owner. The property owner, however, will be responsible for the conversion of their utility service box to receive underground service, and any lateral trenching and conduit in excess of 30.5 meters (100 feet). If the property owner already receives underground service no further action is necessary. At the public hearing, the Board of Supervisors will ascertain whether the public health, safety, or welfare requires the removal of utility poles, overhead wires and associated overhead structures within the designated district area. If the Board of Supervisors approves the creation of the district you will be notified of the time schedules for the conversion of your overhead service to underground service. Very truly yours, Phil Batchelor, Clerk of the Board of Supervisors and County Administrator By: An Cervelli,"Chief Clerk PB:JY:Je G:1GrpD®telTransEngL20001TEtParkerAveUU28notice.doc CLALM u. ,� OF rrtPFu�nenC OF rtYt'ti"fR4 Ct?5TA["Y►i T "i"Y. .� TI c) ' _A FEBRUARY 15, 2000 J 0 Crim Against the Cotity, or District Governed by the Board of Supervisors, Routing Endorsements, � NOTICE TO CLAIMANT Board Action. All Section references are to �AN 0 2Q00 The copy of this document mailed to you is your California Gwarnmern Codes. COUNTY COUNSEL notice of the action takers on your claim by the MARTINEZ,CALIF, Board of Supervisors. (Paragraph IV below?, given ppuurrsuant to Government Code Section 913 and 515.4. Please note all "Warnings". AMOUNT: $50,000-00 CLAIMANT: DORIS SILVIERA ATTORNEY: c/o MARTIN T. GONSALVES DATE . January 20, 2000 Attorney at Law, SBN 111552 January 20,___2000 ADDRESS: 511 West Third Street BY DEL VERY TO CLERK ON: „ Antioch CA 94509 BY MAIL POSTMARKED: Nand-Delivered by Server Toy 7espi e L FROPr3: Clerk of the Board of Supervisors 70t County Counsel Attached is a copy of the above-noted claim. January 20, 2000 PML BA R, Cler lh Dated: By: Deputy IL FRONL County Counsel TO. Clerk of the Board of Supervis s ( This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are to 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 911.0. { ) Other: - Dated: �'�"/ 0 By' Depute' County Counsel EEL PROM Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). TV. BOARD ORDEIL By unanimous vote of the Supervisors present: (- This Claim is rejected in full. O Other: I certify that this is a true and correct copy of the Board`s Order entered in its minutes for this date. Dated: ( '" PHIL BATCHELOR, Clerk„ By &21ZDeputy 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 depositec 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 W attorney. you should do to immediately. *For Additional Warning Sae Reverse Side of This Notice. AFFIDAVIT OF bMUMG I declare tinder penalty of perjury that I am novo. and at all times herein mentioned. have bean a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated- � By: PHIL BATCHELOR By +�" s�=�fi�__ .Ll Deputy Clerk 5.t,,e 1 MARTIN T. GONSALVES Attorney at Law, SBN 111552 RECEIVED 2 511 West Third Street Antioch, CA 94509 3 (925) 757-8300 JAN 2 0 2000 4 Attorney for Claimant CLERK BOARD OF SUPERVISORS DORIS SILVIERA CONTRACOSTACO. 5 6 7 8 9 10 11 In the Matter of the Claim of ) CLAIM AGAINST PUBLIC 12 DORIS SILVIERA ENTITY 13 against [Gov. C. §§ 905, 905.2, 910, 910.2] 14 CONTRA COSTA COUNTY, CONTRA COSTA COUNTY HEALTH 15 SERVICES DEPARTMENT, BRENTWOOD HEALTH CENTER, PITTSBURG 16 HEALTH CENTER PHARMACY and DOES 1 to 50 17 18 TO: CONTRA COSTA COUNTY, CONTRA COSTA COUNTY HEALTH SERVICES 19 DEPARTMENT, BRENTWOOD HEALTH CENTER and PITTSBURG HEALTH CENTER 20 PHARMACY: 21 DORIS SILVIERA, hereby makes claim against CONTRA COSTA COUNTY, CONTRA 22 COSTA COUNTY HEALTH SERVICES DEPARTMENT, BRENTWOOD HEALTH CENTER 23 and PITTSBURG HEALTH CENTER PHARMACY, for the sum of$50,000.00 and makes the 24 following statements in support of the claim: 25 1. Claimant's post office address is c/o Law Office of Martin T. Gonsalves, 511 26 West Third Street, Antioch, CA 94509. 27 2. Notices concerning the claim should be sent to claimants in care of their attorney 28 Martin T. Gonsalves, 511 West Third Street, Antioch, CA 94509. Silviera vs. Contra Costa County Health Center 1 Claim Against Public Entity V vi 1 3. The date and place of the personal injury giving rise to this claim are August 17, 2 1999, at Brentwood, Contra Costa County, California. 3 4. The circumstances giving rise to this claim are as follows: 4 On or about August 17, 1999, DORIS SILVIERA went to the BRENTWOOD 5 HEALTH CENTER to have a prescription for Depakene, brand name "Tegretol", re-filled as 6 prescribed by Dr. Greta Perez, of the BRENTWOOD HEALTH CENTER. BRENTWOOD 7 HEALTH CENTER had DORIS SILVIERA'S prescription for Depakene (Valproic acid) filled 8 by the PITTSBURG HEALTH CENTER pharmacy. DORIS SILVIERA had been taking 9 Depakene, for over ten years for the treatment of seizures related to a brain tumor surgery of 10 1979. Upon picking up the prescription on August 18, 1999, she began giving herself the 11 Depakene medication" at the prescribed dosage, 1 tablet daily, 4 times a day, as prescribed 12 by her doctor and in accordance with the label on the bottle. 13 Over the following week and one-half of taking the "Depakene"from the newly 14 filled bottle, she began to experience increased headaches and shakiness. She experienced 15 extreme and constant frontal headaches from about August 25, 1999 to August 28, 1999. On 16 August 28, 1999, she began to feel very shaky and as though she was going to have a 17 seizure. 18 On August 28, 1993, DORIS SILVIERA was taken by ambulance to the nearest 19 hospital, Sutter Delta Medical Center for emergency evaluation and treatment. Laboratory 20 tests conducted at the hospital revealed a"subtherapeutic Valproic level". DORIS SILVIERA 21 was administered Toradol 33 mg. IV push, for her headache and instructed to take an extra 22 dose of Valproic acid ("Depakene") that night and the following day. 23 The following day, August 29, 1999, her symptoms did not improve. She 24 continued to feel "shaky", DORIS SILVIERA, returned to the Sutter Delta Medical Center 25 Emergency Room. The emergency room physician reviewed the laboratory tests of the 26 previous day and determined that the Tegretol level was low despite the continued use of 27 Tegretol. Poison Control was contacted to confirm that the pills in the Tegretol bottle were 28 truly Tegretol pills. The hospital was informed that they were not Tegretol pills and that they Silviera vs. Contra Costa County Health Center 2 Claim Against Public Entity 1 were possibly actually Verapamil. DORIS SILVIERA was released with instructions to take 2 two tablets of Valproic acid that night and one the following morning. She was also instructed 3 to go back to the Brentwood Clinic immediately the following day and have them refill the 4 prescription. Attached hereto as Exhibit "A" are the Sutter Delta Emergency Reports. 5 5. So far as is known at this time, said injuries to Claimant consisted of extreme 6 constant frontal headache and acute shakiness rendering her with the feeling that she was 7 going to have a seizure. Her adverse physical reaction to the wrong medication inflicted 8 undue emotional distress, because she thought that she was experiencing a life threatening 9 illness. In addition, she is uncertain what, if any, long-term complications may arise for the 10 lack of Valproic acid or the unnecessary exposure to Verapamil, which caused her extreme 11 and emotional distress. 12 The estimated costs to date for medical treatment rendered to DORIS SILVIERA 13 for treatment of the adverse reaction to the wrong medication amounts to$2,523.55. Attached 14 hereto as Exhibit "B" is the ambulance bill, the hospital bill, and the emergency room 15 physician's bill. 16 General Damages $50,000.00 17 Future Medical Treatment Costs $ Unknown 18 Total Claimed $ 50,000.+00 19 6. The names of the public employees causing the claimant's injuries are unknown 20 at this time. 21 7. Jurisdiction over this claim would rest in the Superior Court of California. The 22 claim is based on injury, damage and/or loss including but not limited to medical expenses 23 incurred to date, estimated future medical expenses, and neral damages in an amount to 24 be proved later. 25 DATED: January 12, 2000 f� SALVES, 26 Attorn y for Claimant, DRIS SILVIERA 27 28 5ilviera vs. Contra Costa County Health Center Claim Against Public Entity 3 Ct�a� lore -� SUTTER DELTA MEDICAL CENTER EMERGENCY ROOM REPORT EXHIBIT ffAff SUTTER DELTA MEDICAL CENTER 3901 Lone Tree Way . Antioch, CA 94509 (510) 979-7200 EMERGENCY ROOM REPORT PATIENT: SILVEIRA, DORIS 080965 DATE OF ER VISIT: 08/28/99 TIME OF EVALUATION: 20 :45 PHYSICIAN: MARY A. FITZSIMONS, M.D. CHIEF COMPLAINT: Headache and shakiness. HISTORY OF PRESENT ILLNESS : This is a 63-year-old female with a history of seizure disorder. She states she is worried she is going to have a seizure. She states that has had a frontal headache for the last three days, but all day today, she has been very shaky and feel as though,_she is experiencing the same symptoms as her prodromes before a seizure. She has been taking her Depakene as prescribed. Recently had Lasix started for pedal edema, but denies any other medication changes. She has had no fever. Describes a constant frontal headache with no associated nausea or vomiting. PAST MEDICAL HISTORY: Is positive for seizure disorder and recent diagnosis of pedal edema . MEDICATIONS : Lasix every other day. Depakene daily 4 times daily, 1. tablet . ALLERGIES: Codeine and Tegretol . SOCIAL HISTORY: Positive for cigarette use. REVIEW OF SYSTEMS: General - No fever. Gastrointestinal - No vomiting. Respiratory - No dyspnea. Cardiac -- No chest pressure. Integument - No rashes. Neurologic - Tremulousness, headache, see history of present illness. The remainder of the review of systems are negative. PHYSICAL EXAMINATION: GENERAL: Alert, very anxious female, slight tremulousness is noted. VITAL SIGNS : Blood pressure 136/67, pulse 94, respiratory rate 16, temperature 97 .7 orally. HEENT": Sclerae are anicteric. Conjunctivae are clear. Oral mucosa pink and , moist . Pupils equal, round, reactive to light, 2 mm in diameter. Discs sharp. Fundi without hemorrhages . Tympanic membranes are normal grat. NECK: Supple, no nuchal rigidity. No jugular venous distention. LUNGS: Clear to auscultation. throughout . No wheezes, rales or rhonchi . CARPIAC: Regular rate and rhythm. No click, rub, or murmur. ABDOMEN: Flat . Bowel sounds present . Normal active. Soft to deep I SDKC E11ERGENCY ROOM REPORT PATIENT: SILVEIRA, DORIS 080965 PAGE 2 palpation. No tenderness, masses or guarding. EXTREMITIES: Without clubbing, cyanosis, or edema. NEUROLOGIC: Cranial nerves intact. Deep tendon reflexes are 2+ and equal over the brachioradialis and patellar tendons. Sensation intact to light touch throughout. Mental status alert and oriented times four. MEDICAL DECISION MAKING: The patient presents with a frontal headache . No . evidence of meningismus or fecal neurologic deficit, ruling out meningitis or intracranial bleed. The patient has generalized tremulousness which may be related to anxiety, however the patient is on an anti-epileptic and therefore, this may represent a subtherapeutic or excessive drug level. In addition, the patient may be suffering from metabolic disturbance such as hypoglycemia or hyponatremia. The patient will be evaluated for possible anemia, causing her symptoms. LABORATORY DATA: Complete blood count is essentially normal . Shows a normal white count of 8, 600 with a normal differential . Hemoglobin normal at 13 .4, with a hematocrit of 40 .5 . Electrolyte panel within normal limits. BUN essentially normal at 28, with creatinine .9, glucose mildly elevated at 175 . Liver enzymes within normal limits . Valproic level, however, is subtherapeutic at 5. 7. EMERGENCY DEPARTMENT COURSE: The patient was given Toradol 30 mg IV push for her headache with marked improvement. IMPRESSION: Tremulousness due to subtherapeutic Valproic level . PLAN: Discharge home. Patient instructed to take an extra dose of Valproic acid tonight and tomorrow night . She is to follow-up with her neurologist in 48 hours by phone to discuss the drug level and possible chronic increase in Valproic Acid. The patient is to arrange for recheck of Valproic Acid level in about four to five days . DISCHARGE DIAGNOSIS : General shakiness, subtherapeutic Valproic Acid levels . MARY A. FITZ IMONS, D. c78 08/29/99 : 08/29/99 0 cc : i Pittsburgh Clinic t ,.ty REPORT . tIM£ ' d A 3NDITION ON DISCHARGE: C GOOD kTABLE U FAIR 0 SERIOUS C CRITICAL 0 EXPIRED C3 CORONER NOTIFIED C3 POLICE NOTIFIED I ADMIT C]TRAM FER 0 STABLE C]UNSTABLE :NATURE S4tt ► DeL 39Uf LONE TREE WAY Medical tom" ANTIOCH,CA"509 TIOCH,CA"509 Medical ta (5 0)779-7200 CIENT ACCOUNT V3. AUTHORIZATION NO. DAYS ADMIT DATE TIME MED,RECORD NO. 201451£32{, 08/28/99 2012 0080965 4TtENT NAME t PHON PAT ADDRESS 1100 VILLAGE-DR.—_ Y STATE,ZiP '8RE-NTWO_Obi CA 94513 W _ TAR NO. ADMIT CMF 09x03/.99 Patient Bill Page 1 SUTTER DELTA MEDICAL CENTER OUTPATIENT - FINAL 3901 LONE TREE WAY Telephone: 9257797200 DETAIL ANTIOCH, CA 94509 Tax Id. No : 94-1552887 ----------- Patient ----------- ----- Responsible Party ------ Patient Number SILVEIRA,DORIS M. DORIS M. SILVEIRA 20145181 100 VILLAGE DR 100 VILLAGE DR BRENTWOOD, CA 94513 #109 Medical Record BRENTWOOD, CA 94513 0080965 Birth Date:04/10/36 Age: 63 Sex.: F Admission Date: 08/28/99 08 pm Soc. Sec. :564-76-6485 F/C:60 Room; Discharge Date: 08/28/99 Admitt. Physician: Statement from: 08/28/99 Attend. Physician:DR MARY FITZSIMONS Statement thru: 08/28/99 Company Plan ----- Insurance Coverage ----- Group Number Policy Number 1. 2. 3. 4 . DETAIL Date/Cde Procedure -------- Description --------- Hcpcs Cd Qty Charge Amount 08/28/99 70500236 .9% NACL 58000 1 59.31 08/28/99 72309644 E.R. OXYGEN SETUP 99070 1 54.36 08/28/99 71763379 KETOROLAC (TORADOL) 30MG INJ 1 49.30 08/28/99 71795082 ATIVAN 2MG IV 1 56.40 08/28/99 70600960 CBC, MANUAL DIFF 85023 1 121.67 08/28/99 70610837 COMPREHENSIVE METABOLIC PANEL 80054 1 260.00 08/28/99 70604368 STAT FEE 1 0.00 08/28/99 70619986 VENIPUNCTURE 36415 1 12.00 08/28/99 70600366 AMYLASE, SERUM 82150 1 20.00 08/28/99 70609961 VALPROIC ACID (DEPAKANE) 80164 1 211.71 08/28/99 70501622 IV CATH, JELCO OR ANG 99070 2 39.58 08/28/99 70503339 PUMP-SET/62-701--N 99070 1 74.75 08/28/99 70508973 V5404, 30" EXTENSION 99070 1 16.33 08/28/99 70512272 IV START KIT/ENSUREIT 99070 1 9.50 08/28/99 72351547 E.R. LIMITED MEDICAL VISIT 99282 1 141.75 08/28/99 72350226 CARDIAC MONITORING/IN 99070 1 197.05 08/28/99 72351166 NONINVASIVE B/P MON. 99070 1 42.56 08/28/99 72350283 IV MED. INJECTION 1 41.10 Total Charges 1407.37 CURRENT DETAIL: 1407.37 SUMMARY Date/Cde Procedure -------- Description -------- Hcpcs Cd Qty Charge Amount 250 PHAR PHARMACY 3 146.80 258 IV/SOLU IV SOLUTIONS 1 59.31 09/03199 Patient Bill Page 2 SUTTER DELTA MEDICAL CENTER OUTPATIENT -- FINAL 3901 LONE TREE WAY Telephone: 9257797200 SUMMARY ANTIOCH, CA 94509 Tax Id. No : 94-1552687 ----------- Patient ___________ _____ Responsible Party ------ Patient Number SILVEIRA,DORIS M. DORIS M. SILVEIRA 20145181 100 VILLAGE DR 100 VILLAGE DR BRENTWOOD, CA 54513 #109 Medical Record BRENTWOOD, CA 94513 0080965 SUMMARY Date/Cde Procedure --------- Description -------- Hcpcs Cd Qty Charge Amount 270 CSS MEDICAL SUPPLIES 2 63.86 272 STEISUP STERILE SUPPLIES 4 130.66 279 OTHSUP OTHER SUPPLIES 2 239.61 300 LAB LABORATORY - CLINICAL 6 625.38 450 E/R EMERGENCY SERVICES 1 141.75 CURRENT SUMMARY: 1407.37 TOTAL AMOUNT DUE: 1407.37 SUTTER DELTA MEDICAL CENTER 3901 Lone Tree Way . Antioch, CA 94509 (510) 779-7200 EMERGENCY ROOM REPORT PATIENT: SILVEIRA, DORIS 080955 DATE OF ER VISIT: 08/29/99 TIME OF EVALUATION: 1.250 . PHYSICIAN: THEOPHILE KOURY, M.D. CHIEF COMPLAINT: "I have the shakes" . HISTORY OF PRESENT ILLNESS: This is a 63-year-old female who was seen here yesterday for the same complaints of "shakes" since yesterday. She reports that her arms and hands feel very shaky and she usually gets this before having seizures. She is on Tegretol. She was seen here yesterday and was found to have a low Tegretol level. She was told to take an extra dose last night and tonight as well . She states however that her symptoms are not improving. She still feels "shaky" . She denies any chest pain, shortness of breath, abdominal pain, nausea, vomiting, fevers, chills or shakes. She denies noting any exacerbating factors . This seems to be present almost constantly. She denies any dizziness, lightheadedness or any previous similar history other than again to right before having seizures, which she has not had. She also noted that the Depakote refill that she obtained on August 18, 1999, the pills appear to be different than her usual Depakote pills. She is not sure if this new brand of Depakote has anything to do with it . FAMILY HISTORY AND SOCIAL HISTORY: No tobacco or alcohol use. REVIEW OF SYSTEMS: Otherwise negative . FAST MEDICAL HISTORY: Seizures. MEDICATIONS : Depakote. ALLERGIES: CODEINE AND TEGRETOL. PHYSICAL EXAMINATION: VITAL SIGNS . Pulse 71. Respiratory rate 18 . Blood pressure 11.4/67 . GENERAL APPEARANCE: In general, she appears well: nourished, well hydrated, appropriate interactive. HEENT: Pupils are equal, round and reactive to light and accommodation. Extraocular movements are intact . Sclerae are clear. Conjunctivae pink.. Ear* and nares are clear bilaterally. Mouth, mucous membranes are moist. Uvula is midline. NEC Supple. No lymphadenopathy. LUN S : Clear to auscultation equally bilaterally with no wheezes, rales a,;y SDRC Zb=GMWY ROOM REPORT PATIENTz SILVEIRA, BORIS 080965 PAGE 2 or rhonchi. HEART. Regular rate and rhythm. There are no murmurs, rubs or gallops. ABDOMEN: Soft. Non-tender. NEUROLOGICAL: Cranial nerves two through twelve are intact. Deep tendon reflexes are lt. She has good muscle tone of all four extremities. She does have a fine tremor of the hands, which is very difficult to actually see. She has normal gait. EMERGENCY DEPARTMENT COURSE: The patient presents with recurrent complaints of shales. She was just here yesterday_. I will obtain the labs obtained yesterday to see where her Depakote level was and also to see if any other laboratory was done. If there was not any other laboratory performed, I believe that the chem 7 and complete blood count would be warranted to rule out any electrolyte abnormality or severe anemia as the cause of her tremors. I would also like to check to make sure that the pills she has are truly Tegretol pills and that may explain why her Tegretol levels are low even though she states that she has been taking it regularly which is four times a day. I reviewed yesterday' s records and found that her Tegretol level was 5 . 7 which is extremely low given that she has been taking it four times a day. She had a complete blood count and chem 7 performed and I reviewed those. Those were completely normal . I contacted Poison Control to confirm that the pills in the Tegretol bottle were truly Tegretol pills and I was told that they were not Tegretol pills and they believe that this is actually Verapamil . I performed orthostatic vital signs on the patient and found the pulse to be 102 laying down. Blood pressure 122/74 . Her pulse dropped to 72 standing up with a blood pressure of 104/70 . She was minimally dizzy but was able to ambulate without any difficulty at all. At this point I explained to the patient the findings . .She was given Valproic acid 500 mg p.o. here in the emergency department. Her Accu-Check here is 127 . I did not feel that she needed to be admitted, but clearly she needs to stop taking the pills that she was given at the Pharmacy at Brentwood Clinic. Her instructions are to take Valproic acid two tablets tonight that we provided her with and one tomorrow morning. She is then to go to the Brentwood Clinic tomorrow immediately to have them recheck her pills and refill them. It appears to be improperly refilled. She is to return for any worsening symptoms, chest pain, shortness of breath or dizziness. DIAGNOSES : 1. Evaluation of tremors. 2 . Accidental ingestion of possible Verapamil . THEOPHILE KO Y, M. MRC78 08/ 9/99:08/29/99 49 4 PHYSICIAWS REPORTHISTORYPHYSICAL TIME 1 : f CNDIT#ON ON DISCHARGE. 0 GOOD ,/b1,$TABLE ❑FAIR ❑SERIOUS ®CRITICAL d EXPIRED R NOTIFIdD POLICE NOTIFIEC 3 ADMIT ©TRANSFER ❑STABLE ❑UNSTABLE 3NATURE r Stter DeltaJ f 3881 LONE TREE WAY j ANTIOCH,CA 94U* , `'b Medical Center (510)X7200 TIENT ACCOUNTVO. AUTHORIZATION NO. DAYS DATE TIME MED.RECORD NO. 20146061 8/29/9 1212 tt08096 5 xlT#ENT NAME PHON JADMIT ADDRESS 1100 t,t I#_L.AGE,.IA]Fi. ._. TY,STAT&.ZIP t IVT4 C)D i 5 4513 TAR NO. ADMIT4 GMF Sutcwt . 4 ""t 'o die�-"' 1 it tet' '3901• Lone Tree Antioch, CA . 94509 RUCE M .D . , Medi�ca . , tTH )MAS Q � yC .+�I..es�ti ,. PATIENT NAME PATIENT 'ID SEX DOB � SILVEIRA.00RIS M . 20145181 F 1936-04-10 ER SPECIMEN NO COLLECT MATE TIME REPORT ,DATE 2406669 1999-08-28 20:55 1999--08-2821 : 48 test name results normal values units tech � - FINAL Specimen Comment. ER A E4 FXO TO ER-2125-OM. HEMATOLOGY WBC 8.6 [ 4.5-11.0 x 10 3 RSC 3.97 <[ ] 4.00-5.20 X 10 6 HEMOGLOBIN 13.4 [ * 12.ew-16.0 G/OL HEMATOCRIT 40.5 [ 36.0-46.0 % MCV - 102 [ 80- 100 MCM3 MCH z 34 [ ]} 27-34 PG -'MCHC 33 * 32-36 PLATELET CT. 141 <C 150-400 X103 ROW 14.6 [ *1 11.5-1.5.3 MACROCYTES 1+ tOW PLT CONFIRMED MANUAL DIFFERENTIAL SECS-RELATIVE .56.7 BANDS-RELATIVE 2.2 LYMPHS-FELATIVE 32.2 ; MONO-RELATIVE 7.8 � EOSs-RELATIVE 1.1 % SEGS-ABSOLUTE 4.87 ( ] 1.80-7.70 x 10 3 BANOS-ABSOLUTE 0.19 0 (70--.85 x 10 3 LYMPHS-fSSOLUTE 2. 77 I. 1.00-4 .80 x 10 3 MONO-ABSOLUTE 0.67 ( * 0.03-. 3i� x 10 3 EOa-ASS LUTE 0.1.0 r* (7}t;... ,•,ia x 1.0 3 f CHEMISTW GLUCOSE 1.76 ( > 65-110 iYtC 10L SUN 28 1. 7.0- 1.0 MG/OL CREATININE .9 ( * 0.0-1.5 MG/OL SODIUM ' 141 C * ] 135-148 mEq/L POTASSIM 4.0 C* 3 3.5-5.3 mEq/L CHLORIOa 104 97--107 MMO/L SICARBOhATE 29 C *] 22.e--31.0 MEQ/L CALCIUM 9.6 C " 1 8.5-10.9 MG/OL TOTAL PROTEIN 6.5 [* ] 6.0-8.0 GM/OL ALBUMIN 3.2 <[ 1 3.5-5.0 G/OL *"** CONTINUED **** - DOCTOR: ITZSIMONS , MARY - REFERREDBY : FITZSIMONS , MARY A901 LONE TREE WAY 99.01 •None Tree Way Antioch, CA 94505 THOMAS BRUCE M . D . . Medical Director -PATIENT NAME PATIENT ID SEX 008 LOCATION SILVEIRA ,DORIS M . 20145181 P 1936-04-10 ER SPECIMEN NO COLLECT DATE TIME REPORT DATE 2406669 1999-08--28 20: 55 1599--08-28 21 : 46 . test game results normal values unite tech W** CONTINUATION *�*" CHEMISTRY {cant} SGC7T 27 r "` 0-57 IU/L ALKALINE PHOS 83 0--132 IU/L 6ILIRUBIN---TOTAL .5 ['" ] 0.0--1.5 MG/DL AMYLASE,SERUM 105 [ '"] 0--110 IU/L THERAPEUTIC DRUG MONITORING VALPROIC ACID 5.7 ] 50.0-100.0 MCG/ML 5 i t wicw,a END of REPORT i )OCTOR : gITZSIMON5 , MARY REFERRED BY : FITZSIMONS , MARY .1901 LONE TREE WAY J ANTIOCH , CA 94509 1 09/05/.99 Patient Bill Page l SUTTER DELTA MEDICAL CENTER OUTPATIENT - FINAL 3901 LONE TREE WAY Telephone: 9257797200 DETAIL ANTIOCH, CA 94509 Tax Id. No : 94-1552887 ------------- Patient ----------- ----- Responsible Party ------ Patient Number SILVEIRA,DORIS M. DORIS M. SILVEIRA 20146064 100 VILLAGE DR 100 VILLAGE DR BRENTWOOD, CA 94513 #109 Medical Record BRENTWOOD, CA 94513 0080965 Birth Date:04/10/36 Age: 63 Sex: F Admission Date: 08/29/93 12 pm Soc. Sec. :564-76-6985 F/C:60 Room: Discharge Date: 08/29/99 Admitt. Physician: Statement from.: 08/29/99 Attend. Physician:THEOPHILE KOURY, DR. Statement thru: 08/29/99 Company Plan ----- Insurance Coverage ----- Group Number Policy Number 1. 2. 3. 4. DETAIL Date/Cde Procedure --------- Description -------- Hcpcs Cd Qty Charge Amount 08/29/99 71740740 DEPAKOTE TAB(S) 2 9.40 08/29/99 72351547 E.R. LIMITED MEDICAL VISIT 99282 1 141.75 Total Charges 151.15 CURRENT DETAIL: 151.15 SUMMARY Date/Cde Procedure -------- Description -------- Hcpcs Cd Qty Charge Amount 259 OTH/RX ORAL MEDICATIONS 2 9.40 450 E/R EMERGENCY SERVICES 1 141.75 CURRENT SUMMARY: 151.15 TOTAL AMOUNT DUE: 151.15 y y 3 MEDICAL BILLING FOR EMERGENCY T3REATWN"T: AMERICAN,MEDICAL ESPON E U TER DELTA MEDICAL CENTER CALIFORNIA EMERGENCY PHYSIC EMIT fv 't Alp, 1.644 A *69fk:an I sural""Pon" - dba AMR AWN RESPONSE File 7 P.O.BOX 60000 "''a' 1' MAT-99219270--tit} 001490666 San Francisca,CA 84160-3329 DORIS S I LVEI RA 08/28/1999 .�.. 857.21 � 1110NM 10/13/199 DORIS S I LVEI RA REMIT PAYMENT TO: 100 VILLAGE DR APT 109 109 AMERICAN MEDICAL RESPONSE WEST BRENTWOODi CA 94513-1025 FILE 73329-P 0 BOX 60000 .SAN FRANCISCO, CA 94160-3329 'LEAW CHARW W. d MSA 0 MAMACARD f nQElF]F]QQElElElElC]0ElF1F] EXPIPAMMOATE [IF]Q 40kATURE R EASE ENTER AMOUNT MD.- : PLEASE DETACH AND RETURN THIS PORTION WTH YOUR PAYMENT PATIENT NAM -AC'COUNT�N DATE.- DORIS SILVEIRA 001490666-0001 MAT-99219270-00 09/23/1999 SATE OF;00RPVICE s "rs. r a,4 jjEijvtt✓E O77 77 08/28/1999 100 VILLAGE Dirt-BREN Ell U. TTER DELTA MEMORIAL HOSP 7 .77 77 Y ,MSSA7. r i'.,fa. ;��i.�k .rte,.,....yn f w SR esti >i'=•: _z*}` If you have insurance or program coverage such as Medicare or Medi-Cal that will assist in paying for the services provided, please send us a copy of the card with the reverse side of this form completed. This balance is due within 30 days. Ct3D < ,.z .`7E" tI HAFIQE' A0370 ALS BASE 1 606.50 606.50 A0390 ALS MILEAGE 8 11.70 93.60 93005 EKG MONITOR 1 77.92 77.92 A0398 INFECTION CONTROL 1 14.28 14.28 A0398 02 MASK/CANNULA 1 .00 .00 A0422 OXYGEN 1 51.94 51.94 A0398 EKG ELECTRODES 1 12.97 12.97 CALL RCVD: 19:33 �� 857.21 ,DIAGNOSIS: 784 780797*23 780+19 SEE REVERSE SIDE FOR INSURANCE INFORMATION Send billing inquiries to: American Medical Response, P.O. Bax 3429, Modesto, CA 95353 FED TAX ID: 770324739 Phone Number: 1-800-913-9106 Keep this portion for your-records. Local /dumber: 1-209-238-4710 t Sit#terDoha Medical C e r � SEP 10 1999 3901 Lorre Tree fray Antioch, CA 94509 t�tikitf#i�ktittki� kt��titt � {ktt�t# 1k�iittllll (t� ttki Patient: DORIS M SILVEIRA Visit #: 20145181 436722 0 352 C42 P1 Total Charges: $1407.37 Doris M Silveira Date of Service: 08/28/99 100 Village Dr Apt 109 Brentwood CA 94513-1049 DEAR DORIS M SILVEIRA, Thank you for your choice of Sutter Delta Medical Center for the provision of your health care needs. The date of service and total charges for your care are indicated below. Please make your check or money order payable to Sutter Delta Medical Center, or you may use the form below to provide us with your credit card information. Should you require it, a detailed description of your charges will be provided at your request. For this or any other requests, we may be reached at (925) 779-0210 or (800) 515-5548. If you have insurance coverage for this visit of which we are not aware, you may also provide that information at the number listed above. Once again, with so many choices available, thank you for the trust you place in Sutter Delta Medical Center for meeting your health care needs. PLEASE RETURN LOWER PORTION WITH YOUR PAYMENT —CREDIT CARD AUTHORIZATION— MC(_)VISA(_)AMEX(_)DISC( EXP C / I ) AMT$ CARR # SIGNATURE: PRINT NAME: PATIENT: DORIS M SILVEIRA VISIT #: 20145181 435722 BALANCE: $1407.37 ADM. DATE: 08/28/33 ��k�ku�u�i�t�t tkk��i#��tik�kt t�k�l�ktkt ilk�t'ik� Patient Billing Services Sutter Delta Medical Center 1280 Central Blvd Ste B 352 Brentwood CA 94513-22051 0 F\ �!Z"E 10 1999 ..� St�rt�w Delta AAIiB+d'ial Cf rhter 3201 Lone Tree Wavy Antioch, CA 94509 11,lu�1, 1 {�1����ILr11�u�1111����1��11a1����11}11+fill 1II Patient: DORIS M SILVEIRA Visit #: 20146064 436846 0 352 C42 Pl Total Charges: $151.15 Doris M Silveira Date of Service: 08/25/99 100 Village Dr Apt 109 Brentwood CA 94513--1049 DEAR DORIS M SILVEIRA, Thank you for your choice of Sutter Delta Medical Center for the provision of your health care needs. The date of service and total charges for your care are indicated below. Please make your check or money order payable to Sutter Delta Medical Center, or you may use the form below to provide us with your credit card information. Should you require it, a detailed description of your charges will be provided at your request. For this or any other requests, we may be reached at (925) 779-0210 or (800) 516--5548. If you have insurance coverage for this visit of which we are not aware, you may also provide that information at the number listed above. Once again, with so many choices available, thank you for the trust you place in Sutter Delta Medical Center for meeting your health care needs. PLEASE RETURN LOWER PORTION WITH YOUR PAYMENT ***CREDIT CARES AUTHORIZATION*** MC(—)VISA(—)AMEX(�)DISC( EXP ( I_l_,,,) AMT$ - -- CARD # SIGNATURE: PRINT NAME. PATIENT: DORIS M SILVEIRA VISIT #: 20146064 436846 BALANCE: $151.15 ADM. DATE: 08/29/99 11,1111116#11111a1111111»ltl1lilt 11 Patient Billing Services Sutter Delta Medical Center 1280 Central Blvd Ste B 352 Brentwood CA 94513-2205 0 CA EMF.R PHYS STA , II3 tt BILt1N@ t F10E PHONE SWAM 1601 CUMMINS Lve., #D-21 64 29157 1(800)498-7157 MODESTO CA 95358-5403 ACCOUNT NUMBER DATE OF ILATQM 21-08-20145181 09/10/99 Address Service Requested LOCATION OF SE1It'10E 04120-1 CRP * DELTA MEMORIAL H08P (209) 557-1211 DORIS M SILVEIRA ANTIOCH CA 94509 100 VILLAGE DR #109 BRENTWOOD CA 94513 DATE PIIS DIAGNOSIS DESCRIPTION OF SERVICES AMOUNT 08/2#3/99 23 ** 99284 LEVEL 4 EMERGENCY, PHYS CHA 195.00 * 7840, 7810 EMPLOYER INJURY DATE ADMISSION DATE DISCHARGE DATE NONE L : 195.00 IF YOU HAVE INSURANCE, PLEASE COMPLETE THE BILLING INFORMATION AS REQUESTED ON THE REVERSE SIDE OF THIS STATEMENT. PAYMENT IS DUE UPON RECEIPT OF STATEMENT A FINANCE CHARGE OF 1.5 PERCENT MAY BE REFERRING DOCTOR FI TZS IMON S, MARY M.D. CHARGER EACH MONTH ON ACCOUNTS NOT PAID ATTENDING DOCTOR F I TZS IMONS, MARY M.D. IN FULL.ANNUAL PERCENTAGE RATE 1'896. DORIS M SILVEIRA 100 VILLAGE DR #109 XC-COUNT NUMBER I STATEMENT DATE BRENTWOOD CA 94513 21-08-20145181 09/10/99 PRIMARY POLICY = SECC3NDARY POLICY# 564766485 MAKE CHECK.PAYABLE TO: SEE REVERSE SIDE FOR AN EXPLANATION OF THIS BILL CA EMERGENCY PHYSICIANS Awww 'arrow�;:` .. Iff CA EMMER PHYS * DELTA 1601 CUMMINS DR. , #D--23 avan MODESTO CA 95358--6403 """ 195.00 CA Elm PHYS I�TA 1602 CUNNINS 0-21 �' �''' 68 157 1 800 498-7157 A +*WNW AN MODESTt3 CA 95358-6403 OF S r 21--08-20144 19/99099 Address Service Requested SIMBA, =is OF mm%m 04422-1 CEP * DELTA MEMORIAL HOSP (209) 557-1211 DORIS SILVEIRA ANTIOCH CA 94509 100 VILLAGE DR #109 BRENTWOOD CA 94513 DACE POS DIAGNOSLS DESCRIPTION OF SERVICES AMOLINT 08/29/99 23 * 99284 LEVEL 4 EMERGENCY, PHYS CHA 195.00 ** 7820, 9779 08/29/39 23 7810 99054 SUNDAY/HOLIDAY SERVICE 18.00 EMPLOYER INJLRY DACE ADMISSION DATE DISCHARGE DATE 213.00 YOUR ACCOUNT IS 30 DAYS PAST DUE. PAYMENT OF ANY BALANCE DUE ON THIS ACCOUNT IS YOUR RESPONSIBILITY. THANK YOU. A FINANCE CHARGE OF 1.5 PERCENT MAY BE REFERRING DOCTOR KHOURY, THEOPH I LE M.D. CHARGED EACH MONTH ON ACCOUNTS NOT PAID ATTENDING DOCTOR KHOURY, THEOPH ILE M.D. IN RU} ANNUAL PERCENTAGE RATE 18%. DORIS SILVEIRA 100 VILLAGE DR #109 ACCOUNTNUMBER ST.4TEMENTDATE BRENTWOOD CA 94513 21-08-20146064 10/08/99 PRIMARY POLICY SECOATDARY POLICY MAKE CHECK PAYABLE TO: SEE REVERSE SIDE FOR AN ENPLANATION OF THIS BILL CA EMERGENCY PHYSICIANS CA EMER PHYS * DELTA 1601 CUMMINS DR., #D-21 MODESTO CA 95358-6403 213.00 Clq CLAIM EDAM DE SUPERNISORS DE CO—NMA M51A M=- CALMORNIA .. BUO. FEBRUARY 15, 2000 Crim Against the C ity, or District Governed by the Board of Supervisors, Routing Endorxernents, 1 NOTICE TO CLAIMANT and Board Action All Section ngerences are to The ray of this document mailed to you is your California Government Codes. } mice of the action takers on your claim by the 1ft19=MaW7Board of Visors. (Paragraph IV below!, liven pry to Government Coe Section 913 and AN 0 7 7000 815.4. Plaw fete all "Warnings". AMOt7NT: $200,000.00 COUNTY COUNSEL MARTINEZ CALF. CLAIMANT: PUYA SOLTANI, A Minor AMLNEY: c/o GERALD F. WOODS, ESQ. DATE RECEMM. JANUARY 7, 2000 395 WEST PORTAL AVENUE ADDRESS: SAN FRANCISCO CA 94127 BY DELIVERY To CLEM CIN:-- mr,�y 70 2MO BY MAIL POSTMAR)MD. N OFFrC.E L FROM Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. PHIL Dated: JANUARY 7, 2000 By. Deputy C ,✓ Il. FRCounty Counsel TO: Clerk of the Board of Supervisors ( � This claim complies substantially with Sections 910 and 910.2. } 7tris claim FAILS to comply substantially with Sections 910 and 910.2, and we are to 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: ` $y: Deputy County Counsel M. 3R'tOK- Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). I. BOARD ORDEW By unanimous vote of the Supervisors prat: 'phis 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: —� ? � PwL B,Ax-lawR, aerk„ By r w Q Deputy Clerk WARM NG (Gov. code rection 913) Subject to certain exceptions, you have only six (6) months from the date this notice w,,s pajonally served or deposited in the mail to file is court action on this claims. See Government Code Section 94S.6. You uuy seek the advice of an attorney of your choice in connection with this mutter. If you want to consult an e;ttorney, you should do to immediately. *For Additional Warning Sebe Uverse Side of This Notice. AFHDAVIT C G I declare under penalty of penury flat I am novo, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today 1 deposited in the United States postal Service in Martinez, California, postage full prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated. ,e By: PHIL BATCHELOR BySJ2�, Deputy Clerk L1t"'• IY'nrwn,a'♦rwr..t ar...,.,...... t t.....t.r....... •, f� 0�zt; IX THE MATTER OF THE CLAIM OF: .PUYA SOLTANI, a Minor AGAINST Contra Cotta ,.County Name and P. O. Address of Claimant Puya Soltani, a Minor RECEIVED c/o Gerald F. Woods, Esq. 395 gest Portal Avenue JAN 7 2000 San Francisco, CA 94127 CLERK BOARD OF SUPERVISORS Tel. No. : 415 -759-1900 L7RA SPACE OR 9AIM N . ST THE UNDERSIGNED CLAIMANT HEREBY MAKES CLAIM AGAINST Contra Costs County IN THE SUM OF $ 200,000 . AND IN SUPPORT OF SAID CLAIM REPRESENTS THE FOLLOWING: 1. WHEN DID THE DAMAGE OR INJURY OCCUR (GIVE EXACT DATE AND HOUR) July 7, 1999 2. 'WHERE DID THE DAMAGE OR INJURY OCCUR (INCLUDE CITY AND COUNTY) Shell Ridge Recreation Area Walnut Creek Open Space, County of Contra Costa (see photocopy of Park) 3. HOW DID THE DAMAGE OR INJURY OCCUR (GIVE FULL DE'T'AILS) Child caught her arm on an exposed sharp object in treehouse - sharp object believed to be a nail 4. WHAT PARTICULAR ACT OR OMISSION OF THE PUBLIC OFFICERS, SERVANTS OR EMPLOYEES CAUSED THE INJURY OR DAMAGE Maintained an artificial premises r a tree house - in a dangerous condition S. WHAT ARE THE NAMES OF THE PUBLIC OFFICERS, SERVANTS OR EMPLOYEES WHO CAUSED THE DAMAGE OR INJURY Unknown 6. WHAT DAMAGE OR INJURIES DO YOU CLAIM RESULTED (GIVE FULL EXTENT OF INJURIES OR DAMAGES CLAIMED) Severe laceration to arm requiring plastic surgery, scarring and future plastic surgery 7. HOW WAS THE AMOUNT CLAIMED ABOVE COMPUTED (INCLUDE THE ESTIMATED AMOUNT OF ANY PROSPECTIVE INJURY OR DAMAGE) Medical expenses ._ approximately $ 7,500.00 Scarring and emotional trauma $ 192,500.00 8. NAMES AND ADDRESSES OF WITNESSES, DOCTORS AND HOSPITALS EXPENDITURES MADE ON ACCOUNT OF ACCIDENT OR INJURY Date Item tmount SEND NOTICES TO (ATTORNEY) Gerald F. Woods, Esq. 395 West Portal Avenue San Francisco, CA 96127 TEL NO. :-- -4,15-759-1200 Signature o Claimant GERALD F. WOODS On Behalf of Claimant Puya Soltani, a Minor x € x • �y x • t� � �)1 yt�' � � �'�:. •`«. a 'M!`.�. yeti . MF y`y 4• , t Lj Z LJJ PY vKb�1 .'�s..�a �• l � irS 1 t/e G CLAIM IBQA-'D Qf SUFIERN ISORS bF MMA T =; C"AUEbENIA R0AR ACT ufY i EBRI1ARV:15.5 20 Claim Against the County, or Dstrict Governed by the Soard of Supervisors, Wing En dDrsements, NOTICE TO CLAIMANT and Board Action. All Section references we to 3 N cry of this document nailed to you is your California Goverment Codes. notice of the ution taken on your claim by the Board of Supervisors. (Paragraph ill belovO, liven =Wppu�rrsuant to Goverment Cade Section 913 and 915.4. Pmse rate ail "Warnings". AMOUNT: NONE STATED JAIL 11 2/11 CI AIMANT: KATHY A. TEUTSCU COUNTY CALIF. ATTC WZY: DATE RFS: January 11, 2000 ADDRESS: 3713 Mr. DIABLO BLVD. , #34 BY DEjC1ray To CL.M ON: JANUARY 21, 2000 LAFAYETTE CA 94549 BY MAIL POSTMARKED. Hand-Delivered L PROX- Clerk of the Board of Supervisors Tri: County Counsel Attached is a copy of the above-noted claim. PML BA R, Cleo Dated: January 11, 2000 $y: Deputy IL FROM County Counsel M. Clerk of the Board of Supervis rs (, This claim complies substantially with Sections 910 and 910.2. } This claim MILS to comply substantially with Sections 910 and 910.2, and we are to 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: -W By: Deputy County Counsel III. FROft Cleric of the Board 7C1: County Counsel (1) County Administrator (2) ( ) Claim was retw ned as untimely with notice to claimant (Section 911.3). IV BCIART! 0tDF.It: By unanimous vote of the Supervisors praesrt: 'ibis Claim is rsjocted in full. } Other. I certify that this is a true and correct copy of the Board's Ceder entered in its minutes for this date. Dated: - _ PHIL BATC:iIEw& Clerk„ B Deputy Clerk WARMING (Gov. code section 913) !Subject to certain exceptions, you have only six (d) 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 94S.6. You may seek the advice of are attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning Sae Reverse Side of This Notice. AI'MAVTT OF b ADING 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 full, prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: 2 2 By: PHIL BATCHELORBy 1 Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INNSMISTIQNS TO CLA 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 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claim must be filed with the Cleric of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Er_&_. See penalty for fraudulent claims,Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Cleric's filing stamp REC CU Against the County of Contra Costa or ) JAN 2000 i ) eim4A-tDistrict) CLER 8 �p OF SUppgrpV1S (Fill in name) ) A coSrp c RS The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ and in support of this claim represents as follows: N �i ry FN - _D e M i lv 4,--ri C- 1. When did the damage or injury occur?(Give exact date and hour) Wuh-T 2. Where did the damage or injury occur? (Include city and county) k ` . How did the damage or injury occur?(Give full details;use extra paper if required) %el��> ' e 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? e- 5. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Clive full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses, doctors, and hospitals. 9. hist the expenditures you made on account of this accident or injury. SATE TT AMUM ) Gov. Code Sec. 910.2 provides"The claim must be ) signed by the claimant or by some person on his behalf." SENP NOTICES T (Attorney Name and Address of Attomey } (Clai ant's Signature) (Address) 9 ( l Telephone No. )Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any Use 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($10,000),or by both such imprisonment and fine. ED REC Hand delivered to: co,tC + �GON��AG05'CAOVI Ms Teutshel, I understand from our conversation today that your primary interest is to obtain financial reimbursement and that you have contacted an attorney. As I stated,I am unable to provide you with two of the items you have requested: 1. all lost wages 2. stress for insufficient funds for living expenses As we discussed, all claims and complaints requesting financial consideration must be filed with: Clerk of the Board of Supervisors 651 Pine Street 1'`Floor Martinez CA 94553 Sin e , y elfor Patient Itel ons M lj�b MmRITHEW MEMORIAL HOSPI'T'AL & HEALTH CEIItTERS TM$MXFWPArEMU: PATIENT COMPLAINT/GRIEVANCE PATIENT NAME: -J7y1 `i' ,-I-f U"7-5 'I+C, t_ pHaNr=NuMB Ft: ADDRESS:--_a-313 b t p I c (vc�, #-3 q CrTY/STATE2iP: L-Iq/pA V c TT- 4 �yS MEDICAL RECORD# c 7 8' 7 DATE OF BIRTH:__�I DATE OF T REATMENTMSIT: _ 11 ' ` DATE COMPLAINT BEING FILED: BRIEFLY DESCRIBE COMPLAINT Provide detab of c omptaint with spodk Mormatim such as names,dates, seqmwe of events,etc. Attach as much additional k�tcam`amaabon as Is necessary. 0 A 40 .,..rc t' 7 t 1 3 1 � ' k�' l C- C,() (Xri..e♦ `1 t-.c.)8--5 &-&3 "G' i opo, F'0017 {i l C t►.) i tiO — (Zevnr7 7I3I 94 - c, (Ve0 aAc otic w �C S w A f 1 rte- t 7c�e t r t C ` E 4-u E a e-s D/t - -A-WL)L Ke-A t,t A4 Gt i V e-A r;.. A- rJg-LO -X& -E- -v,2 jlo ( t-i x A� Vit-, # 66c,4- L`(e t�l-S o ,5' 4 A 4-ke- o o+ h igve Lee e 4 t ?'n �R. Nt1 .'► r rs 'ny �. tve.� • o� `�l�z..l 9� - -� c�e��-- � `b`����v�i ,��, � sed-,� p �p��. `--�,�.., a- C6,— or- 4 'D .-1-c' -o X " �7- 5h c. T C n ��What acUm are you requesting? f' A-c4 i �e tO c t- t'�� 14-x.rNG\ cZ0eXa-S e LkAg �c)R.o_�. fl-� &4.0 ep; C � iL1CL 0+� i I 'i 1 Fi L--se. gLQ 6'-"e' fri�ic For-, e & C--C 4i rn { l Signature—Person Submrhtng Complaint: Did employee complete form? If other than patient,h9cate. hip: 0 yes Ono Slgnahn�--Employes Remo Complain YOUR COMPLAINT WILL BE THOROUGHLY INVESTIGATED AND"YOU WILL RECEIVE AN ANSWER WITHIN THIRTY DAYS. THANK YOU FOR BRINGING THIS TO OUR ATTENTION. WE STRIVE TO PROVIDE QUALITY CARE. 0 4z "1 Ar PA , . ..Lr ff �► r dA- 40F'& ji � y 4-LfK co 41, fes-. 14, Ow CIA, Ca- 40 uj�k I ° e , -. ev% fes; , 4 - ,, ilk APPLICATION TO IfILE LATE CLAIM BOARD OF SUP VISORS OF CONTRA COSTA MUM, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT FEBRUARY 15, 2000 Against the County, Routing ) The copy of this HocumenE malle3 to you is your Endorsements, and Board Action.) notice of the action taken on your application by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Cade.) ) given pursuant to Government Code Sections 911.8 and 915.4. Please note the "WARNING" below. Claimants RAYMOND HARLESS � Attorneys DEBORAH G. LEVINE, State Bar No. 57607 1981 North Broadway, Suite 405 JAN Address: Walnut Creek. CA 94596 COUNTY COUNSEL MARTINEZ CALIF, Amount: SUPERIOR COURT JURISDICTION By delivery to Clerk on January 6,___2000 Date Received: By mail, postmarked on Hand-Delivered I. s Clerk of the SUR o Supery sora Toe County Counsel Attached is a copy of the above noted Application to File Late Claim. DATEDs January 7, 2000PHIL B,A M, Clerk, By - Deputy I. s Cour y CounselTO Clerk o the o Supervisors (� The Board should grant this Application to File Late Claim (Section 911.6). ( ) The Board should deny this Application to File Late Claim (Section DATED 1-1 b �QQ VICTOR WF.STMAN, County Counsel, By Deputy mous vo e of Supery sora presen (Check one only) ( ) This Application is granted (Section 911.6). C ,) This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Boardfs Order entered in its minutes for this date. DATE: PHIL BATCHELOR, Clerk, BDeputy WAM'ING (Gov. Code +1911.8) If you Kish to file a ocurt action an this matter, you must first petition the appropriate oourt for an order relieving you from the provisions of Government Code Section 945.4 (olaimspresentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months from the date your application: for leave to present a late claim was denied. You may seek the advise of any at of your choice in oonneoti+cn with this matter. It M want to consult an attaml you, should do so immediate) , s Clerks y County s ra or Attached are copies of the above Application. We notifed the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has ben filed and endorsed on the Board+s copy of this Claim in accordance with Section 29703. DATLDsL " --� PHIL BATCHELOR, Clerk, Deputy V. FROM: 1 ty Cou—im-7 (23 County Administra or 701 Clerk of W10 Boar of Supervisors Received copies of this Application and Board Or-der. DATED: . County Counsel, By County Administrator, By - - - -- APPLICATION TO FILE LATE CLAIM Office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: (925)3351800 Martinez, CA 94553 Fax: (925)646-1078 Date: January 10, 2000 To: Joan Staley From: Victor J. Westman, County Counsel By: Monika L. Cooper, Deputy County Counsel (Y)4-(, Re: Raymond Harless Claim Our office is recommending that the Board of Supervisors grant the Harless' Application to File a Late Claim. Raymond Harless was a minor during the filing period, and under Government Code section 946.6 the Court would be required to grant relief. CONFIDENTIAL ATTORNEY CLIENT DOCUMENT 44 v 414,Z4 4 1 DEBORAH G. LEVINE, State Bar No. 57607 1981 North Broadway, Suite 405 2 Walnut Creek, CA 94596 (925) 933-5100 3 Attorney for Raymond Harless 4 5 6 7 8 9 In the matter of the Claim of APPLICATION FOR PERMISSION TO FILE LATE CLAIM 10 Raymond Harless [Government Code section 911.4] 11 against RECEIVED 12 County of Contra Costa 13 / JAN 0 6 2000 14 TO: County of Contra Costa CLEAK CONRS TRA COSTA CO. 15 Application is hereby made for permission to present the attached claim after notification of 16 the expiration of the time limit provided in Government Code section 911.2 17 As stated in the attached claim, claimant's cause of action accrued between January-February 18 1999 and April 14, 1999. 19 Claimant has been notified that portions of the claim prior to March 28, 1999 were not 20 presented within six months after the event or occurrence and were not acted upon (see attached 21 letters by Monica Cooper and Board of Supervisor"Notice"). 22 The reasons that the portions of the claim that occurred prior to March 28, 1999 were not 23 presented within six months of that date are as follows: 24 1. Raymond Harless,the person who sustained the injury, was a minor during all of the time 25 specified in Government Code section 911.2 for the presentation of the claim. 26 2. The failure to present the claim earlier was through surprise in that the information which 27 gives rise to this claim did not come to light until several months after April 13, 1999, when the 28 Contra Costa County Department of Social Services removed Raymond Harless from his foster home I placement. with Tom Bertinuson. The Moraga police department investigated the conduct of Mr, 2 Bertinuson in relation to another child. During that investigation it was learned by the Moraga Police 3 that Raymond had been molested by Mr. Bertinuson. A criminal complaint was filed against Mr. 4 Bertinuson based on the molestation of Raymond on August 10, 1999. This claim is based on the 5 same facts which gave rise to the criminal charges filed against Mr.Bertinuson. Thus, the facts giving 6 rise to this claim were not available to counsel until shortly before the original claim was filed. 7 8 Dated: January 3, 2000 9 Deborah G. Levine 10 Attorney for Claimant 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 -2 - Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRTJCTIONS TO CLAIl1IAiT 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'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. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this farm. RE: Claim By Reserved for Clerk's filing stamp } RAYMOND TUM HARLESS � a Minor } } 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 Superior and in support of this claim represents as follows: Court Ju-Fl sdiction 1. When did the damage or injury occur? (Give exact date and hour) Continuously from approximately January-February 1999 through April 1999 2. Where did the damage or injury occur? (Include city and county) 328 Rheem Blvd., Moraga, CA 3. How did the damage or injury occur? (Give full details; use extra paper if required) Raymond Harless was placed in the-'foster home of Thomas Arthur Bertinuson by the Contra Costa County Department of Social Services. During the time Raymond was under the supervision of the Department of Social Services, he was sexually molested by foster parent Bertinuson and exposed to sexual material in that foster placement. dA 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See #3 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Unknown at this time. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) Emotional distress. 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) & Names and addresses of witnesses, doctors, and hospitals. Michael Maes, Detective, Moraga Police Department 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT } Gov. Code Sec. 910.2 provides "The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney_ Name and Address of Attorney ) Deborah G. Levine } 1981 N. Broadway, Suite 405 ) C Walnut Creek, CA 94596 } (Claimant's Signature) } Law Offices of Deborah G. Levine } (Address) 1981 N. Broadway, Suite 405 Walnut Creek, GA 94596 Tele hone No. (925) 933-5100 )Telephone No. (925) 933-5100 P NoncE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill, account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000), or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine. OCT 14 1999 : If { JkMENDED C WW m: soAxz►OF S1Il•>RvUO RS OF CONTRA COSTA COIF MuslicnPNS T A. Ciales raelatiu5 to at acdo q for*wk or for fejurl to Permit or to pavenal property or Srouriarg crops tmd ttrttieb accrut m or before kvmbcr 31. tM, anestt he pres9ttet4 cwt hent thaa the ttMDr' day alter tete merest of dw cause of;hien. CLiats relatsad" cmm of scdoa for death or for Isjury to peri* or to personal property or grvwia=crops and which mcrot et or atter January 1. 19111111.aw t be pttu ted act tatter than As ototttlts after dw accrual or time canoe of active. Chines r+t"at to my other cause or aetles man be pr+toe-ted sot laxer than one year after at accrual of clue dwrr of sedom (Gem Cods i!i L2.� fi. Claims must be filed wits the t;:k rk of the Bottrd of St pemisors ate its ofriet is Roam 1046. County . AAminisuauion Raitdins;,GS i Fine Street.Msrtiats.CA %551 Cr U Claim is a*nst a ditttticat pvtrrred by t#st Board of Supervisors. ratter &as the Couarr. tat same of the District mould he Riled in. D. 1f the claim is ageing otere than one public entity.separate claims most be tiled apiest unit petbtic Badu. L Ltile. set peasity for fraudulent claims. Penal Code mac,.12 at the earl of t!!s form r w r • • r • • r r r a r r r • r r w r • r • w r w r w w r r r • w r r r r r w r w r r r • r r w r r r w r r AMSNDFT) 1M.Claim by ) Reserved for Ch:rt'1 filia5 Stamp RAYMOND TOM HARLESS, ) a Minor Against the Cotxnrj of Coats Coats or Pixv ct} (pal to Name) amended Toe undersigned claimant bereby makes/ctaita &going the Comaty of Contra Costa or tht above named District in the suet of S Super 20 i.support of this claim reproseats as follows- Cour jurisdiction L When did the damage or is jury occur" (G+•~ooaor atm tbw) Continuously from approximately January-February, 1999 through April, 7.999 �................... .. ....... ...................... .... ......................... 2. Vr' tm did On damage or iajury acxatr? (far6w&cvy uw C*a wy) 328 Rheem Blvd . , Moraga, CA .................... .. ......................_.... ................................... 5. Suer diel the damage or injura omr' t ••wo trwrar...r rarw r drrquit t, Raymond Hairless was placed in the �oster home of Thomas Arthur Sertinuson by the Contra Costa County Department of Social. Services. During the time Raymond was under the supervision of the Department of Social Services, 'he was sexually molested by foster parent ..................,.......,.............................................................. 4. Wbat particular act or am,satoe eo at part of emery or diseriet officers, ar-nuts.or employee* caused the kiUry or damta r? Borti.nuson and exposed to sexual material in that foster placement. (Over) YD ' S «.. __. . 1U4 msttl Al:) !!1501 be1J?� Et:01 WA—,t2-•d 'a 2 I NISTVd DLltfW AD 331AA0 MVI 't 9T c TT 615-trz-14.DCi • F'! abS Wei -1d101 S. Wkst art:the manes of corn,)or district 011tH m stwam=or attpioyet:s co rl6r.the dam w or iayory? Unknown at this time _...._... ...............---- .r..._r---- .._..._..._w._.----------------- ._.. s, what dam�aM or iwjuriet eo yom claim rnotud! t CA-*sw totem«rwy...o.r.dww+t.+eI h i AM.*r-+®+rr+ft 1W Oft Emotional distress _....... _..... ............ ........ ...--------- .«............, .................... ........ ..... +. Now was the a�o wt Claimed 90"at Competed' t 1 rr asuAMd OEM" t of MM 0 WIP+eM.w to or rR/rR�e• r ....._.w...r•..•_r...w.w.w..n_....r..z...r r..w.................rs... ......... .. ....... t. plaaatnes axd Ir►ddrtsica<oa'rViteemiCi.doctors,aad ltospitais. Michael Maes, Detective, Morava Police Department ......................................................................_...._......... 9. List the t1prenditern rot o+ade on accousit tat this WW"d or i ujwrY: c►.r rr�v� a! # U r • # • r # • M r • # • • w # • r # • • • r R R w • • # e • r P •'+ •+ # • # # # R R # # • • # • ♦ # R R Gor.Code SM 910.2 provides: ""lire claim own be sip med b. tk Claimant SEND NOTICES TO: (Anorsty) or by saw pm an Aix behalf., Panic mod Addr+crs of Attortrt y r r~ Deborah G. Levine 1981 N. Broadway, Suite 405 Walnut Creek, Ch 94596 (Clmissaaawt's 5iptatmrt) Law Offices of Deborah G. Levine 1981 N. Broa0l",buite 405 Walnut Creek, CA 94595 7ate�1►ooc t+t+r. (9 2 5) 933-5100 Teal rhowc No. L9 2 5) 9 3 3-51{7 0 P M # • # # r # � P # # # # M F R F F # / # F # • # # R R R t # R # i F e # # # e # � # R # • R w +w • # • R • NOTICE 72 of Ow Peftal Coale p aoim- "Every pems<wbo.,whet,imrtrm to ddr md.ptama for a/seras►ce or f'or p•y.octrt to arry au tae boud or oKlcrr,or to any L% i ity,city or diurin board or o!'flcer,ordwrixed sa allow mer pa;Ow mnrt it Sctwiowt,may tabs or froo&lcut doism.WL occomat-vmwber.or wrrilkg.it pumbbAk okkar by ismprisarmasa" h dte cowed jarl for a Period of so mors tbam ons yaw.by a tine of trot macoatdimg mot d ommo d dWbn($1J00).or by baht moth iaspriaomasew and lave,or by imnl►rtiwaavrmew in tl►t sltaat pr mm,by a fwe of oat'tsamm"Aft Us thrAmod dollars(SiO.tiN). or by both made iapar'insomatt awl tint. zd `d ir,.i vr-iA A a-r wa�O-1 OdINDJ tj:et 6661-4Z-41$E NISIb'cf ONVW 40 331-4=10 MV-1 <+rOT : tT 66- bC -2 C� to: WARD OF SUPERVISORS OF CON1AA COSTA COUNTY A. Claims relating to eanacs of action for death or ror injury to person or to personal prtperty or pvwisy crops and wkicb accrue on or before Clcx ber 3L 1"7, t=arot be prtaen ND41 a;ot later thaw the 10001 day after the accrual of the cause of scr+ie+n. Claims tag to gusts of action for b=ath or for injory to ptrsots or to personrd prop=t7 ar ming crop$ allot Which accrt+e on or adder January 1. 19*L f=lirt De ptcrrtsted not later than As amounts after tate accrual of the sawn of=aims. CWMS relating to any other cause of cation roust be prgsEssctl slot Isar tban one year after the actrunl of the cansit Of actin". (tare. Cade 1911-2. ) 8. Clamss must be filed with the Clerk or the Board of Supervisors at its office is bloo=m 106. Conary lldmisiscratioo E+aiidlel,651 plot 5ctset.Mardne3.CA Mal C. Cf Claim is atainst a din ict yavtrscd by the Board of SopttYison. rztbtr than the Country, rhe Ga=me of the district thoo14 be filled in. 33. V the claim is aye Inst more than one public entity.,separate cJaints must be filed against tacit public edeity. E. Laud, Sec pcnaky for fraadutcm claims. PC" Codd Sec-72 At the cwrl of this rarm.. • r • ■ • w s ■ ■ • • • • w ■ r s r r • ♦ f • • !� ■ • ■ r r w ■ ♦ • ♦ • • t ■ • • • • • • r v • • w r a r ♦ ♦ RE:Claim by ) Reserved for Clerk's filing Stamp Raymond Tom furless A Minor (8/14/89) Against the County of C00%ra Colts SEP 2 '03 1999 or District) __ --.. ._.. ....... _._.� (Fill in Smit) The vaidersigned claimant hereby h=akes claim agttiast tbt County of Contra Cost,* or the above named Diarict its the sum of S LOO I 0000 and in support of this claim represfetits as rallows: 1. When did rhe damage or injury occur" (Gs•.rare+Doo mod sear 1 On.or`about April 13, 1999 2. 'Whim did the damage or injury occur? t`u7 aw CsamtY) Rhee'ym Boulevard, Moraga, CA 3. How dW the dannate or injury of CUr" (Clue rot�a+«iLr wx rw•+►•"r srwirmd; Raymond Barless was placed in the foster horse of fir. Bertinuson by the Contra Costa County Department of Social Services. In that home Raymond was exposed to sexual material and was sexually molested. 6. `What particufatr act or omission an the part of County or district of kers. krvznrs, or employees caused the +s jury or dasenle* The Contra Costa County Social Services Department negligently placed, supervised, entrusted, controlled, maintained and cared for Raymond ffarless in the foster home of Thomas Arthur Bertinuson. The Contra Costs County Social Services Department breached its.mandatory duties to inspect, supervise, and contrql said foster parent; to supervise, control, maintain and care for the persona 36ond furless; to monitor the condition of Raymond Harless; and to take necessary action to oaf eguard the growth and development of Raymond Barless while placed in said foster home. The Contras Costa County Social Services Department breached its mandatory duty to notify the appropriate licensing agencies; of incidents at the faster hoose of Thomas Arthur Bertinuson which jeopardized the health and safety of Raymond lfarless. SO' d Z NISIVd :)*ddW _4C? 33IA=10 Mtv-1 V6 : T 66-VT-:I�=>C) S. Witat ar+r the Haunt'of comely or district of crrs,serva"M or cmplaym cawing the damatc or iajnr77 Dnknovtt at this tithe - e - w - What daaM or injuria tto vol claim twuitcd' t cAwe fto.strut*r as d■wre■rn slwir..eil. A"aA twotsswwyrr L asCor ante M 16,) fauotioual distress y, if** wa the above Claimed mooumt eornputct" t ieciwk wo osomw wsw+■c or sew"w :ww iftjw er awwwr, ) ••. ........................................... ...... .... ........ . .................. S. Nanwz mad addrmsr!;of wit retua.damn.and hospitals Hiebael Maes, Detective, Mbraga Police Department Y ...................................................... . 9. Twat the elpt"dicurp you made an,accouat of this accident or injury: Bose to date _-_v���'._ ... MEM A.%40(' 4"t R o w ■ i w ■ s e A N ■ ■ N ■ ■ ■ ■ ■ p ■ ■ W w ■ R M ■ f Y F l� ■ R ■ w r/y w }I ■ w,111 # 1! R • v sr r r r o • • Y Goo. Codi SM 1)1041providev "rhe Claim must be Nped b, the claimant SEND NO'nCES TO- (Attorney) Or by some person on his bahalf.- Namsr and Addrtess of Attormev DEBORAH C. LEVnM Attoraye? at Law (Ctaitha»x's Signature) Walnut Creek, C 1981 N. CA A 94598 Suite 405 Law Offices of Deborah G. Levine 1981 ifortb Bro�aWay, �Suite 405 Walnut Creek, CA 94596 TOephonc No. (925} 933--5100 Tdephont ?Yo.{925} 933-5100 e R � s ■ K r t ■ t ■ ■ ■ ■ , M ■ ■ * N R • !! i ■ f ■ * W • • • 1Y ♦ R ■ ■ R ♦ r • • : w w ■ s w ■ f ■ , t w • NOTICE Seclive 72 of the Pa"Gads pttr►ideg- `Lrvar7 persons wbio.Wirth irrw-M to mefr=d,Pr=Mmta for aliewamcc or for palnnemt to ZDY sots boa"or orficcr.or tra sari'art cc tY•r district boarrd ar vffx=,tsMormd to xftw wr M tiro ismat if Vautne,any fahe Or rrandulest tdaisk bait sccornK.uartber.Or wridnj,m peel babk 6du r by itapritnevinrt is the c"way jail for a period of not mare thus ont year. by a fist of out c2cmditrh not thomsaad dollars($3,000).or by both such imprisoomcast and (ire,or br iMspriisatawaK in the I'-I prime.by a bat oraw comadiah trot tba umd daliars (slo oD0). or by boeh "Wh imapriaoaaw" Sad Ear tro -a r NISIVd 3'"W zit 33IAA0 MVI VST : TT 66-VT-40 VIC'T00 J.WP-STMAN DEPUTIES: - PHILLIP S.ALTHOFF COUNTY COUNSEL JANICE L.AMENTA NORA G.BARLOW B.REBECCA BYRNES SILVANO S.MARCHESIANDREA W.CASSIDY CONtRA COSTA C LINTY MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL TIS ry /y 6�+a}� y ./��tA� c VICKIEL.DAWES OFFIC, OFT.HE G0V �CL►,i.71�1 `G� MICHAELARKE D.FAR SHARON L.ANDERSON ''� ! a+ MICHAEL ' f+�iPyMtN1STRATIO�7:$S91Li31N© LILLIAN T.FUJII ASSISTANT COUNTY COUNSEL � DENNISC.GRAVESF � GF3 JANETL.HOLMES GREGORY C.HARVEY MARTIfi+( Z, Cs•LIFORklA 553-1229 KEVINT.KERR ,, BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V.LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE Ml.GGLI 4 PAUL tv VALERIE J..RA RANOHE OFFICE MANAGER STEVEN P.RETTIG DAVID F.SCHMIDT DIAPHONE(925)335-1800 BAR A RA N.ER FAX(925)646-1078 NOTICE �� � �r��j���� JACQUELINE Y.WO D JACQUELINE Y.WOODS AS TO A PORTION OF THE CLAIM TO. Deborah G. Levine Law Offices of Deborah G. Levine 1981 N. Broadway, Suite 405 Walnut Creek, CA 94596 RE Claim of Raymond Tom Harless Please Take Notice as Follows. In regards to the claim you submitted on October 14, 1999,portions of your claim are timely and portions are untimely. The portions of your claim prior to April 14, 1999 that you presented against the County of Contra Costa governed by the Board of Supervisors fail to comply substantially with the requirements of California Government Code Sections 901 and 911.2, because they were not presented within six months after the event or occurrence as provided by law. Because the portions of the claim prior to April 14, 1999 were not presented within the time allowed by law, no action was taken on those portions of your claim. The claim was forwarded to the Board for action on the timely portions of the claims. Your only recourse at this time is to apply without delay to the County of Contra Costa governed by the Board of Supervisors for leave to present a late claim as to the claims which are untimely. See Sections 911.4 to 912.2, inclusive, and Section 946.6 of the Government Code. Under some circumstances, leave to present a late claim will be granted. See Section 911.6 of the Government Code. You may seek the advice of an attorney of your choice in connection with this matter. If you desire to consult an attorney, you should do so immediately. VICTOR J. WESTMAN COUNTY COUNSEL By: Monika L. Cooper Deputy County Counsel Page 1 el 4-1-,r-00 CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5,Evidence Code§§641,664) 1 declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this NOTICE OF UNTIMELINESS AS TO A PORTION OF THE CLAIM by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Executed in Martinez,California. Dated: October 19, 1999 X cc: Clerk of the Hoard of Supervisors(original) Risk Management Page 3 DEPUTIES: WdTOR J.WESTMAN PHILLIP S.ALTHOFF COUNTY COUNSEL JANICEL.AMENTA NORA G.BARLOW B.REBECCA BYRNES SILVANO B.MARCHESI ANDREA W.CASSIDY CONTRA COSTA.CC�UNTY MONIKA L.COOPER CH IEF ASSISTANT COUNTY COUNSEL VICKIE L.DAWES OFFICE OFTHE COUNTY-COUNSEL MARKES.ESTIS SHARON L.ANDERSONw MICHAELD.FARR W(N7ADMINISV ' LILLIAN T.FUJII ASSISTANT COUNTY COUNSEL 651 PfNESTREET,;gth.FLOOR DENNISC.GRAVES JANET L.HOLMES GREGORY C.HARVEY B MARTINEZ CALIFORNIA-94553-1229 ENARDL.K BERNARD KNAPP ASSISTANT COUNTY COUNSEL EDWARD V LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE MUGGLI PAUL R.MUh11Z VALERIE J.RANCHE OFFICE MANAGER STEVEN P.RETTIG DAVID F SCHMIDT PHONE(925)335-1800 November 1, 1999 BARBARRAANN.ER A BAR .SU7LIFFE FAX(925)848-1078 JACQUELINE Y.WOODS Writer's Direct Dial: (925) 335-1862 Deborah G. Levine Law offices of Deborah G. Levine 1981 N. Broadway, Suite 405 Walnut Creek, CA 94596 Re: Claim of Raymond Tom Harless Dear Ms. Levine: This confirms that the claim you filed on October 14, 1999 was an amendment to your original September 28, 1999 claim. You are correct that the amended information relates back to the date of your original claim. Referring to the letter I sent you on October 19, 1999, you should replace the April 14, 1999 date with March 28, 1999. Therefore, the portions of your claim prior to March 28, 1999 were not presented within six months after the event or occurrence as provided by law and were not acted upon. You should continue to follow the warning set out in the October 19, 1999 letter regarding filing for leave to present a late claim within six months. I hope this clarifies the status of your claim. You may contact me at the above number if you have any questions. Very truly yours, VICTOR J. WESTMAN COUNTY COUNSEL Monika L. Cooper Deputy County Counsel 1:\TORT\RJ SK-MGT\CLAIMS\2Levine0l.wpd 3DF.D CLAIM CLAIM cl RT} QF L1pER1'I5O OF l►N;" 'a mels C `ltli'Tl'� CALIFORNIA ,UC"I ER 26, 1999 prom Against the County, or District Governed by 1 NOTICE TO CLAIMANT the Board of Supervisors, Routing Woromrits, ) .� cpy of the dommnt mailed to and Board Action. All Section references we to ) you is y°1� Cl�ifornia Goverm�errt Codes. 1 txrtice of dtie action taken an your claim by the 3MUIUMsuant Board of Supervisors, (Paragraph IY belovA, given 39 to Goventrmnt Code Section 513 and ril.5.4. Tease Mute dl "Warnings'. OCT 141999 .AMOUNT: SUPERIOR COURT JURISDICTION COUNTY CtJUNSi:t. CLAIMANT: RAYMOND 'ICOM HARLESS, A MINORMARTINEZ,CALIF. ATTORNEY: DEBORAH G. LEVINE DATE RECEIVED: ocTOBER 14, 1999 LAW OFFICES OF DEBORAH G. LEVINE ADDRESS: 1981 N. BROADWAY, SUITE 405 BY DEI.,IVERY TO CLnX ON: OGS ER 14, 1999 WALNUT CREEK CA 94596 By MAIL POSTMARM:r..HA IVERED L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. OCTOBER 14, 1999 PHIL BA � & Cher Dated: By: Deputy Ii. FRONT County Counsel TO. Clerk of the Board of Supervisors This claim complies substantially with Sections 910 and 910.2. ( This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on around that it was fled late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). (v0ther: ,In Al L4_17 Dated: By: Deputy County Counsel IIi. FRO?4, Clerk of the Board 7U County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). Tr. BOARD SBR; By unanimous mote of the Supervisors Present: �7 This Claim is rejected in full. O Ckhen I certify that this is a true and correct ropy of the Board's Order entered in its minutes for this date. Voted: I PML.BATCIIEIM, Clerk. By v Deputy Clerk - — WARNING (Gov. code sen ion 13) Subject to certain exceptions, you have only six (6) months from the date this siotice 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 yon �4ant to consult an arorney, you should do to immediately. *for Additional Warning See Reverse Side of This Nottice. AFfIDAVhT OF i13AE KC; 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 111; and that today I deposited in the United States Postai Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:42A 2417By: PIEL BATCHELOR By Deputy Clerk 0c: Cctrnry Counsel County, Administrator APPLICATION TO FILE LATE CLAIM ` l BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Application to File Late Claim ) NOTICE TO APPLICANT FEBRUARY 15, 2000 Against the County, Routing ) The copy of thia7ZooLnenE ma.153 to you is your Endorsements, and Board Action.) notice of the action taken on your applioation by (All Section References are to the Board of Supervisors (Paragraph III, below), California Government Code.) ) given pursuant to Government Code Sections 911.8 and 915. 1. Please note the "'W'ARN'ING" below. Claimants James Woodard .av LET) Attorneys Address 2885 Concord Blvd. , �N`;y COUNSEL Concord, CA 94519 MARTINEZ CALIF. January 24, 2000 Amounts By delivery to Clerk on Date Received: By mail, postmarked on January 21, 2000 I. : ark o t e RZq of Supervisors TO: County Counsel Attached is a oopy of the above noted Application to File Late Claim. 000 DATED: January 24, PHIL BATC MM. Clerk, By Deputy I. a 5KRy Counsel TO: Mark o the 9602 o Supervisors C ,) The Board should grant this Application to File Late Claim (Section 911.6). , C �') The Board should deny this Application to File Late Claim CSee ion 911.6). DATED: / 00 VICTOR WES'nW, County Counsel, Deputy . KM WER Fy' Miffmous vote a Supery sora presen (Check one only) ( ) This Application is granted (Section 911.6). ( This Application to File Late Claim is denied (Section 911.6). I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. DATE: f 0 PHIL BATCHELOR, Clerk, By Deputy WATSM (Gov. Code 1911.8) If you wish to file a oourt action on this matter, you not first petition the appropriate court for an order relieving you from the provisions of Goverrnent Code Section 945.4 (claims presentation requirement). See Govermwt Code Section 946.6. Such petition must be filed with the oourt within six (6) months from the date your application for leave to present a late olaim was denied. You may seek the advise of any attorney of your ohoioe in ocanection with this matter. If M want to oonsult an attorne you should do so imoediatel . V. : Clarko : County County s a or Attached are oopies of the above Application. We notifed the applicant of the Board's action on this Applioation by mailing a oopy of this document, and a memo thereof has ben filed and endorsed on the Board's oopy of this Claim in accordance with Section 297113• Deputy DATED: .:2 C� � PHIL BATCEIIIAR, Clerk, ByaV, V. FROM: 1 unty Counsrel 2 County A strator Tot Clerk of the Boar of Supervisors Received oopies of this Application and Board Order. DATED: County Counsel, By -- -- -- - - County Administrator, _-- APPLICATION TO FILE LATE CLAIM --, . REC D JAN 2 4 2000 c 3=;1r•aORS CL Co TRACt7tST:�1.2. 66 _ _ . . ... ..................... ... . ......................... ... Claim to BOARD OF SUPERVISORS OF C OIM COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to per- sonal property or growing crops and which accrue on or before December 31, 1967, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of actio for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1986, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (govt. Code 5911.2. ) B. Claim must be tiled With the Clerk of the Board of Supervisors at its office in Roam 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 RE: Claim By Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa ) or ) JAN 1 1 2000 District) CLERK 80AAD OF SUPERVISORS CONTRA COSTA Fill n name ) CO. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of ®,dt and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) .;L1,99 /1p�Ox /;t.'/0 A,AA. 2. Where did the damage or injury occur? (Include city and. county) A1#1A1 77 r�ton) r`A-t L. t r}' , r rr 0#4 3. Hoer did the damage or injury occur? (Give full details; use extra paper if�� required) $$730 W#9 66-t"2> 06 6V!D6AvCE, JVe)tj T A/-.t 7&D 4. What particular act or omission on the part of county or district officers, servants or employees caused the injury or damage? (over) 5. What<are the names of county or district officers, servants or employeescausing °the damage or injury? p&PuTy Bp qN )4NOW-5k 1 S&tZ e-b 7HC- Na 0 >e or 567; , . 'i�� �- � 6vA5 rkc- APPAOVIN6 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage. MX �� ` , �.as 7' �v 4ND IvdT A,—r-r PNC—TO . 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. res,frAv`Del?-u rrau pl, c(,.4-7)e 1u Tmo:r-- #g&rr 47- 7- 7- r/ + . 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT I-V6 Al C- Gov. Code Sec. 910.2 provides: "'The claim must be signed by the claimant SEND NOTICES Toa (Attorney) or some person on his behalf." Name and Address of Attorney (Claimant's Signature CeMWAb 8"D. ss � X14-- ---- Telephone No. "Telephone No. A. 6- 6 7V-42 73 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, hill, 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 bath such imprisonment and fine. as rp �u Lit Ul hti 1- } wtr oyy� ++Mnn Yrs + L • w