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HomeMy WebLinkAboutMINUTES - 01182000 - C24-C25 CLAIM $OARD OF SUPERVLSORS OF Q7[MA_COSTA OOUN TY,_CA.I DU NIA BdARD ACT1 JANUARY 18, 2000 Crim Against the County, or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT Ind Board Actium. AI! Section referenc The copy of this docurrlent mailed to you is your California Goverment Codes. Notice of the action taken on your claim by the Board of Supervisors. ftagraph IV below, given DEC 16 1999 pursuant to Goverrmnt Code Section 913 and 815.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: In Excess of $10,000.00 MARTINEZ,CALIF. CLAIMANT: Viresh Prashar ATTORNEY: Christopher D. Dolan, Esq. DATE RECEIVED: December 16, 1999 CBD December 16 1999 ADDRESS: The Dolan Law Firm BY DELIVERY TO CLERK ON: 425 Pacific Avenue December 15, 1999 San Francisco CA 94133-4606 BY MAIL POS L FROM: Clerk of the Board of Supervisors TQ County Counsel Attached is a copy of the above-noted claim. Dated: December 16, 1999 PHIL By: Deputy ,, IL FROM County Counsel T't?. Clerk of the Beard of Supervis rs (Al"'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 910.0. ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �,Dmuty County Counsel M. FROM: Clerk of the Board 'TD: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEX By unanimous vote of the Supervisors preaemt: 60 Tbis Claim is rejected in full. Other: I certify that this is a true copy of the Board's Order entered in its minutes for this date. 0010 Dated- too PHIL BAT'CCHFWR. Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Govermment Code Section 943.6. 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`Ibis Notice. ,AFEWAVIT OF MAIMG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the 'United States Postal Service in Martinez, California, postage full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated By: PHIL BATCHELOR $y2's` -- ply Clerk ,. or: County Counsel County Administrator This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. The County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. A-, ~ y, CBD REC�GEIVU) THE DOLAN LAW FIRM DEC 16 1999 � 425 Pacific Avenue CLERK BOARD OF SUPERvj San Francisco, California 94133-4606 CO TA CO. ` 415-421-2800 (Voice) 415-421-2830 (Facsimile) Christopher B. Dolan December 15, 1999 County of Contra Costa. Clerk of the Board of Supervisors 651 Pine Street I" Floor Martinez, California 94553 Attention: Civil Claims Division Re: Prashar v. County of Contra Costa: et. al. Notice of Claim [Government Code §910] Dear Madam or Sir: The Dolan Law Firm has been retained to represent Mr. Viresh Prashar in his claim against the County of Contra Costa for his injuries resulting from the July 3, 1999 accident with Michael E.Sloan (CA D.L. No. M0507995) in San Francisco. The following is provided pursuant to California Government Code § 910: a) NAME AND ADDRESS OF CLAIMANT Viresh Prashar 110 Ralston Avenue Belmont, CA 94002 b) ADDRESS TO WHICH CLAIMANT WISHES NOTICES TO BE SENT Mr. Christopher B. Dolan THE DOLAN LAw FIRM 425 Pacific Avenue San Francisco, CA 941334606 G:\Clients`,Prashar\Corr-gen\Pmshar Notice of Intent to Sue 15 December 1999.LBH.wpd County of Contra Costa l December 15, 1999 Page 2 C) DATE, PLACE AND CIRCUMSTANCES OF OCCURRENCE GIVING RISE TO THE CLAIM On the morning of Saturday,July 3, 1999,Mr.Prashar was riding his 1993 Ducati Supersport motorcycle and turned on the corner at 28th and Dolores Street in San Francisco. Mr. Prashar was driving at approximately 20-25 m.ph. After slowing down,Mr.Prashar made a decision to pass and changed lanes. Before Mr. Prashar changed lanes,he signaled and checked to make certain that it was safe for him to do so. Suddenly and without signaling, a white Ford Taurus with a CA license plate no.3RHM264,made an unannounced left turn from Lane One(1)over to Lane Two (2). Mr. Sloan,the driver of the white Ford Taurus, attempted to make a U-turn to get into a parking slot on the other side of the road. Mr. Prashar, in an attempt to avoid a collision the white Ford Taurus, tried to let up off the brakes and swerve to get rotation in the front tire. However, Mr. Prashar's motorcycle started to slide sideways. There was nothing that Mr. Prashar could do to avoid sliding. Then,Mr. Sloan cut Mr. Prashar off and the two vehicles collided at this point. The point of impact was on the rear driver's side and the rear bumper's side. There were two witnesses to this collision. Plaintiff has residential information on both witnesses. This has resulted in wage loss, medical expenses, and other general damages in excess of $10,000.00. Because Mr. Sloan was driving a County of Contra Costa vehicle and under their employ at the time of the collision, agency theory applies and liability is imputed to this government entity. d) GENERAL DESCRIPTION OF DAMAGES INCURRED As a result of the collision, Mr. Prashar has suffered from a left fractured clavicle. He also has suffered from a contusion to the left hip as well as abrasions and bruises to his knees.In addition to Mr. Prashar's physical injuries, he has suffered emotionally. Because of the negligence of Mr. Sloan, Mr. Prashar has yet to recover from the damage to his property. His motorcycle as well as his riding equipment, watch and clothing were damaged. Finally, Mr.Prashar has had to take off from work. He has missed nearly ten days as a result of the collision. e) THE NAMES OF THE PUBLIC EMPLOYEES CAUSING THE INJURY OR DAMAGE 1. Michael E. Sloan H G:\Clients\Prashae,CorrrgenTrasharNotice oflntent to Sue 15 December 1999,LBH.wpd County of Contra Costa December 15, 1999 Page 3 H f) AMOUNT CLAIMED Pursuant to California Government Code, section 914, subsection (f), Mr. Prashar states that his claim is in excess of$14,444.44, and is in an amount such that jurisdiction over his claim will rest with the Superior Court of the County of San Francisco of the State of California. Please find enclosed an additional copy of this letter enclosed. We request that you return an endorsed date-stamped copy of this letter in the enclosed return envelope. Very truly you , Chri r B. , Esq. On Behalf of Cl mant, Viresh Prashar cc: County of Contra Costa County Counsel Attn: Monica Cooper 651 Pine Street 8"'and 9'h Floors Martinez, CA 94553 G:\Clients\Prashar\Corr-ge&,PrasharNotice oflntent to Sue 15 December 1999.LHH.wpd k ru mom 8 CA t OWN . err RECEIVED DEC 131999 CLERK BOARD of SUPERVISORS Clerk of the Board Co TRA C TACo. Board of Supervisors COUNTY OF CONTRA COSTA 651 Pine Street Martinez, CA 94553 BEFORE THE BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA In the Matter of 'the Claim of Michele Aiello, Claimant, VS . The County of Contra Costa I CLAIM AGAINST A PUBLIC ENTITY On behalf of Claimant, JAMES C. GLASSFORD, Attorney at Law, hereby presents this claim to the COUNTY OF CONTRA COSTA, pursuant California Government Code, Section 910 : 1 . The name and post office address of the claimant is: Michele Aiello, 5551 Likens Avenue, Martinez, CA 94553 . 2 . The post office address to which JAMES C. GLASSFORD, Attorney at Law, desires notice of this claim to be sent is Law Offices of JAMES C. GLASSFORD, 500 Ygnacio Valley Road, Suite 250, Walnut Creek, CA 94596 . 3 . On or about September 23, 1999, Claimant received personal injuries under the following circumstances: Claimant visited the Contra Costa County Animal Services Department at 4849 Imhoff Place, City of Martinez, County of Contra Costa, CA 94553; while visiting the shelter, Claimant was exposed to Claim of Michele Aiello 1 animals with rabies and came in contact with said animals; said animals with rabies presented a dangerous and hazardous condition at the time of the injury; that the dangerous condition created a reasonably foreseeable risk of the kind of injury which was incurred; said public entity negligently through its employees created the dangerous condition and after actual and constructive notice of the dangerous condition a sufficient time prior to the injury to have taken measures to protect against the dangerous condition permitted said dangerous condition to exist on its property or on property over which it had control; said public entity through its employees was negligent in the supervision, maintenance, inspection and repair of its property and property over which it had control; further, said public entity knew that the animals were rabid or carried the rabies virus, knew that the animals should be quarantined and kept separate from the other animals and away from the general public, had policies in place that governed the handling of rabid animals, and negligently and carelessly failed to follow said policies and allowed the general public, including the Claimant, to come in contact with the animals; further, said public entity negligently failed to warn of said dangerous condition; that as a direct and proximate result of the carelessness and negligence of said public entity and its employees and the above-described dangerous condition, Claimant sustained personal injuries and damages . 4 . So far as it is known to Claimant and JAMES C. GLASSFORD, Attorney at Law, at the time of the presentation of this claim, Claimant has sustained the following losses, Claim of Michele Aiello 2 injuries, and damages : exposure to the rabies virus, medical expenses and future medical expenses, lass of earnings and earning capacity and future earnings and earning capacity, and general damages cognizable under the law. 5. The true names and capacities of the public employees responsible for the accident referenced above are unknown to the claimant and JAMES C. GLASSFORD, Attorney at Law, who therefore claim that Does 1 through 100 are in some way responsible for the damages of the claimant. 6 . So far as it is known to Claimant and JAMES C. GLASSFORD, Attorney at Law, at the time of presentation of this claim, claimant has incurred damages in an amount within the jurisdiction of the superior court of unlimited jurisdiction. Dated: December 9, 1999 Respectfully submitted by Law Offices of JAMES C. GLASSFORD by J m� s C. Glassf Claim of Michele Aiello 3 ... ..... . . ... . . ..... ... ....... ...... ... �` e,116 � ............. ....... �, S k . g � � r \� r 4 $ . � _ �A\ � k 0 0 Tp f m m Tp CT Gcr0 $ 40 � � ft ". $ A _ ( s H.to 0 . 4 7 � � . � y� s er to o o ro 00 iD r4 rr oma ' (0 4 0 N p40r W � +r�, Z 1g LM { (`YC� ��M M}� {� ►i SITZERYISORS-OF = A 12QL �IMARD,AM IM .3ANMY 18, 2000 Crim Against the County, or District Governed by 1 the Board of Supervisors, Routing Endor'rerr�errts, } NOTICE TO CLAIMANT and Board Ammon All Section Defer �,. The cM of the dourr>ant mailed to you is your Wforrra Government Codes. ',fir a tati of action taken an your claim by the i Board of Supervisors. (Paregraph IV belavA, Oven D 1999mrsuant to Government Cade Section 813 and 815.4, nate all Wrings". COUNTY COUNSF-L, AMOUNT: $3,0001000-00 MWINE21 CALDER CLAIMANT: Michael Ard ATTORNEY: c/o Michael A. Melly, Esq. DATE RECEr F1Y0: December 17, 1999 Cynthia F. Newton, Esq. ADDRESS: Walkup, Melodia, Kelly & BY DEILTMY TO CLERIC ON'. 11 ,=be - -17, 1929 Echeverria 650 California St. , 27th Flr. BY MAIL POS'TI►+l,AP=: Dpcia ► 1 g2() San Francisco CA 94108 L PROK Clerk of the Board of Supervisors 70t County Counsel Attached is a copy of the above-noted claim. December 17 1999 PHIL BA erk Dated: By: Deputy R. Cl III FRONL County Counsel 7'O: Clerk of the Board of Supervisor This claim complies substantially with Sections 910 and 910.2. ( ) This claire 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. 7be 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). ` f { VL.4 -. BGG-' ff T f✓'c.r`4.�rt.w!+r.......�..+ � r v fi lnn4 Trelay 4 B . .1 Dated: '� _ ' ' y' y __ Deputy County Counsel III, FROM Clerk of the Board TU: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). BOARD ORDIX By unanimous vote of the Supervisors present 'This Claim is rejected in full. Other:_ her. I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Datad: l o PHIL BATCMLCI►R. Clerk, By > � Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only Six (6) months from the date this notice was personally served or deposited im the mail to Bit 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. YIIIII� Iu.1Y.uY�.YYYrY� YYY� IYIYY�,...�nw1a..YY.1 rrrw.nMA 7I s OF 1� V I declare under penalty of perjury that 1 am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, Postage fullti prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as Shown above. Dated: By: PHIL BATCHELOR By ( SCJ Deputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Act such as actions in inverse condemnation, actions for specific relief such as mandamus or injunction, or Federal Civil Rights claims. The above list is not exhaustive and legal consultation is essential to understand all the separate limitations periods that may apply. The limitations period within which suit must be filed may be shorter or longer depending on the nature of the claim. Consult the specific statutes and cases applicable to your particular claim. the County of Contra Costa does not waive any of its rights under California Tort Claims Act nor does it waive rights under the statutes of limitations applicable to actions not subject to the California Tort Claims Act. Law Offices of 'PAUL'V.MELODIA WALKUP, MELODLA, KELLY & ECHEV'ERRIA CYNTHIA F. NEWTON DANIEL J.KELLY MICHAEL 1. RECUPERO JOHN ECHEVERRIA A Professional Corporation DOUGLAS S.SAELTZER RONALD H.WECHT 650 CALIFORNIA STREET,26TH FLOOR, SAN FRANCISCO, CALIFORNIA 94108-2702 KHALDOUN A.BAGHDADI MICHAEL A.KELLY TELEPHONE(415)981-7210 FACSIMILE (415)391-6965 DORIS CHENG KEVIN L.DoMECUS JEFFREY P.HOLL OF COUNSEL DANIEL DELCOSSD JOHN D.LINK RICHARD H.SCHOENBERGER WESLEY SOKOLOSKY,M.D.,J.D. December 15, 1999 //��/y AIRRECEIVED +�ED BRUCE WALKUP MM W///��� (1914-1994) DEC RICHARD B.GOETHALS,JR. 7 1999 (1950-1994) Via Certified Mail/Return I CLERK SOAR©Cy! SUp VISORS Receipt Requested CONTi�A 87A The Board of Supervisors County of Contra Costa 651 Pine Street,No. 106 Martinez, CA 94553 Re: Claim of Michael Ard Dear Sir/Madam: Enclosed herewith please find the original and one copy each of the claim for personal injury damages against the County of Contra Costa in the above referenced matter, as well as the court's November 1999 order permitting the claim to be filed late. Please acknowledge receipt on the enclosed copy and return it to us in the envelope provided. Thank you for your anticipated cooperation. Very truly yours, CYNTHIA F. NEWTON Cl~NN\sg Enclosure cc: Tom Manning, Esq. ►1 c IVED DEC 17 1999 CLAIM FOR PERSONAL INJURY DAMAGES AGAIN 'JERK OARc U �oVJSORs THE COUNTY OF CONTRA COSTA ON A TO THE BOARD OF SUPERVIOSRS OF COUNTY OF CONTRA COSTA You are hereby notified that Michael Ard claims damages from.the County of Contra Costa as follows: A. NAME AND ADDRESS OF CLAIMANT: Michael Ard 245 H Street Martinez, CA 94553 Phone: 925 228-9090 Age: 37 (date of birth 9/10/61) B. ADDRESS TO WHICH COMMUNICATIONS CONCERNING THIS CLAIM SHOULD BE SENT: Michael Ard c/o Michael A. Kelly, Esq. Cynthia F. Newton, Esq. Walkup, Melodia, Kelly & Echeverria 650 California Street, 26th Floor San Francisco, CA 94108 Phone: 415 981-7210 C. DAMAGE OR INJURY OCCURRED ON THE FOLLOWING DATE IN THE FOLLOWING MANNER: On or about August 8, 1998, when claimant suffered a psychiatric/psychotic episode as a result of inappropriate and improper discontinuation of his psychiatric medication. During the episode, apparently claimant suffered a significant fall sustaining back and neck fractures requiring extensive surgery and hospitalization. Claimant was taken to Mt. Diablo Hospital where he was originally treated, received additional treatment at John Muir Medical Center, University of California San Francisco Hospital and Santa Clara Valley Medical Center where he remained hospitalized from August 24, 1998 through October 15, 1998. D. ACT OR OMISSION CAUSING INJURY AND DAMAGE: County mental health care providers including physician Dr. Hernandez and Dr. Champlin managed claimant Ard's mental health care. Drs. Hernandez and Champlin, and others whose names are currently unknown to claimant, inappropriately and negligently evaluated, examined, treated, diagnosed and cared for claimant Ard causing him to suffer a psychological or psychiatric event on or about August 8, 1998 during which claimant was unable to properly ambulate, recognize dangers, care for himself and exercise appropriate judgment, such that he suffered a serious fall fracturing his back and neck, requiring extensive medical care and treatment and causing permanent significant disability. Such negligent care included, but was not limited to, discontinuing specific psychiatric medication, without appropriate monitoring and follow up care, such that claimant suffered a psychiatric/psychotic episode during which he fell causing serious injuries. Claimant is unaware of specific additional negligent care and reserves the right to amend this care as those facts become available. As a result of his injuries, plaintiff suffered paralysis. E. AMOUNT OF CLAIM: $3,000,000 including medical expenses, lost income and general damages. Dated: December 1 ,1999 WALKUP, MELODIA, FELLY & ECHEVERRIA By CYNTHIA F. NEWTON Attorneys for Claimant 2 O .. - Fn) ' r 1 CAW OFFICES OF Wmxup,MELoDIA,KnLY&ECHEvER.wA ! ;. ,. _• •: A r=reamslvNu coaPanr►TIoN : ' . ..... '--' • ��= _. .,, 2 650 CALIFORNIA STREET,2GTH FLOOR K Tr•" 3 SAN FRANCISCO,CALIFORNIA 94108-2702 i'•• :,,t:CAF (415)981-7210 F, y 4 MICHAEL A. KELLY (State Bar#71460) CYNTHIA F.NEWTON(State Bar#130955) 5 ATTORNEYS FOR CLAIMANT 6 7 8 1N THE SUPERIOR.COURT OF THE STATE,OF CALIFORNIA 9 IN AND FOR THE COUNTY OF CONTRA COSTA 10 11 MICHAEL ARD' Case No. C99 03069 12 Petitioner, . ORDER PERMITTING FILING OF !3 V. LATE CLAIM AGAINST GOVERNMENTAL ENTITY 14 CONTRA COSTA COUNTY, [Government Code§946.61 15 Respondents. Date: November 5, 1999 • Time: 5:30 a.m. 16 Dept.: 17 Trial Date: None 17 18 It is hereby ORDERED,ADJUDGED, AND DECREED that the petition for an order 19 permitting a late claim against governmental entity is GRANTED on a combination of the grounds 20 of incapacity and also on the grounds of mistake,inadvertence and excusable neglect. 21 Dr.Davis S. Bradford's declaration along with the previously provided medical records 22 establish that it was more probable than not that petitioner was incapacitated and that based on that 23 incapacity petitioner's parents were overwhelmed with providing care for petitioner. 24 25 111 26 -1- OIDER PERMITTING FILING OF LATE CLAIM AGAINST GOVERNMENTAL ENTITY(Government C*dc§946.61 I The Court fcuther finds thatlapplication was made to the Board within a reasonable time in 2 that once petitioner's condition improved regarding his mobility and pain tolerance,the claim was 3 investigated and filed within one week. 4 5 DATE: JUDGE OF THE SUPERIOR COURT 6 7 g APPROVED AS TO FORM: 9 CRADDICK,CANDLAND&CONTI 10 11 BY: Thomas Manning 12 Attorneys for Defendant 13 14 15 16 17 1$ 19 20 21 22 23 24 25 26 -2, taw t,�1GSS 6F ' PETTrIONEWS REPLY TO RESPONDENT'S OPPOSITION TO PETITION FOR ORDER PERMITTING LATE CLAIM sua t.aosrta s AGAINST GOVERNMENTAL ENTITY 1G0vern0te6t Code§946.61 ten•►woa •w I'WK6C7D.rJtXn�wGa. yaf0!•t7gt tat SlYit•f�ty I The Court fiuther finds thalpplication was made to the Board within a reasonable time in 2 that once petitioner's condition improved regarding his mobility and pain tolerance,the clainn was 3 investigated and filed within one week. 4 5 DATE: NOV 18 'I JUDGE OF THE SUPERIOR COURT 6 JAMES R. IREMBATH 7 g APPROVED AS TO FORM: 9 CRADDICK, CANDLAND&CONTI 10 Thomas Mannidg 12 Attorneys for De Ia t 13 14 15 16 1'7 I8 19 20 21 22 23 24 25 26 -2- &AW off KU lot � r Htua.anui, . co01uiTluaw PETITIONER'S REPLY TO RESPONDENT'S OPPOSITION TO PETITION FOR ORDER PERMC[TING LATE CLAIM e n csiO lM+SURT AGAINST GOVERNMENTAL ENTITY[Cavernmenc Code§946AI law FLOOR 6W1f%jx SCC,CAUF09MIA 94101-tint qui•Si•77in i y s . u t a S f C L C w c y ��q 2. tC f T CJ f" e� P F Z- �I 7 L V ru CD ru tb NCD 0 ttt Ln u� } t c CLAIM BQAI ) OF SMERVISO S OF CON`Tf2.A MSTA CQUh'T'Y. CLALTF't)TtMA „ MARD AC110(It JANUARY 18, 2000 Crim Against the County, or District Governed by 1 the Board of Supervisors, Routing Erdor �� � ; �` � � NOTICE TO CLAIMANT and Board Action. All Section refer reso j The copy of ttis dominant mailed to you is your Caiiforria Governrrnent Codes. ` DEC > 4, 1999 notice of the action taken on your daim by the Board of Supervisors. (Paragraph IV belowi, given : �,�r � t � ptrsuem to Government Code Section 913 and 815.4. Please note all "Warnings". AMOUNT: Jurisdiction of Superior Court CL4dMA'NT: Victory Aiello, a minor ATTORNEY: c/o James C. Glassford DATE RECEIVED: December 13, 1999 Attorney at Law December 13 1999 ADDRESS: 500 Ygnacio Valley Rd, Ste 25dBY DELIVERY TO CLERK, ON: � Walnut Creek CA 94596 December 10, 1999 BY MAIL POSTMARKED: L FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 13 1999 PHIL Bey ,LOR, Cle Dated: ' By: Deputy ` IL FROM: County Counsel TO. Clerk of the Board of Supervi ors ( is 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 13 days (Section 910.8). ( ) Claim is not timely filed. Ilse 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 111. PRONL Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Clam was returned as untimely with notice to claimant (Section 911.3). TV BOARD ORDER: By unanimous vote of the Supervisors present: F1F1This Claim is rejected in full. � )` Comer: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated. E " l PHIL$AT'CHELOR, Clerk, By Deputy Clerk WARNING (Gov. code section 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this (natter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAn.ING -- 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 IS; and that today I deposited in the United States Postal Service in Martinez, California, postage full) prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: � ', By PHIL BATCHELOR By Deputy Clerk rz: rounty ram5r) County Administrator 4 JAMES C.GLASSFORD ATTORNEY AT LAW 500 YGNACIO VALLEY ROAD,SUITE 250 CIVIL LITIGATION WALNUT CREEK.,CA 94596 (925)274-0210 December 9, 1999 Clerk of the Board DECEIVED Board of Supervisors COUNTY OF CONTRA COSTA DEC + � g 651 Rine Street Martinez, CA 94553 CLERK BOARD OF SUPERVISORS C TA Re: Aiello vs . County of Contra Costa Date of Accident: September 23, 1999 Dear Clerk: Enclosed herewith fdr" preseritment 'to the Board of Supervisors are claims for damages on behalf of Michele Aiello and Victory Aiello, a minor. Please file these documents and return an endorsed-filed copy of the claim in the enclosed, self-addressed, stamped envelope. Thank you for your courtesy and cooperation. Yours very truly, _44 times C. Gla G\vss Civil litigation since 1974 Clerk of the Board -: RECEIVED Board of Supervisors COUNTY OF CONTRA COSTA DEC t 01999 651 Pine Street Martinez, CA 94553 EftlC BOARD OF SUPERVISORS CONTRA COSTA CO. BEFORE THE BOARD OF SUPERVISORS COUNTY OF CONTRA COSTA In the Matter of the Claim of Victory Aiello, a minor, Claimant, VS . The County of Contra Costa CLAIM AGAINST A PUBLIC ENTITY On behalf of Claimant, JAMES C. GLASSFORD, Attorney at Law, hereby presents this claim to the COUNTY OF CONTRA. COSTA, pursuant California Government Code, Section 910 . 1 . The name and post office address of the claimant is : Victory Aiello, a minor, 5551 Likens Avenue, Martinez, CA 94553 . 2 . The post office address to which JAMES C. GLASSFORD, Attorney at Law, desires notice of this claim to be sent is Law Offices of JAMES C. GLASSFORD, 500 Ygnacio Valley Road, Suite 250, Walnut Creek, CA 94596 . 3 . On or about September 23, 1999, Claimant received personal injuries under the following circumstances: Claimant visited the Contra Costa County Animal Services Department at 4849 Imhoff Place, City of Martinez, County of Contra Costa, CA 94553; while visiting the shelter, Claimant was exposed to Claim of Victoria Aiello, a minor 1 animals with rabies and came in contact with said animals; said animals with rabies presented a dangerous and hazardous condition at the time of the injury; that the dangerous condition created a reasonably foreseeable risk of the kind of injury which was incurred; said public entity negligently through its employees created the dangerous condition and after actual and constructive notice of the dangerous condition a sufficient time prior to the injury to have taken measures to protect against the dangerous condition permitted said dangerous condition to exist on its property or on property over which it had control; said public entity through its employees was negligent in the supervision, maintenance, inspection and repair of its property and property over which it had control; further, said public entity knew that the animals were rabid or carried the rabies virus, knew that the animals should be quarantined and kept separate from the other animals and away from the general public, had policies in place that governed the handling of rabid animals, and negligently and carelessly failed to follow said policies and allowed the general public, including the Claimant, to come in contact with the animals; further, said public entity negligently failed to warn of said dangerous condition; that as a direct and proximate result of the carelessness and negligence of said public entity and its employees and the above-described dangerous condition, Claimant sustained personal injuries and damages . 4 . So far as it is known to Claimant and JAMES C. GLASSFORD, Attorney at Law, at the time of the presentation of this claim, Claimant has sustained the following losses, Claim of Victoria Aiello, a minor 2 injuries, and damages : exposure to the rabies virus, medical expenses and future medical expenses, loss of earnings and earning capacity and future earnings and earning capacity, and general damages cognizable under the law. 5 . The true names and capacities of the public employees responsible for the accident referenced above are unknown to the claimant and JAMES C. GLASSFORD, Attorney at Law, who therefore claim that Does 1 through 100 are in some way responsible for the damages of the claimant. 6 . So far as it is known to Claimant and JAMES C. GLASSFORD, Attorney at Law, at the time of presentation of this claim, claimant has incurred damages in an amount within the jurisdiction of the superior court of unlimited jurisdiction. Dated: December 9, 1999 Respectfully submitted by Law Offices of JAMES C. GLASSFORD by rhes C. Glassford Claim of Victoria Aiello, a minor 3 CLAIM BOARD OF SIMERNISMS OF CQMA COSTA CO 7lti o CAi MENIA _BOARD A= JANUARY 1$, 2000 Dim Against the County, or District Governed by ) tN Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT end Board Action All Section references are to ) The copy of this document mailed to you is your California Government Codes. D I1] notice of the action taken on your daum by the Board of Supervisors. (Paragraph IV beiov4, given 1 & 1999 scant to Govermmnt Code Section 913 and DEC 815.4. Purse note all "Warnings". COUNTY COUNSEL AMOUNT: UNKNOWN MARTINEZ,CAUF_ CLAIMANT: MICHAEL BYFORD ATTORNEY: WILLIAAM J. DULLEA, BAR# 74342 DATE RECEIVED: December 15, 1999 Two 'Theatre Square, Ste. 234 ADDRESS: Orinda CA 94563 BY DELIVERY TO CLERK ON: December 15, 1999 BY MAIL POSTMARKED. December 14, 1999 L PROft Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL R, Clerk Dated: December 16, 1999 By: Deputy , IL FROM County Counsel TO: Clerk of the Board of Su isors ('This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated: --By. -6�`--'"Deputy County Counsel EL PROM- Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDEX By unanimous vote of the Supervisors present: 00 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. slated` PHIL BATCMWR. Clerk, By Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the snail 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 Sat Reverse Side of This Notice. A M_AVIT OF MALT NG I declare under penalty of perjury that l am now, and at all times herein mentioned, have beam 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. ►' tit� By. PHIL BATCHELOR By SJ14A Deputy Clerk Ll CC: County Counsel County Adndnistmtor 1 William J. Dullea (Bar #74342) Two Theatre Square, Suite 234 2 Orinda, CA 94563 (925) 258-0060 RECEIVED 3 4 Attorney for the Claimant MICHAEL BYFORD DEC 15 1999 5 CLERK FARD OP UPERVISORS T O _ 6 7 8 MICHAEL BYFORD, CLAIM AGAINST A PUBLIC ENTITY 9 Claimant, 10 VS . 11 CONTRA COSTA COUNTY ANIMAL 12 SERVICES DEPARTMENT, 13 Respondent . 14 15 1 . The address of Claimant is as fellows : 5513 Michigan 16 Boulevard, Concord, California 94520 . 17 2 . The address to which the Claimant desires notice of this 1$ claim to be sent is as follows : William J. Dullea, Two Theatre 19 Square, Suite 234, Orinda, California 94563 . 20 3 . On September 20, 1999, Claimant visited the Martinez 21 Animal Shelter and was exposed to rabies. 22 4 . Claimant was required to undergo a series of painful 23 injections . In addition, he has suffered, and continues to suffer, 24 from emotional distress caused by not knowing if he will contract 25 rabies . 26 5 . The name of the public employee (s) causing the injury is 27 unknown. 28 Claim Against a Public Entity - 1 1 6 . The amount of damages are unknown to Claimant at this 2 time. 3 4 i 5 Dated. William J. Dullea, attorne for 6 Claimant MICHAEL BYFORD 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Claim Against a Public Entity - 2 V N 0 uk ON U � 5,.r.., CD L t` t, Cl.CD r� NA��� * �• CO W �`✓ tri` i W M 1 1 Sf r' rR ti CLAIM BOARD OF SUPERVISMS t7F C0MA COSTA CC)Llri"T'Y, CAI:Tk`t`ENIA _BOARD AOO JANUARY 18, i600 Claim Against the County, or District Governed by the Board of Supervisors, Routing Endorsernents, 1 NOTICE TO CLAIMANT rdnd Board Action. All Section references we to The copy of Itis document mailed to you is your California Government Codes. ) notice of the action taken on your daim by the Board of Supervisors. (Paragraph IV below}, given � x77 Tr pursuant to Govermient Code Section 913 and 815.4. Please nate all *Warnings". AMOUNT: Unknown CLAIMANT: Melanie Calleja MART EZ Ca,IF. ATTORNEY: William J. Dullea DATE RECEIVED: December 3, 1999 Two Theatre Square, Ste. 234 December 3, 1999 ADDRESS: Orinda CA 94563 BY DELIVERY TO CLERIC ON: BY MAIL POSTMARKED. Transmittal L FROM: Clerk of the Board of Supervisors IOr County Counsel Attached is a copy of the above-noted claim. PHL BA R, Clerk December 6i1999Dated: By: Deputy II. FROM: County Counsel TO. Clerk of the Board of Supervi rs ( 7`iis claim complies substantially with Sections 910 and 910.3. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to 'present a late claim (Section 911.3). Other Dated: I --77ill By: L& 4uty County Counsel mL PROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER. 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. Datod. a" PML BATCHELOR, Clerk, By - Deputy Clerk WARNING (Gov. code section'913) Subject to certain exception:, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAIISNG 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: X-'N By: PHIL BATCHELOR. By4 IPA,,., 1 Ikputy Clerk M. County Counsel County Administrator office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: 335-1800 Martinez, CA 94553 Fax: 646-1078 Date: December 2, 1999 RECEIVED To: ANN M. CERVELLI, DEC 0 3 1999 CLERK OF THE BOARD OF SUPERVIS RS CLERK BOARD OF SUPERVISORS From: Victor J. Westman, County Counsel '`°' coNTRAC�sTACO. M J'. By Gregory C. Harvey, Assistant County Cd if w'l Subj: Claim of Melanie Calleja Please handle the attached claim in your normal manner. It was erroneously sent directly to this office, rather than to the Board of Supervisors as required by Code. cc: William Dullea Two Theatre Square, Suite 234 Orinda, CA 94563 CONFIDENTIAL ATTORNEY CLIENT COMMUNICATION 1 William J. Dullea (Bar #74342) Two Theatre Square, Suite 234 2 Orinda, CA 94563 (925) 258-0060 3 4 Attorney for the Claimant MELANIE CALLEJA 5 6 7 8 MELANIE CALLEJA, CLAIM AGAINST A PUBLIC ENTITY 9 Claimant, 10 VS . 11 CONTRA COSTA COUNTY ANIMAL 12 SERVICES DEPARTMENT, 13 Respondent . 14 15 1 . The address of Claimant is as follows : 5181 Kiowa Court, 16 Antioch, California 94509 . 17 2 . The address to which the Claimant desires notice of this 18 claim to be sent is as follows : William J. Dullea, Two Theatre 19 Square, Suite 234, Orinda, California 94563 . 20 3 . On September 23 and September 24, 1999, Claimant visited 21 the Martinez Animal Shelter and was exposed to rabies . 22 4 . Claimant was required to undergo a series of painful 23 injections . In addition, she has suffered, and continues to 24 suffer, fro emotional distress caused by not knowing if she will 25 contract ra ies . 26 5 . The name of the public employee (s) causing the injury is 27 unknown. 28 Claim Against a Public Entity - 1 1 6 . The amount of damages are unknown to Claimant at this 2 time . 3 4 f 5 Dated: , qu illiam J. Du11ea, attorney for 6 Claimant MELANIE CA.LLEJA 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Claim Against a Public Entity - 2 0 o ✓ W q 0 tD rn rr 0 CD to 0 E lett 4 t-h W W H- (D I-A w. C-4 r . tD N W N (p i +T > Q ¢1 U1 w N ri W m m N• b Ui fD0SDps CV r-r �D ti 0 iD 0 to {D 0 til ArTC1' US Ln Ul W lO f) no�.+ S}d p 0 N "� t ++ t i 5 j t I CLAIM IBQAEM OF SU ERMORS OF CQNM A =TA CO=s i.ffD N'1A ' JANUARY 18, 1999 Claim Against the Canty, or District Governed by ) CLC } a the Board of Supervisors, Routing Endorsements, ) cou,..,�COUNSEL NOTICE TO CLAIMANT' and Board Action. All Saction references we to ) MAS INEZ CALIF-Ttte copy of this docmnt Hauled to you is your California Government Codes. y retice of the action taken on your daim by the Board of Supervisors. (Paragraph IV belov4, given pursuant to Government Code Section 913 and 815.4. Rase note all `Warnings". AMOUNT: $3,825.00 CLAIMANT: BERNAD= DUGAN ATTORNEY: DATE RECE : DECEMBER 10, 1999 ADDRESS: 370 VERNAL DRIVE BY DI.L MY TO CLERK, ON: December 10, 1999 ALAMO CA 94507 BY MAIL POSTMARK: DECEMBER 9, 1999 .L PRONE Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. PHILark Dated: DECEMBER 10, 1999 B $A R, - ly: Deputy 41 IL FROM County Counsel TO: Clerk of the Board of SupervisorY (This claim complies substantially with Sections 910 and 910.2. ( ) This claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. 'The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { ) Other: Dated:( "" '' By: — - Deputy County Counsel HL PROM Clerk of the Board O : County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV. BOARD CARDER 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: Cid PHIL BATCHELOR, Clerk, By , ; Deputy Clerk WAG (Gov. code section 13) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the snail 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 clatter. If you want to consult an attorney, you should do to immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF IVSD nAU 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. '` ): PHIL BATCHELOR By I � Deputy Clerk W. rAwnty Counsel County Administrator 'laimyto: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 'day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp ,-97C V ar;Q W+Z.. h to l V -7 ) RECEIVED Against tfie County of Contra Costa or ) DEC 10 1999 (Fill in name) District)) CLERK gOA TD IRA U,, ,. The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$3 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 etails; use extra paper if required) What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? GG/ g..,. `fir J../(ffllrr 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6, "What damage or injuries do you claim resulted? (Give fall 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.) r ' e .+ g. Names and addresses of witnesses, doctors, and hospitals. A -1 t.- ,l.�"�G j .. t Q 9. List the expenditures you made on account of this accident or injury. DATE TIME A.Q.UNT Gov. Code Sec. 910.2 provides"The claim must be signed by the claimant or by some person on his behalf" NDN 'ITE TQ.- Name Name and Address of Attorney ) ) j (Claimant's 'ignature) 2LZ L (Address) y y Telephone No. )Telephone N NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one you,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the stage prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. l _.Y ( • * 4- +�'j Vim' ! • ........ p .. Tb4pin Construction r✓ l ESTIMATE� 2717 North Main St. Unit C Walnut Creek,Creek, CA 945?6 DATE ESTIMATE# License #626819 1112211999 351 (925)943-6817 Phone (925)937-4846 NAME/ADDRESS VHS BERNADETTE DOUGAN 370 VERNAL DRIVE ALAMO PHOTO i SERVICE# STATUS JOB ADDRESS NONE ACTIVE 370 VERNAL DRIVE ITEM DESCRIPTION QTY EMPLOYEE RATE TOTAL DO 104 SUPPLY&INSTALL SET OF TX 3,825.00 3,825.00 68"ENTRY DOORS. PAINT TO MATCH EXISTING. 0I" �w7 I I 4 SINCERELY TIM TOUPIN TOTAL $3,825.00 �dQy- Warranty t 18130-395-3667 Limited Warranty for Woad and Glass Doors and Entry Units Feather River Door("FRD")warrants all products sold for one year from the date of shipment,and at the time of shipment, to be of good material and workmanship and to be free from defects which would render said products unserviceable or unfit for their ordinary,recommended use,except as limited by this document. WARP TOLERANCES;Warp shall not be considered a defect unless it exceeds 3/16"in the plane of the door itself.Warp is any distortion in the door itself and does not refer to the relationship of the door to the frame or jamb in which it is hung.The term warp shall include bow,cup,and twist.Measuring the amount of warp present in a door,the following method shall be used:Bow,cup,or twist shall be measured by placing a straightedge,taut wire,or string on the suspected concave face of the door at any angle,(i.e.horizontally,vertically,diagonally),with the door in its installed position.The measurement of bow, cup,or twist shall be made at the point of maximum distance between the bottom of the straightedge,taut wire,or string and the face of the door tolerance. LIMITATIONS: The following shall not be considered defects in materials and workmanship and are not covered by this limited warranty: 1. Unsatisfactory service or appearance caused by failure to follow recommended handling,finishing and maintenance instructions.The appearance of field finished doors is not warranted in any event. 2. Natural variations in color or texture of the wood. 3. The warranty against warp does not apply to the following: a.all 1-3/8"and 1-3/4"doors which are wider than 42"or taller than 96" b.doors that are improperly hung or do not swing freely. 4. Damage caused by extreme temperature buildup where a storm door is utilized. 5. Damage associated with the structure and/or materials to which the product is attached,or other causes that do not arise out of the product itself. 6. Damage caused by placement of a door without providing adequate overhang. Adequate overhang depends on the typical weather conditions of the area where the door is installed,but typically means an overhang projecting a distance from the structure one half the elevation difference between the bottom of the door and the base of the overhang structure at the point which is farthest from the door. 7. Damage resulting from exposure to direct sunlight of more than two hours per day at any time during the year. 8. Any discoloration or irregularity in glass that is not visible from farther away than 6 feet. WARRANTY PERFORMANCE 1. If at the time a product shipment is received,said product(s)is found to have a defect which can reasonably be discovered by inspection of the entry unit do not install the unit,the purchaser must within ten(10)days,send written notice of said discovered defect to FRD. 2. If a defect is discovered or occurs after a door is fitted and hung,written notice of said defect must be sent to FRD within 30 days after discovery.FRD will not be liable for any doors repaired or replaced without its prior written consent. 3. Photos of the product,showing the defect or failure,should accompany the notice if possible.All notices concerning this warranty should be sent to: Feather River Door,9296 Midway,Durham,CA 95938. conditions.This deferral will not be counted against the warranty period. 4.Before any permanent repair to the product is made,the purchaser must allow FRD's agent to enter the property and structure where the product is installed,and examine and take photographs of the product(if not provided by purchaser). 5. If,after inspection,FRD determines that there is a defect or failure covered by this warranty,FRD will elect either to: a.Repair or arrange for repair of the product only without charge;or b.Replace the product only without charge,in the same stage of fitting and/or finishing as was originally supplied. 6. FRD will perform its obligations under this Warranty within 60 days after appropriate notice is given by the purchaser. 7. If the claimed defect is warp,FRD may defer repairing or replacing the product for a period of up to 12 months from the date of shipment,as it is not uncommon for a temporary warp condition to occur as the door adjusts to seasonal humidity and temperature. FRD's sole liability under this warranty is limited to such replacement or repair and it shall not be held liable in any form of action for direct or consequential damages to property or person.THE FOREGOING WARRANTY IS EXPRESSLY MADE IN LIEU OF ALL OTHER.WARRANTIES WHATSOEVER,EXPRESS,IMPLIED AND STATUTORY,AND INCLUDING WITHOUT LIMITATION,THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS.As there is variety of conditions under which FRD products may operate,any greater responsibility than herein set forth cannot be assumed by FRD unless a specific warranty is requested by the customer and agreed to by FRD in writing. Snlai/lniarm�►iion soo Main at. Stored For Feather River use only Chico.�.9692H 1(800)395-3667 Pax(430)695-9207 P.O. # Proposal Date Ordt�( Ll Store To Customer Store customer Street Name revue Street Address Address city Statezlp City ep zip tore ore q r� Phone Fax Phone .7 9%1Phone A.Species: Palntable Maple Knotty Pine❑ Oak ❑ I Mahogany❑ I Cher ry❑I Black Walnut Other❑] B.Swing: LJ 1:1 1�1 a E�� N 7 [7 0 El Shown as In-5WIng Left Hand Right Hared Leh Hand R)ght Hand Left Hand Right Hand Left Hand Right Hand Left Hand wght Hand G:Dour Model + - "+ Custom❑ Glass Design* VND-d Size 1 See Notes x $ Total 5-72,11-5 D:Sidelight Model* Custom❑ Gass Design Size to 11 See Notes Qty X $ Total E: Option To Increase Height: Add %To Doors(s) &SideliSM(s) (1)Up to 80"add$0, (2)80.1"to 84"add 10%, (3)84.1"to 90"add 20%. (4)90.1"to 96"add 300k,Total $ F: Add for Arch Top (inciudea Trim) Cd Add for Round Top(Includes Trim) ❑ ❑ El El $850 $1500 $1500 $1800 $950 $1800 Total S H: Transoms $ Custom See Notes ❑ Glass Design 11 of 11 Size X Panel Mould $200 ❑ Mullions $200❑ Total S I: Extras: Total 1: Handle Set f i.%M AlZ V, (Double Doors only) lets Active# 2 $ Gummy $ `3( 3 Total ' 165 K: Int. Trim: M-6 ❑ M-7 ❑ M-10❑ M-13❑ HSME ondude�,,price) Sub Total Si_ �t EXt. 1 riTYl: M-1 A❑ M-1 B❑ M-2A❑ M-2B❑ M-3A❑ M-9B❑ L: Glass Choices: f (i) Background J Border: 1❑, 2❑ 3 ❑ 4❑ Sales Tax ( %) (2) Came Choice: Lead ❑ Brass 9 Copper❑ (Southwest Gass only) (3) Glazing: Single Glaze ❑ Tr! Grand Total $� + g pie Glaze �„ Mt Prehang: Exterior K Interior❑ None❑ Feather River Use Only (1) Bore Type: A$ZL B❑ CF❑ cr❑ F❑ G ] SW❑ NoneE] (2) Hinge Finish: Bright Brass 9, Andque Brass ❑ (3) jamb Width: 4-5J8"0 Other (4) Threshold: Oak X Alu .Gold ElAlum.Bronze ❑ El Note (s) Net Unit b 3 c. 1 R.O. N: Premium Natural❑ O. Southwest smooth A❑ B❑ C❑ � T Medium ❑ Finish: Antique A❑ B❑ C❑ —T—AIL,((— &Al Dark❑ Knotty Pine Distressed A❑ B❑ C❑ Q None ❑ Only weathered A ElB E-1C El Send Tem�t. A Changes:Any changes submitted after project Is commenced,will be subject to additional charge. Sold By Customer bate E-1 ti S wkx�,a• A'� F 5. 0 8 •W4 U 44 y �, 4P nr � •c�a V1 a� d. we, Y w La O }huh CLAIM * AIM / BOARD OF SLtP'ERVISORS OF CO-)MLA COSTA COLMM1 � CALFORNIA BOARD AL"TiOht JANUARY 18, 2000 Crim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action All Section references are to ) 'the copy of this dacumnt trailed to you is your California Government Cones. . mice of the action taken on your claim by the Board of Supervisors. (paragraph IV below), liven pffsuent to Gavenvent Code Section 913 and DEC 17 1999 815.4, Plaw nate all `Warnings". AMOUNT: $1,000,000.00 COUNTY COUNSEL CLAIMANT: Michael Melvin Edwards MARTINEZ,CALIF. ATTORNEY: DATE RECEWED: DECEMBER 17, 1999 ADDRESS: 909 Barrett Avenue BY DELTMY TO CLERK, ON: December 17,- 1999 Richmond CA 94801 December 16, 1999 BY MAIL POSTMhRICfiD: 1 PROK Clerk of the Board of Supervisors Wk. County Counsel Attached is a copy of the above-noted claim. PHIL B R. Clerk Dated: December 17, 999By: Deputy FRONL County Counsel 'TCI: Clerk of the Board of Supervi 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. 7'be 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: 'd By: L' 2" Deputy County Counsel IM FROM: Clerk of the Board Tch County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). hN. BOARD ORDEM 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:_ Y- ---PHIL BATCHELOR, Clerk, By w Deputy Clerk 'DARNING (Gov. We section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited is the trail to file a court action on this claim. Sea Government Code Section 945.6. You may sack 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 Ws Notice. AFFIDAVIT OF 1MAnJNG 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 fulls prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: l� By: PHIL BATCHELOR By puty Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INS=TIONS TO CL 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 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. 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. Ermd. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Against the County of Contra Costa or ) DEC 17 1999 t . `, :, ; ! CIERK BOARD OF SUPERVISORS District) T ('Fill in name) 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? (rive 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 full4, tails, use extra paper ifrequire/,/�''{/'•'� (,, ]j yam.+ ''�-��^ }} �+ [ ((). J L 4< M y it p. 7 •.� 2 , } axi two e� ", � r �Kj�y ,�,�'l� f <'� '.tr""' yb �r@a �Y,�'•<s9'.3 ,�• �! ' t6�' Aw.'iw� 4•.,fL# !` !'kw.l' <�',�(7y.�i..< • {''•�F,•.}T'�e,..., i der*" ,//y�f�$ goy'`f� t r.. Si« iQ Te f o 7aro' l` Sax✓fkc:P '-.. G.:,A ::'- f> x: �.�•�' r�9rT ,s � � wld�e 3^.h ps3� I F /.� ,j+ •V" k'sk f I <,S<, , <.vr3_.J t S v.J'. f �I ansp"��► + y . _/^V"'�^� ���,r0 -�.: `tee]f;+�• �'ls.+. Ls'IW �rl •0.(, x j Tvrfg : ` I s° <d< * <� w ' `de 0 ++ a` rf fr �q ,r ,,c yrt,�n� , '� �•x Ivo b• - �.e,,P�`' a a � > ,y° a'tr _-'��t ¥"¢`� ,.J' ...1�•. "`a�.. .ice/` .e ,c'haG� 'R.' ad°°�w+ - s+ i..,,,,:.: '� � 2`Yn.• > A V.- cr6'j�'r.N �•T 9X..�:�d. i.�:.. 'Y� J�' At".'".��!."�...WTs � � � ez r <: < �e ,/.fa f.�,...,�i�,,6 �r� r3A`Ja ���'' :,,� ;�,. ,: �,r"`�t�t t;.�.F•�..�'a." '',�,,,yi r�„?�"`.�r�s� `'�,* � a1�+a All o tic 6y �. �% a ,m..••,; C all ,x: ^,?"u,.K:. `+NFe` Af''';`�.++'`..�7�►';, ;;i! :1+' �T Jam" R. °°" 4.w ry�a �8�ie, s'+7� � l'��"",,'�r "Y 'd,,�` +��E•l+:A'� ,/. ,p,y (��� Se.o-::.:leas^-sex", f �:xaa'S�J "�' :.. ar ,G .. � ` X'Y .ear•' a�•:,�/ �T" w P' '} r �` s $a`. f` `. �IT�r'. o. .►$'Axda�`r�'�d< •� 'ab P�..f ���. r .. !/J/♦,may 3 "C'. fA,rtt �N$y ,e�!>" "p�• < �, ,er � VMS vtz;/04�j aaa.r t iaa•F Naw r, y.✓ }y, yrs � - ad•' 4k i+ a"�o:•ftrafxa ; I'�'q^ .<.: ...,oaf: -.. 4. What particular act or orniss-ion on the part of county or district officers, servants, or employees caused the injury or damage? "k- YE. f A -f-,(mv e. 5. What are the names of county or district officers, servants, or employees causing the damage or injury? SFWD 5. What damage or injuries do you claim resulted? (Give full extent of injuries or damages Attach two estimates for auto damage.) b , `+ .$ �6 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) Q '' •• ll ` �r g 8 Names and ddresses of witnesses docto�r�a�f als. N .l? i t w �3i E £ Ek ket,i e 'pend..e•S'.•k , 3. Y. List the exitures you made on account of this accident or injury. DATE TIME AMQ ox Ca } Gov. Code Sec. 910.2 provides "The claim must be SEND NOTICES 10: -(Ang=y } signed by the claimant or by some person on his behalf." Name and Address of Attorney ) g '01 } (Claimant's Signature) } (Address) Telephone No. )Telephone 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 f ne of not exceeding one thousand(S 1,040),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. 7 a OIX o TI loom Q-I 1 777 f C' Z ! CL BI BOARD OF SUPERVISbRS OF COMA COSTA CdUNNT . CALIFORNIA BOARD AL"I10ftt JANIZARY 18, 2000 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The cry of this document mailed to you is your California Goverment Codes. N` A mice of the actim taken on your daim by the Board of Supervisors. (Paragraph IV belovv), liven suant to Government Code Section 913 and 915.4. Please note all 'Werninps". COUNT Y 0NSEL MAR T INE<i CALIF. AMOUNT: Jurisdiction of the Superior Court CLAIMANT: Cherronda Gray ATTORNEY: c/o Harvey Sohnen DATE RECEIVED: December 14, 1999 Law Offices of Harvey Sohnen December 14 1999 ADDRESS: 1850 Mt. Diablo Blvd. , Ste 650 BY DE1dVERY TO CLERK ON: y Walnut Creek CA 94596-4427 BY MAIL.POSTA+IARXED: December 13, 1999 L FROM: Clerk of the Board of Supervisors Ta County Counsel Attached is a copy of the above-noted claim. Dated: December 15, 1999 PHIL BAT "R Clerk By: Deputy '. 41 IL FROM County Counsel M Clerk of the Board of Supervisch c' is 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: %q? JIBy: County Counsel III. FROM- Clerk of the Board 70t County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TVf BOARD ORDIX By unanimous vote of the Supervisors present: [Xi 'Ibis Claim is rejected in full. O tkber: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PAIL.BATOR. Clerk, By c 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 nail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney. you should do to immediately. *For Additional Warning See Reverse Side of This Notice. AFFTDAVIT 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 fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: CPJ NIL BATCHELOR By ',. Deputy Clerk CC: County Counsel County Adntini",mtor RECEIVED LAW OFFICES OF HARVEY SOHNEN 1850 Mt. Diable Blvd., Suite 650 DEC 141999 Walnut Creek, CA 94596-4427 Tel. (925)945-1117 CLERK BOARD OF SUPERVISt)RS FAX (925)945-1245 December 13, 1999 Clerk, Contra Costa County Board of Supervisors 651 Pine Street,Room 106 Martinez, CA 94553 Re: Cray v. County of Contra Costa Enclosure: CLAIM AGAINST PUBLIC ENTITY These are famished for the purpose designated below: (X) Please file the enclosed original. (X) Please return to us endorsed file copies. {) Please issue original {) Summons {) Writ {) Abstract and return to us. { } Please present Judgment to Judge for signature and ( ) File and Return {) Please record enclosure(s)and return to us. {) Please set hearing on {) Our check in the amount of$enclosed to cover costs/fees. Kindly return your receipt. (X) A self-addressed,stamped envelope is enclosed. { ) Other: LAW OFFICES OF HARVEY SOHNEN BY: ISA CORDOBA RE IVEO In the Matter of the Claim of DEC 14 7999 CHERRONDA GRAY, Claimant ct1Rx 10ARD cF supERVISORS V. CLAIM AQAJNS1 COUNTY OF CONTRA COSTA, .Does 1-20, Inclusive, Respondents Cherronda Gray hereby presents this claim to the COUNTY OF CONTRA COSTA ("COUNTY') pursuant to § 910 of the Government Code. 1. Name and current post office address for Cherronda Gray is as follows: 19 Sapphire Court,Hercules, CA 94547. 2. The post office address to which Cherronda Gray desires notice of this claim to be sent is as follows: care of attorney Harvey Sohnen, 1850 Mount Diablo Boulevard, Suite 650, Walnut Creep, CA 94596,telephone (925) 945-1117. 3. DAM,PLACE AND CUCLTMSIANCES (A). Cherronda Gray is a 29 year old resident of Contra Costa County.Her date of birth February 24, 1974. She tripped and fell while walking on a set of stairs in a public area outside the Contra Costa County Courthouse,Richmond Branch, at 144 37th Street,Richmond, CA on November 16, 1999 at approximately 3:30 p.m. The accident occurred in the lower set of outdoor stairs facing 37th Street. More particularly it occurred at the middle of three steps in this set of stairs,about 146 inches from the inside north edge of the step.Respondent COUNTY owns and/or maintains the public sidewalk and steps in question. The steps were partially constructed with yellow bricks,which had large pieces broken off in the area where Claimant fell. Respondent created, caused,allowed, contributed, or assisted in the creation of a dangerous and defective condition of said public property,which existed upon such premises in sufficient time for the Respondent to have actual and/or constructive notice of such condition,and for the Respondent to correct or warn Claimant of the existence of such condition,which Respondent negligently and carelessly failed and neglected to do. 4. QFMML DESCRIPDDN OF=MY OR LQSS Claimant's left foot was injured,with symptoms including a torn ligament and swelling. Additionally,she has experienced pain and mental and emotional distress as a result of the injuries in question. She has sustained special damages in an amount yet unknown,which include treatment at Doctors Medical Center, San Pablo,CA,x-rays,use of a half cast and 1 crutches,and the following prescription drugs: acetaminophen with codeine, and naproxen. The amount of Claimant's health care treatment expenses is unknown at this time. Although the amount of Claimant's injuries or loss is not fully date ' ed at the time, said amount is within the jurisdiction of the Superior Court and exceeds$ Ott. Dated: December 13, 1999 `" --- HARVEY SOHNEN Attorneys for Cherronda gray 2 � �,� � � �� � �' � � � �, ® o �� �, �- ,� J� Q .7� �! �,> N �` '� C`1 � ��� � �o � � � � t'�'!+ � '���'' '✓� � � ,�` ,';1.!y`�L�`'�. ..� � � �� � ��� '%' � � ;t' t� � .� G� �;v �: „�.�'�'� �'- � ;��� .�. ,��:. r � � v" ti't��� 1t '��,,. � �`' ` 2�� �i.�F`� r � '�''� '� ��ti�'! r � � ��� 1lt.�. ti {' a �ylr��«+#xa i�� ««��4 CLAIM BOARD OF SUPERVISORS DE Cbri'fi`RA COSTA C©=o CALMENIA BOARD AMg4 J !ALY 18,2000 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, i NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this docwent r4led to you is your California Goverment Codes. 1D notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV belovA, given DEC 16 1999 psuant to Government Code Section 913 and 915.4. Please note all "Warnings". COUNTY COUNSEL AMOUNT: UNKNOWN MARTINEZ,CAL R CLAIMANT: Peter Jelen ATTORNEY: William J. Dullea, Bar#74342 DATE RECIUVED: December 15, 1999 Two Theatre Sq. , Ste. 234 December 15 1999 ADDRESS: Orinda. CA 94563 BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED. December 14, 1999 L PROM: Clerk of the Board of Supervisors T0. County Counsel Attached is a copy of the above-noted claim. Dated: December 16, 1999 PHIL BATCHMO& C l--M. By: Deputy � el IL FROA— County Counsel TO± Clerk of the Board of Supe isors (This claim complies substantially with Sections 910 and 918.2. ( ) `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: ji-• By: Deputy County Counsel M1 PROM: Clerk of the Board TA: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDIX By unanimous vote of the Supervisors present: {A ?bis Claire is rejected in full. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. ID Dated: al 010 0 PHIL BATCHELOR, Clerk, By Deputy Clerk WARNING (Gov, code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this mutter. If you want to consult an attorney, you should do to immediately. *For Additional Warning See Reverse Side of'Ibis Notice. AFMA'VTT OF MAIMG I declare ander penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: rIz y: PHIL BATCHELOR By Deputy Clerk CSC: County Cosmsel County Administrator r. 1 William J. Dullea (Bar #74342) EREEDTwo Theatre Square, Suite 234 2 Orinda, CA 94563 999(925) 258-0060 3 FRV1SORS CO. 4 Attorney for the Claimant PETER JELEN 5 6 7 8 PETER JELEN, CLAIM ACAINST A PUBLIC ENTITY 9 Claimant, 10 VS . 11 CONTRA COSTA COUNTY ANIMAL 12 SERVICES DEPARTMENT, 13 Respondent . 14 15 1 . The address of Claimant is as follows : 2798 Eastgate 16 Avenue, Concord, California 94520 . 17 2 . The address to which the Claimant desires notice of this 18 claim to be sent is as follows : William J. Dullea, Two Theatre 19 Square, Suite 234, Orinda, California 94563 . 20 3 . On September 21, 1999, Claimant visited the Martinez 21 Animal Shelter and was exposed to rabies . 22 4 . Claimant was required to undergo a series of painful 23 injections. In addition, he has suffered, and continues to suffer, 24 from emotional distress caused by not knowing if he will contract 25 rabies . 26 5 . The name of the public employee (s) causing the injury is 27 unknown. 28 Claim Against a Public Entity - 1 1 6 . The amount of damages are unknown to Claimant at this 2 time . 3 5 Dated: (-2 William ' J. Dullea, attorney for 6 Claimant PETER J'ELEN 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Claim Against a Public Entity - 2 H- 0 £ m rtt rr n m w L1 � m w n � N h' w- Cn 8 H- C4'rt tD t� to G w r tt N Ln9 ft cot H- ro ; 0 t3ro0 rr rt �r moron rr0 �Pl Ul w H rr I-oll IC- r <, O rr en, CD v 0 va � z r� r CLAIM BOARD OF SUPERVYSQ S OF CO)'T�A MSTA CD=s, CA, L:, FtN[A BOARD ACTId11t JANUARY 18, 2000 Claim Against the County, or District Governed by 1 ft Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. AR Section referemes are to The copy of this dDmment mailed to you is your California Goverment Codes. ) Mice of the action taken on your daim by the Board of Supervisors. (Paragraph IV belovrl, given fluent to Government Code Section 913 and 3 A. Phase note all "Wangs". AMOUNT: JURISDICTION OF SUPERIOR COURT CLAIMANT': BRIAN JONES Pv �l'I� COUNSEL �� A1.1F ATTORNEY: C/O Robert Diskint, S.B.#88232 DATE RECEIVED: December 7, 1999 CRITCHLOW & DISKINT ADDRESS: 300 Drake's Landin Road, Ste 250BY DELIVERY TO CLERK ON: par-m}-gr 7, 19cac)� Creenbrae CA 94904 BY MAIL POSTMARKED: T) r-,Pm-oar 7 19Qq L PitONL Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. PHIL BA R, C1Z2 . Dated: Dp-cember 7, 1922 By: Deputy IL FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 410 and 910.2. ( ) 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 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`' '� y �I-,,� I��4 ,_,Deputy County Counsel 11L PROX Clerk of the Board TLT: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 9113). IV. BOARD ORDEP.- By unanimous vote of the Supervisors present: (14 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. y4 / LiML BATCHELOR. Clerk, By �,.� � Deputy Clerk IV WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do to immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAUJNG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: ti P L BATCHELOR By „ Deputy Clerk CC: County Counsel County Administrator I Robert Diskint, S.B. #88232 RECEIVED CRITCHLOW& DISKINT 2 300 Drake's Landing Road, Suite 250 DEC 7 � � Greenbrae, CA 94904 3 415-925-1000 415-925-0936 (fax) CLERK BOAR5MTU EFIS 4 CONT ACOSTACO. 5 Attorney for Claimant BRIAN JONES 6 7 8 9 10 In re The Matter of The Claim of I1 BRIAN JONES, CLAIM FOR PERSONAL INJURIES 12 Plaintiff, 13 V. 14 COUNTY OF CONTRA COSTA, 15 Defendants. 16 17 18 1. Claimant is Brian Jones, c/o Robert Diskint, Critchlow & Diskint, 300 Drake's 19 Landing Road, Suite 250, Greenbrae, California 94904 (Tel: 415-925-1000); 20 2. Notice should be sent to the above address; 21 3. Claimant was injured on June 9, 1999 at the Contra Costa Regional Medical 22 Center. He was wrongfully and forcibly ejected from the hospital, although seriously ill and 23 awaiting surgery. This claim is not to be construed as limiting or excluding any other areas 24 of liability, legal or factual, which may become known to the claimant upon discovery 25 conducted during the course of investigation or litigation. 26 4. Plaintiff suffered extreme emotional distress as a result of being ejected from 27 the hospital and suffered pain and suffering caused by his medical condition without proper 28 medical attention. Page 1 of 2 Claim for Personal Injuries yet ,n e,-s 1 5. Dr. McDonald was the treating physician. The names of the persons who 2 ejected him and who were responsible for the ejection are unknown. 3 6. Jurisdiction rests in the Superior Court. 4 5 Dated: �*z CRITCHLOW& DISKINT 6 7 By: Robert Diskint 8 Attorney for Claimant BRIAN JONES 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 Page 2 of 2 Claim for Personal Injuries I PROOF OF SERVICE 2 I, JENNIFER ANN TAYLOR, declare that I am over the age of eighteen years and 3 not a party to this action. My business address is 300 Drake's Landing Road, Suite 250, 4 Greenbrae, California 94904. 5 On December 6, 1999, 1 served a copy of the attached CLAIM FOR PERSONAL 6 INJURIES by placing a true copy thereof enclosed in a sealed Federal Express envelope 7 for FedEx Priority Overnight delivery, tracking #8154-8520-41422, addressed as follows: 8 Clerk of the Board of Supervisors County Administration Building 9 651 Pine Street, Room 106 Martinez, CA 94553 10 11 1 declare under penalty of perjury under the laws of the State of California that the 12 foregoing is true and correct, and that this declaration was executed on December 6, 1999, 13 in Greenbrae, California. 14 15 TAY OR 16 ---- 17 18 19 20 21 22 23 24 25 26 27 28 S` CD -e _ D :aI-D �. < 1 0 CL W4 CD CD -- 3 Orr 04 a .., 41b- #4 w RECIPIENT; PEEL FERE ..W "�� � 0 � lei q,-. =1 �. . s N V f�� } o a ti y� O C tII f� IXN 0— yrr �r/ r ;^ IE W.- III ru CrLn a 3 Ln I ru C3 ri} tu TE. ru R j c Fit X� p N�, ru : . OWA ' { gob . s - EDN lit ❑ - g oil tim .� �.... I t - � x' s � m � sr AIDED CLAIM -' CLAIM ]ROAM Of SUPERVISORS DE QbMA_ COSTA MTNMCA11F ORNT e Bopp JANUARY 18, 2000 Cutin Against the County, or District Governed by I ft Board of Supervisors, Routing Endorserneents, I NOTICE TO CLAIMANT and Board Action. All Section references are to I The copy of ttis document mailed to you is your California Goverment Codes. I notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV beloo, given y-- V pursuant to Governrn nt Code Section 913 and 835.4. Please note all "Warnings'. AMOUNT: $5,000.00 Rd �.C?UMSrL CLAIMANT: Gregory Lee 10AuR CI't4 CA1��e•. C AMRNEY: DA-M RECErjM: December 30, 1999 ADDRESS: c/o Mar j ella Harris BY DELIVERY TO CLERK ON: December 30, 1999 1849 1st Street Richmond CA 94801 BY MAIL POSTMApj=: December 23, 1999 1 FROft Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. December 30 1999 PHIL BAT R, Clerk Dated: ' Ay: Deputyl:a-� IL FROM: County Counsel TO. Clerk of the Board of Supervi rs (tis 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: / "" .� e By: Deputy County Counsel III. PROM Clerk of the Board TO. County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). PV. BOARD ORDEFL By unanimous vote of the Supervisors tA 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. IDated: 4 �.PML BATCHELOR, Clerk, By Deputy Clerk WARMING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFF'ID►A'm OF MAnI NG I declare under penalty of perjury that t am now, 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. By: PHIL BATCHELOR By „� .- De uty Clerk �..�`. p r- -. office of the County Counsel Contra Costa County 651 Pine Street, 9th Floor Phone: 335-1800 Martinez, CA 94553 Pax: 646-1078 Date: December 29, 1999 To: Ann Cervelli, Chief Clerk Clerk of the Board of Supervisors From: Victor J. Westman, County Counsel by: Gregory C. Harvey, Assistant County Counsel t Subj: Claim of Greg Lee Please treat this letter as an amendment to the claim filed on December 13, 1999 by Gregory Lee. cc: Risk Management GIA ROAIM OF" SUPERNISORS OF �Q'ti'TT�A Gt)STA COUh"I'Y. CALiFt�ttNTe BOARD A00 i uAR.Y 18, 2000 Crim Against the Cwity,'orr District Governed by the Board of Supervisors, Routing Endorsemerits, , t. NOTICE TO CLAIMANT Md Board Action. All Section references wign The copy of this document railed to you is your California Goverrrfient Codes. ` ` trotice of the action taken on your claim by the Board of Supervisors. (Para a h IV bel*, liven DEC 14 0� ppuurrsuant to Goverrmnt Cod Section 913 and vU f-,f, COUNSEL 815.1. Please mote all "Warnings". TNT EZ,CALiF AMO ({ CLAIMANT: Gregory Lee AMRNEY: DATE RECENED: December 13, 1999 ADDRESS: c/o Marjell.a Harris BY DELIVERY TO CLERK ON: r5cr�amlv�r � �, 1A4A 1849 1st Street Hand-Delivered from Risk mt. Richmond CA 94801 BY MAIL POSTMARKED: Mg L PRO hL Clerk of the Board of Supervisors 70. County Counsel Attached is a copy of the above mod claim. Dated: December 13, 1999 B HIL BA R. Clark Y: Dep 41- 601 IL FRONL- County Counsel TO Clerk of the Board of Supervisoff ( ) This claim complies substantially with Sections 910 and 910.2. { , -ji is claim FAILS to comply substantially with Sections 910 and 910.2. and we are so notifying claimant. The Board cannot act for 13 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 113L IPRO?4- Clerk of the Board TQ County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). TV. 204M ORDEN' By unanimous vote of the Supervisors Present: { ) This Claim is rejected in full. { ) Other: I ca tify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: PHIL BATCHELOR, Clerk. By . Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. if you want to consult an attorney, you should do to mediately. *For Additional Warning See Reverse Side of This Notice. A MAVTT OF G I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez„ California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: By: PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Administrator '�IC��I'oki.WESTMAN a purlEs: PHILLIPS.ALTHOFF COUNTY COUNSEL JANICE L.AMENTA NORA G.BARLOW B.REBECCA BYRNES SILVANO B.MARCHESIANDREA W.CASSIDY CH IEP ASSISTANT COUNTY COUNSEL tC }N F A COSTA' �TY MONIKA L.COOPER u MARKE S.ESTIS SHARON L.ANDERSON MICHAEL D.FARR C{ k U}INI$Tt�!'L�iC >9tJN._i6 `; LILLIAN T.FUJI[ ASSISTANT COUNTY COUNSEL JANETI L,HOLMESGRAVES C. HOLMESS MAf T II OOW 1229 KEVIN #HERR GREGORY G.HARVEY r BERNARD L.KNAPP ASSISTANT COUNTY COUNSEL EDWARD V LANE,JR. BEATRICE LIU MARY ANN MASON GAYLE M(}G(,n,LI PAUL R.MUIWIZ OVALERIE J.RANCHE OFFICE MANAGER STEVEN P RETTIG DAVID F.SCHMIDT PHONE(925)335-1800 BARBARAIt SUTLIFFE FAX(925)06-1078 JACQUELINE YWOODS NOTICE OF INSUFFICIENCY ANIS/O NON-ACCEPTANCE QF CLAIM TO: Gregory Lee c/o Marjella Harris 1849 1st. Street Richmond, CA 94801 RE: CLAIM OF: Gregory Lee 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 3. 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. [ 15. 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 Page 1 amount claimed 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 [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 .Monika L. Cooper _ ERTIFICATE 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;1 am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of 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: December 15, 1999,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM;GOVT.CODE§§916,910.2,920.4,910.8) Page 2 'Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIIYtANT 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. (Govt. Code§911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. If Claim is against a district governed-by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity,separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. * * * a a * a * x a * * * a * * RE: Claim by ) Reserved for Clerk's Filing Stamp Against the County of Contra Costa fl V EI v or DEC 1 lqq District) CL RK DNTR OFSraER O88 {Fill in Name} The undersigned claim t hereby makes claim against the County of Contra Costa or the above named District in the sura of S=ZJ��'and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Bate and Hour) r. - ; _- -- Page- ------ __- -y= =___ _ __U '=- ��'' 2. Where did the da or injury occur? (Include City and County) _-`- -- 3. How did the damage or injury occur? (Give hM details;use extra paper if required) _ '_ 4. . What particular act or�lomission on the part of county or distric officers, serve ts, or employ ees caused the ,� �,�vinjury or damage? (Over) -auk pue luawuosuawl gone, gloq ,Cq jo `(000'0IS) siellop puesnogl u23 lulpaaaxa Sou jo au ji a.Cq'uosud ale3s ay3 u1 luawuosuduri ,Cq.ro.'aur pue 3uawuosudw! gans gloq Cq 1o'( 0006IS) �gllop pussnog3 ano aulpaaaxa 3au jo auks Xq 'aeafi auo usgpt alouc lou}o pound a joi I!sf Annoy aql ul 3uawuosudw!dq.gag3!a algegslund s!'Sulll.gb jo 'laganoe 'lunoaae '11!q `w!ela 3ualnpmrr;jo asle{xue'aumua dl auras ag3 Cad.qo bolls of paz!uog3ns'J33WO.ro p.rsoq lal.r3slp.ro,C31a'63unoa Cue of 10'J23WO Jo p.rsoq 341M.Cas o3 luaus ud aoj jo aausbops aoj s3uas2ad'pnwj3p of luam gllb'ogb uosaad SiaAa„ :sap!eoid apo leuad aql.lo ZL uop3aaS . �� IZOAI Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y -•---r- -ox auogdalas •oNj auogdala.L r' {ssajppd) { 211"euarrs s,3uewluo) 92uJouv 3o ssajppv pus aweN „31egaq siq uo uosiod awos.+q Ja {.fau.golld) :rj,L S331109 QK3S luewrela aql Sq paugls aq lsnw Lump agJL" :sap!,toad Z"016 -Ja5 apo 'A09 ,Iti owV IN3LI rva :Sjnful jo luap!a,e slg3,}o lunoaas uo apew noiCswnllpuadxa aql ls!'I '6 ilel!dsoq PUT's.ropop'sassaul!b;o sassaappe pile sawell •g ------------------------------------------------ -"---------------- (•aSinuep.ro.ianful aAp3adsosd.4L'uvJOpwxqoluw patsautrsa aro apnlaul) ypalndwoa iunowe paw!ela aAoqu aql se.+.bog -L V (-a9riruwp own ao}saiswpsa oxr q-rid -paunrla-Satunp ao salan(ul jo ruarxa un}am!)) `pai!nm w!ela noA op saunfur io sageursp 3sgtA ^9 Z,Unful ao a$swsp aql Su!snea mSoldwa ao'slus.+ras's raoWo lau3s!p ao.Chinon so saureu ay3 ars;eq & •S �'Z."-, d NS ! s AAo- to z6kz 5 ,-A f� CA- t`- �9t�. -� .6 p ■� � 4b ffrrh t gEErtb �yyyss,yypsyyy��rryy w ,67LCL'47US4 ACCT: 1406249 GUAR: 558-21-9753 LEE,GREGORY MARSHALL,PENNELLAME 1849 1ST STREET 1849 1ST STREET RICHMOND, CA 94801 RICHMOND, CA 94801 510-233-9888 (H) 510-233-9888 (H) 9 M ADM/SER: 09/05/99 UR CHG: 0 CCHP-MC 0 ED DISCHARGE: AR CHG: 346.11 SP 0 FB 09/11/99 LST STMT: BALANCE: 0 -------------------------------------------------------------------------------------------- BCH DATE BCH SER DATE USER PROCEDURE BL# DESCRIPTION AMOUNT TOTAL 09/07/99 185 09/05/99 MEDICLOSE 31009002 ED CARE URGENT LEVEL 3 162 .00 162 .00 09/07/99 185 09/05/99 MEDICLOSE 31009011 EVALUATION & MANAGEMENT 90.25 252.25 LVL 2 09/10/99 161 09/05/99 MEDICLOSE 51510501 SUTURE TRAY 68.12 320.37 09/10/99 161 09/05/99 MEDICLOSE 55047401 SPONGE GAUZE 4X3 2.80 323 .17 09/10/99 161 09/05/99 MEDICLOSE 55110100 SYRNG SOCC CATH 3 .94 327.11 09/10/99 161 09/05/99 MEDICLOSE 55158703 N. SAL. 1000CC 15.79 342 .90 09/07/99 186 09/07/99 MEDICLOSE 70006670 DIPHENHYDRAMINE HCL - 3.21 346.11 DIPHENHYDRAMINE HCL 25 MG/CAP CAP 09/12/99 2 09/11/99 MEDICLOSE CCCHP-MC 1 CONTRA COSTA HEALTH PLAN - -86.53 259.58 MC - FINAL - BILL # 1 11/23/99 146 11/18/99 PAO.MW PCCHP-MC 1 CONTRA COSTA HEALTH PLAN - -259.58 0 MC Doctors ITEMIZED STATEMENT Medical-Cer.,ter FUE73147 OFALL CHARGES San Pablo Campus P.O.BOX 73147D 1-ER 08/12/99 1 Tenw'Cnlifoenio Ilealih5ystem SAN FRANCISCO,CA 44160-73147 RUMFOM GREGORY D LEE 9921900067 M 9Y 08/07/99 08/07/99 029002 MEDT-CAL LOCAL INITIA CCHP 621301099 GREGORY D LEE ❑ MASTERCARD CARD NO j 1849 1ST STREET ❑ WSA ExPIRAT7ONDATE RICHMOND CA 94801 SIGNATURE PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE :: :DATE (7ZM N0.'< DMAIPIRON E Of QTY UNIT PRICE 7Y3TAL CHARGES 08/07/99 3374 IPRATROPIUM INH 0.02% 250 4 1 24. 55 24. 55 08/07/99 4943 TRIPLE ANTIBOTIC 144S 250 5 1 7. 99 7. 99 08/07/99 6460 ALBUTEROL INH 2.5MG 250 3 2 13. 32 26. 64 TOTAL PHARMACY 59. 18 08/07/99 1042 NACL IRRIG 0.9% 500ML 258 7 1 117. 10 117. 10 08/07/99 1284 NACL 0.9% 250ML 258 6 1 167. 90 167. 90 TOTAL PHARMACY IV SOLUTIONS 285. 00 08/07/99 199 SYRINGE 30 CC LUER LK 270 14 1 12. 70 12. 70 08/07/99 2425 SUTURE,ETHILON 270 9 1 37. 20 37. 20 08/07/99 2425 SUTURE,ETHILON 270 18 1 37. 20 37. 20 08/07/99 258 CATH ANGIO 18GA X 1.25 270 13 1 35. 30 35. 30 08/07/99 296 DRESSING XEROFORM 1 X 8 270 12 1 19. 70 19. 70 08/07/99 327 DRESSING 4 X 4 SPONGES 10/PK 270 10 1 19. 70 19. 70 08/07/99 327 DRESSING 4 X 4 SPONGES 10/PK 270 16 1 19. 70 19. 70 08/07/99 3334 SLIT POLYSORB 4-0m, 0 = 270 17 1 39. 40 39. 40 08/07/99 339 DRESSING KERLIX SMNGE R&L 270 11 1 28. 20 28. 20 08/07/99 761 TRAY LACERATION A0ME 270 . 19 1 90. 00 90. 00 08/07/99 85 GLOVE TRIFLEX SZ d' 15 1 15. 60 15. 60 TOTAL MEDICAL/SURGICA4 SU-PPLI,ES 354. 70 08/07/99 120 HHN, INSTRUCT W/1 ST TX 411G. 8 1 137. 90 137. 90 TOTAL RESPIRATORY SERVICES 137. 90 08/07/99 522 ED VISIT LEVEL 2 450 1 1 400. 00 400. 00 08/07/99 582 PULSE OXIMETER SINGLE 450 2 1 39. 00 39. 00 TOTAL EMERGENCY ROOM 439. 00 TOTAL CHARGES 1, 275. 78 10/27/99 2008 974 (T)*COMM./HMO/PPO/ INS. PYMT - 130. 39 10/27/99 2028 974 (T)*HMO/PPO CONTRACTUAL W/O - 1, 145. 39 Continued ADDITIONAL PATIENT BILLING MAY BE NECESSARY FOR PLEASE REFER TO PATIENT ANY CHARGES NOT POSTED WHEN THIS BILL IS PRE- 9921 900067 NUMBER ON ALL INQUIRIES PARED, OR IF ANY INSURANCE CARRIERS DO NOT PAY AND CORRESPONDENCE. ANY AMOUNT OF TYPE AMOUNTS SHOWN. PLEASE RETAIN FOR YOUR RECORDS Doctors ITEMIZED STATEMENT Medical Center FILE 73147 OFALL CHARGES San Pablo Campus,, P.O.BOX 73147 D1-ER 1 08/12/99 2 Tenet'Californio HealihSyotem SAN FRANCISCO,CA 94160-73147 GREGORY D LEE 9921900067 M 9Y 1 08/07/99 48/07/99 029002 MEDI-CAL LOCAL INITIA CCHP 621301099 i GREGORY D LEE ❑ MASTERCARD CARD NO I J 1849 1 ST STREET ❑ VISA EXPIRA77ONDATE RICHMOND CA 94801 SIGNATURE PLEASE DETACH AND RETURN THIS PORTION WITH YOUR REMITTANCE DATE" [7YtM Nov DEscRIPnON c °'; " Q u lT�t#tCE TOTAL CHARGES' TOTAL PAYMENTS/ADJUSTMENTS - 1, 275, 78 I�f , ADD177ONAL PATIENT BILLING,MAY BE NECESSARY FOR PLEASE REFER TO PA77ENT ANY CHARGES NOT POSTED WHEN THIS BILL IS PRE- 0. 00 9921900067 NUMBER ON ALL INQUIRIES PARED, OR IFANY INSURANCE CARRIERS DO NOT PAY AND CORRESPONDENCE. ANY AMOUNT OF THE AMOUNTS SHOWN. PLEASE RETAIN FOR YOUR RECORDS Children's Hospital Oakland � EMERGENCY DEPARTMENT RECORDnrr, Page 1 747 52 nd St. (510)428-5240 W PATI DATE T I E IAGE 1 2 3 :a 4 Trauma Elt° ° TEGORY AG (CI C RI AR A ROVIDER REATHING rmai CLAY/ F ": �> ❑Labored El Rapid BROU HT BY: RELATIONSHIP: I EjOear Wheezing []Decreased ❑Coarse ❑ Stridor ARRIVAL MO WALKED ❑CARRIED []AMBULANCE UNIT LATION: Cap Refill: >2 Sec. 2 Sec. ATION: branes: lot ❑ Poor Tui or CHIEF COMF_k60d1C V-- SIGN or ❑Cool ❑Diaphoretic ❑Flushed PM Pale ❑Clammy ❑Cyanotic ❑Dusky fAllert Oriented 13CooperativeALLERGiIES CONSCIOUSNES leeping ❑Lethargic ❑Unconscious MEDICAT{O S: []RespondatoRaio sad Irritable ❑Combiative IMMUNIZATION: UTD/w last tetanus TRIAGE ASSESSMENTANTERVEN HT T ULS RE B.P./to S ture) kg cm °C R.N. HISTORY: PHYSICAL Describe Problem. VOftrmal. No V or comment implies system not examined. GENERALASSESSM€NT: to `1.-� HEAD '> EYES v r EARS ❑ NOSE ❑ uL t rYtaZ THROAT - �* NECK G+ LUNGS HEART CHEST l3 _ BACK ❑ ABDOMEN. GU ❑ ZJ PMH/FH/SH: ❑ NONCONTRIBUTORY EXTREMITIES ❑ ✓yr`' SKIN ❑ c vV•a., NEURO } LYMPH NODES ❑ {,y.. s ' ❑ See continuation page for Progress i P cedure Note OTHER ❑ y.: <a. CONSULTATION: Ph 'cian/Services: 'c'ti` Time Called: Time Reached: Time Arrived: Physician/Services: Time Called: Time Reached: Time Arrived: ATTENDING NOTE: Attending Signature Attending Printed Name d DIAGN SIS: (List most seveff first) DI OSITIt?N:TIM INSTRUCTION SHEET GIVEN: ¢ CONDITION:, ❑Fever 5 ;IOME ; ❑ADMIT TO: ❑Vomiting&Diarrhea 611 ❑TRANSFER❑PMD CALLED ❑Dehydration AFTER CARE IN TRUCTIONS: ❑Wound Care == y ❑Head Injury Varicella ❑Fracture ❑Sedation ©Otitis Media ❑Croup a > FOLLOW UP: Culture Results I hereby acknowledge receipt of iiilbovp instructions. I understand that only emergency treatment has been render"d that I am responsible for arranging follow-up care. if chil s condNion worsens,I will call my physician 4oftact gn emergency department at once. t. S! ature Dlscharoed By Phvaician Slanature Phveician Printed Name L Children's Hospital Oakland EMERGENCY DEPARTMENT RECORD [r H Page 2 .,. ,t 4 �� i r.' J.R 747 52 nd St. (510)428-3240 W TIME TEMP PULSE RESP BP 5802 02 OTHER NURSING NARK TIVE(TIME&INITIAL EA0H ENTR A �- U , Dip Urine time: : Glucose Check time: mg/dl time: mg/dl enter time for each test ordered. LAB/RADIOLOGY ORDERS: Time Lab Results Time Lab Results• Time Lab Results Radiolo /X-ray: Amylase: CSF Routine/w C&S: Urine C&S 5Y Y: Ui / WBC/RBC; / (write in time,study&results) BUN/Creat: / U/A c diff.: Bili T/D: / Prot/giu: Gram Stain: WBC/RBC: / Blood C&S Glu: L.E./Nit.: / Ca(ionized): Urine HCG: CBC tr diff: Lytes: / / Na/K: STD Panel H/H: / G.C.Cult. WBC: Cl/CO2: / Strep Screen Chlamydia Sag/band: RPR Ly/ATL: / (/w cult if needed): Platelet: K ABG: FI02 pH PCO2 - P©z BE date ORDERS: Meds/ other studies) IV SOLUTION: t f> SITE: SIZE: INITIALS AMOUNT TOTAL TIME REMARKS Vc6 '.•z INFUSED INFUSED p :M. Physician's 9lgncc atu < 0 MEDICATION GIVEN: 0 Medication DOSE R TE TIME INITIALS 14,151 t� _11r 4 W _ uM' Nurse(Initial/5ignatureRitie):," Nurse(Initial/SignatureiTitl e): {/ Air rrc®/Iniitat/Cinneir rru/7ittni• /, nn�rrrerr nr nnnrrinnrrnr.r nc�r•Tr.� . n 1. :� / � ,- Children's Hospital Oakland �. -HISTORY & PHYSICAL EXAMINATION LE�� t� IA. E�►�� � S'� °,xf` J q/'15/94 A NAME /'�' E DAT F EX MM TIME DATE OF SURGERY CHIEF COMPLAINT PRESET ILLNESS ( a t'Lhfil At, FAST HISTORY: NbNi ' IF YEI,SPECIFY OPERATIONS [� ( c.-, SCS tj til'-•; e:�-P'r. TRANSFUSIONS -q ❑ BLEEDING PROBLEMS '� ❑ INJURIES ❑ ILLNESSES ❑ ❑ IALI&9-- - ALLERGIES *1&4 ❑ SIGNIFICANT PSYCHOSOCIAL NEEDS(FAMILY HX,SOCIAL HISTORY ETC.): LMP IMMUNIZATION STATUS MEDICATIONS ��"'t^ L REVIEW OF SYSTEMS WT. K VITAL SIGNS: T �' P (4PR NORMAL S 'r NORMAL ABNORMAL FINDINGS SKIN ABDOMINAL HEAD GENITALIA EYES RECTAL ❑ N/A ENT [ EXTREMITIES ❑ • D P NECK `Q NEUROLOGIC,AL HEART -LLYMPHATICS BREAST PELVIC `® ❑ NIA LUNGS �, t. U- . IMPRESSION: tf4/4L.1 PLAN: I DISCUSSED FAMILY'S EXPECTATIONS ❑ PT.AND/OR FAMILY INFORMED OF RISKS,BENEFITS,&ALTERNATIVES OF SURGERY. r- M.D. { -SIGNATURE r FORM#65410 `§ �j� �` f � . ��/� �.�-- �� �v �y a t� 'i gc ,-�, �. �'G. j�. �Y w' � s s OP 40 4► The Board of Supervisors Contra4�� ,� Ghil Batchelor of the ard County Administration Building County Administrator and Costa 651 Pine Street, Room 106 (925)�ss•tsoo Martinez, California 94553-1293 ���n� /9 � John Gioia,1st District ��/ Gayle Uiikema,2nd District Donna Gerber,3rd District >. Mark DeSaulnler,4th District f Joe Ganciamills,5th District ids 4° January 21, 2000 Ms. Marjella Harris 1849 lst Street Richmond CA 94801 Re: Claim of Gregory Lee-Original Materials Request Dear Ms. Harris: Enclosed please find copies of the original medical reports and photograph submitted with your claim for Gregory Lee on December 13, 1999 to the Clerk of the Board of Supervisors. Unfortunately, we cannot return the original materials of claims filed with the Clerk of the Board of Supervisors as they must remain a part of our permanent claim records. Sincerely, gm,-./ Joan Staley Deputy Clerk Clerk of the Board of Supervisors Encs: Copies- Medical Records/Photo 111:r . �'y CLAIM BOARD OF S[MRVIS RS DE COMA MS'TA MUh`TY. CALEMMA IMARD_ACT!O[ JANUARY 18, 2000 Claim Against the County, or District Governed by 1 V e Board of Supervisors, Routing Endorsements, 1 NOTICE TO CLAIMANT and Board Action. All Section referemces are to 1 The copy of tors document meiled to you is your California Goverrrnent Codes. notice of the action taken on your damn by the Board of Supervisors. (Paragraph IV belov4, given O pursuant to Goverrrnant Code Section 913 and 915.4. Please note idl "Warnings". COUNTY C $641.23 for medical. bills; NfARTI ZCAUFL $5,000.00 for pain and suffering CLAIMANT: DIANE LEWIS SBN 91179 ATTORNEY: c/o R. Nicholas Haney, Esq. DATE RECEIVED: December 8, 1999 227 Broadway December 8, 1999 ADDRESS: Richmond CA 94804 BY DELIVERY TO CLERK ON: BY MAIL POSTMARKED: Hand-Delivered L FROM: Clerk of the Board of Supervisors TO. County Counsel Attached is a copy of the above-noted claim. Dated: December 9, 1999 By; DepuPHIL B HELOR, 2ti6�� ty II. FROM: County Counsel M. Clerk of the Board of Supervii6rs ( 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; ` r` By; r Deputy County Counsel IB. PROM Clerk of the Board 710. County Counsel (1) County Administrator (T) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). 1V. BOARD ORDER: By unanimous vote of the Supervisors present: {-A This Claim is rejected in full. Other: I certify that this is a true and correct copy of the Boards Order entered in its minutes for this date. Dated: PHIL BAT CHEWR, Clerk, By J& _ Deputy Clerk Z Jr WARNMO (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do to immediately. *For Additional 'Burning Ste Reverse Side of This Notice. AFFIDAVIT OF MAJMG - - 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 I8, 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. PHIL BATCHELOR By Deputy Clerk CC: County Counsel County Adminiumtor R.NICHOLAS HANEY Attorney at Law 223 Broadway Richmond,California 94804 RECEIVED (510)237-1624 '7 FAX:(510)237-7267 D E C 0 8 1999 CLERK BOARD OF SU ERVI OR CONTRA COSTA CO. December 6, 1999 Clerk of the Board of Supervisors Contra Costa County 651 Pine Street, 1st Floor Martinez, CA 94553 ATTN: RISK MANAGEMENT DEPARTMENT RE: FORMAL NOTICE TO PUBLIC ENTITY, CONTRA COSTA COUNTY, OF CLAIM WITHIN SIX (6) MONTHS - DATE OF LOSS: 6/9/99 1. CLAIMANT: DIANE LEWIS 2549 Valencia Way San Pablo, CA 94806 510) 236-7945 2. SEND NOTICES TO: R. NICHOLAS HANEY, ESQ. SBN 91179 227 BROADWAY RICHMOND, CA 236-1624 (office) 510) 237-7267 (fax) 3. Claimant on 6/9/99 was caused to sustain a severe sprained ankle, and bruises, abrasions, cuts and scratches to her leg, knee and also back injuries as a result of being thrown over the handle bars of her bicycle when her bicycle fell into a deep depression in the middle of the street at 5th and Chesley Streets, in Richmond, CA, County of Centra Costa. She required emergency room and follow up medical treatment for these injuries. 4. Claipant Diane Lewis suffered extreme pain and suffering as a result of this fall. Her injuries sustained included knee, leg and back injuries and caused her to seek medical treatment for the same and I enclose herewith all of those medical reports and bills. The bills are $641. 34 in addition to the Emergency Room bill. See attached, 5. Contra Costa County, and its employees and agents are Z� responsible for this accident and caused this accident. 6. The amount claimed is under $10.000.00. Jurisdiction for this claim is the Municipal Court of the State of California. Claimant demands $641. 34 for medical bills and $5,000.00 for pain and suffering. RESPECTFULLY SUBMITTED: R. NICHOLAS HANEY, ESQ. SBN: 91179 ATTORNEY FOR CLAIMANT RECEIVED MEDICAL REPORT DEC U 8 1999 Claim.No. CL RK Il ARD OF SUPERVISO Is CONTRACt1ST'ACD, Patient's Name: DIANE LEWIS Age 42 S M Phone(5.10 236-7945 Occupation: Employer Phone Address: 2849 VALENCIA WAY SAN PABLO CA. 94806 Date of Injury : 6-9-99 Date Of First Treatment: 6-14-99 Patient's Account of Injury:I WAS RIDING MY BIKE ACRO$CHI; LEY WHEN MY BIKE WENT INTO A HOLE IN TETE STREET. I MIPl'ED OVER THE HANDLEBARS Diagnosis:RT KNEE,LT ANKLE,SPRAIN.-STRAIN.LT LOWER MID SHAFT BRUISING. 844 845 - Pre-existiag Injuries or Illness: Treatment Rendered:PHYSICAL&ORTH EXAU PHY ICAL THERAPY ICEHEAT TRA- SOTJND MASSAGE SPINAL MANIPULATION. X-Ray:NONE Findings Hospitalued Yes NO If Yes,Where? Surgery Yes NO If Yes,Explain Prognosis:PATIENT CONI7NUES TO HAVE SLIGHT INTERMITTENT EXACERBATIONS OF SYMP "OMS. Permanent Impairment-Yes NO IF Yes,Explain in Detail Patient still under treatment _Patient discharged(Date) _ Patient disabled from To Date of last visit 7-21-99 Have you reported this injury to any one else? Yes NO If Yes To Whom? Bill To Date$ 641,34 (Itemized Statement Attached) Estimated Final Bill$ Has This Bill Been Paid? Yes NO If Yes,By Whom P'rovider's Name Typed: PATRICK J. SZUCS_a.Q. DEGREE: CH ROPRACTIC Address: 221 BROADWAY RICHMOND CA. 94804 PHONE: (510)232-8434 IRS NO. : 68-0071699 r DATE 8-3-99 Provider's Signature . S T A T E M E N T PATRICK J. SZUCS, D.C. 5 221: Broadway 08-03-1999 Richmond, CA 94804 (510)232-8434 BALANCE: $641.34 ACCOUNT NUMBER: 1000-561 DIANE LEWIS LAST CLAIM: 2849 VALENCIA WAY LAST PAYMENT: SAN PABLO CA 94806 LAST CHARGE: 07-21-1999 Date Description Code Charge Credit Adjust Balance 06--14-1999 Cold Packs 97010 18.45 .00 .00 18.45 06-14-1999 Ultra Sound 97035 20.91 .00 .00 39.36 06-14-1999 Massage-Brief 97124 22.14 .00 .00 61.50 06-14-1999 NP OV Intermediate 99204 92.24 .00 .00 153.74 06-415-1999 Cold Packs 97010 18.45 .00 .00 172.19 06--15-1999 Ultra. Sound 97035 20.91 .00 .00 193.10 06-15-1999 Massage-Brief 97124 22.14 .00 .00 215.24 06-15-1999 EP OV Brief 99211 20.02 .00 .00 235.26 06-17--1999 Cold Packs 97010 18.45 .00 .00 253.71 06-17-1999 Ultra sound 97035 20.91 .00 .00 274.62 06-17-1999 Massage-brief 97124 22.14 .00 .00 296.76 06-17-1999 EP OV Brief 99211 20.02 .00 .00 316.78 06-17-1999 CMT 98940 40.00 .00 .00 356.78 06-23-1999 Cold Packs 97010 18.45 .00 .00 375.23 06-23-1999 Ultra sound 97035 20.91 .00 .00 396.14 06--23-1999 Massage-brief 97124 22.14 .00 .00 418.28 06--23-1999 EP OV Brief 99211 20.02 .00 .00 438.30 06-23-1999 CMT 98940 40.00 .00 .00 478.30 07-12-1999 Cold Packs 97010 18.45 .00 .00 496.75 07-12-1999 Ultra Sound 97035 20.91 .00 .00 517.66 07-12-1999 Massage-Brief 97124 22.14 .00 .00 539.80 07-12-1999 EP OV Brief 99211 20.02 .00 .00 559.82 07-21-1999 Cold Packs 97010 18.45 .00 .00 578.27 07-21-1999 Ultra Sound 97035 20.91 .00 .00 599.18 07--21-1999 Massage-Brief 97124 22.14 .00 .00 621.32 07-21-1999 EP OV Brief 99211 20.02 .00 .00 641.34 TOTALS 641.34 .00 .00 Continued. . . S TATEMENTv ' PATRICK J. SZUCS, D.C. 221 Broadway 08-03-1999 Richmond, CA 94804 (510)232-8434 BALANCE: $541.34 ACCOUNT NLR4BER: 1000-551 DIANE LEWIS LAST CLAIM: 2849 VALENCIA WAY LAST PAYMENT: SAN PABLO CA 94806 LAST CHARGE: 07-21v-1999 Data Description Code: Charge Credit Adjust Balance For proper credit, please enclose this portion with your payment. DIANE LEWIS BALANCE: $641.34 2849 VALENCIA WAY PAY THIS AMOUNT: $ 641.34 SAN PABLO CA 94806 AMOUNT ENCLOSED: Please fill in blank. DATE DUE: PATRICK J. SZUCS, D.C. Tax ID:68-0071699 THANK YOU. 221 Broadway Richmond, CA 94804 ACCOUNT NUMBER: 1000-56.1 - BROADWAY CHIROPRACTIC TAX I .D. : 68-0071699 PATRICK J. ' SZUCS, D.C. DCO-13887 RICHARD M. NORTON. D.C. DCO-011631 221 BROADWAY RICHMOND. CA. 94804 (510) 232-8434 PHYSICAL THERAPY Diag. Date Notes s .w•--• ,rte �-�„c.,_sf " i - i i c j I t BROADWAY -CHIROPRACTIC TAX I .D. : 68-0071699 � PA'T'RICK J. SZUCS, D-C- DCO-13887 RICHARD M. NORTON, D-C. DCO-011631 + 221 BROADWAY RICHMOND, CA_ 94804 ( 610)232-8434 PHYSICAL THERAPY ©iag. Date Notes f �1 1 � i I , f i 3 s BROADWAY CHIROPRACTIC TAX I.D.68071699 PATRICK J.SZE1C5,D.C. DOO.13697 f RICHARD M.NORTON,D.C. D004iia 221 BROADWAY DIANE LEWIS RICHMOND,CA 94804 2849 VALEN CLA WAY (510)232.8434 SAN PABLO CA 94 806 FAX(510)2233.4106 NOTES PHYSICAL THERAPY 06-14-99 T 0 * NOTE FOR D. LEWIS * BD: 04-21-1957 at 10:25 a By: LK Patient continues to have right knee pain, tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine 06-15-99 T 0 * NOTE FOR D. LEWIS * BD: 04-21-a1957 at 09:34 a By: LK Patient continues to have right knee pain., tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine 06--17-99 T 0 * NOTE FOR D. LEWIS * BD: 04-21-1957 at 10:28 a By: LTi Patient continues to have right knee pain, tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine 06-23-99 T 0 * NOTE FOR D. LEWIS * BD: 04-21-1957 at. 01:01 p By: LK Patient continues to have right knee pain, tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine 07-'-12.299 T 0 * NOTE FOR D. LEWIS * BD: 04-21-1957 at 04:37 p By: LK Patient continues to have right knee pain, tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine 07-21-99 T 0 * NOTE FOR D. LEWIS * BD: 04-21-1957 at 09:27 a By: LTi Patient continues to have right knee pain, tenderness decreased range of motion. Physical medicine services included superficial and deep heating methods of moist heat hot packs/ice packs, and ultra sound soft tissue mobilization myofascial release and massage and mechanical mobilization of spine -AUTHORIZATION TO RELEASE X-RAYS & INFORMATION ��}}__ r (NAME OF HEALTH CARE PROVIDER.CLINIC,HOSPITAL.ETC.) Address c�o Cab �/ d_ / f'rKs�, °�-- r SAS 1, 1= Birthdate-1-4request the following information: (PATIENT'S NAME) ' Ea-%--Rays ffr-9listory "ecords gnosis f-ieporrts ffr eatment concerning my: 0 Illness 2'--Accident © Injury ® Other To be released to: (NAME OF PRACTITIONER. � AL,EMPLOYER,NEXT OF KIN,ETC.) ATRICKJ. SZUCS, D.C. For the purpose of: 22I gRCfA-- I (REVIEW,EVALUATION,INSURANCE CLAI V ryry ppAjt Y PURPOSE REASONABLY RELATED TO THE AGOVE). I understan that I have aright to receive a copy of this authorization upon my request. Signature: Date: Patient 5eE g Fear t Cl rdian 9 Dr. Signature Date: Address 817 \ MISSION PAINTING(2W)227.7610 r REQUIRED FOR YOUR CASE HISTORY FILE �tr. : Name L 0 L&Lt Date - Address 22LkR )LX=!?o� CJ-0- X - City n State CIA, Zip 9 Telephonr (JLC'L_J—6-7 c? Socia!Security No.�(P D-/` - Driver's License No. Age Birthdate P77 Sex— Marriage Status: M CW D No.Children 73 _ Occupation Employer Years Employed Employer's Address Work Phone Bank Spouse's Name Occupation Employer Person responsible for this account Referred by INSURANCE INFORMATION / /' Are you covered by Medicare? Yes❑ No 9 Medi-Cal? Yesie No❑ County Do you have any group,union or personal health and accident insurance? Yes❑ No Name of Insurance Company Croup No. I.D.No. Address City State Zip Is your condition due to an accident or illness? Did your accident occur while at work? Yes ❑ No 0' When Were you involved in an automobile accident? Yes Cl No When Cash payment Other SYMPTOMS HEAD: LOW BACK: SHOULDERS: HIPS,LEGS&FEET ❑ Headache ❑ Low back pain ❑ Pain in shoulder pint(R-L) ❑ Pain in buttocks(R-L) ❑ entire head ❑ Low back pain is worse when: ❑ Pain across shoulders ❑ Pain in hip joint(R-L) ❑ back of head ❑ working ❑ Bursitis(R-L) ❑ Pain down leg(R-L) ❑ forehead ❑ lifting ❑ Arthritis(R-L) ❑ Pain down both legs ❑ temples ❑ stooping ❑ Can't raise arm 0 Leg cramps ❑ migraine ❑ standing ❑ above shoulder levet ❑ Pins&needles in legs(R-L) ❑ Heads feels heavy ❑ sitting ❑,over head ❑ Numbness of leg(R-L) ❑ Lass of memory ❑ bending ❑ Tension in shoulder(R-L) ❑ Numbness of feet(R-L) ❑ Light-headedness ❑ coughing ❑ Muscle spasms in shoulders ❑ Numbness of toes ❑ f=ainting ❑ Pinched nerve in low back Cl Fleet feel cold ❑ Lights bother eyes C7 Slipped disc ARMS&HANDS: ❑ Cramps in feet(R-L) ❑ Loss of smell ❑ Low back feels out of place ❑ Pain in upper arm I4-Swollen ankles(R4j ❑ Loss of taste ❑ Muscle spasms ❑ Pain in forearm ❑ Swollen feet(R-L) Loss of balance ❑ Arthritis ❑ Pain in hands ❑ Painful joints in toes ❑ Dizziness ❑ Pain in fingers ❑ Pain in foot( -L) ❑ Loss of hearing ❑ Pinched nerve in arm 13-ain in knee L) Pain in ears ❑ Pinched nerve in fingers ❑ Ringing in ears MID-BACK: ❑ Sensation of pins&needles in arms ❑ Buzzing in ears ❑ Mid-back pain ❑ Sensation of pins&needles in fingers ❑ Pain between shoulder blades ❑ fingers go to sleep NECK: ❑ Sharp stabbing pain in mid-back ❑ Hands cold GENERAL: ❑ Pain in neck ❑ Muscle spasms ❑ Swollen joints in fingers ❑ Nervousness 0 Neck pain with movement ❑ Sore joints in fingers ❑ Irritable ❑ Pinched nerve in neck ❑ Arthritis in fingers ❑ Depressed ❑ Neck feels out of place ABDOMEN: ❑ Loss of grip strength ❑ fatigue ❑ Stiff neck ❑ Nervous stomach ❑ Generally feel run-down Muscle spasms in neck ❑ Nausea CHEST ❑ Loss of sleep 0 Grinding sounds in neck ❑ Gas Cl Chest pain 0 Loss of weight ❑ Grating sounds in neck ❑ Constipation ❑ Shortness of breath Popping,sounds in neck ❑ Diarrhea ❑ Pain around ribs ❑ Arthritis in neck Have you had X-rays before? ❑Yes 0 No When? What areas were X-rayed? WOMEN ONLY: ❑ Menstrual Pain ❑ Cramping ❑ Irregularity Date of last period? Are you now pregnant? ❑ Yes ❑ No How long? PAYMENT IS EXPECTED AT TIME OF'VISIT,UNLESS OTHER AR NGEMENTS H E BEEN MADE. *1" PATIENTS SIGNATURE AUTOMOBILE AND JOB INJURY INFORMATION Name L,_Il Qkly-- L nl� gym -- Date 2q Telephone —23L-75565— Address 23L-755"5Address State zip JOB INJURY INFORMATte a---�"' injury reported to employer ❑ Yes o Date Employer Employer's Address Descripti�qfe�nt AUTO ACCIDENT INFORMATION: Date 9 Time Y11-'Al2P" Police report made? ❑ Yes M40 Date Location 't---.5fkt Chesle VY Z;c kNo6d Were you struck from: Behind ❑ Right Side ❑ Left Side ❑ Front ❑ Were you: Driver ❑ Passenger ❑ Description of Accident: il. 6ike + lt4-r) CL hole In Were you injured? a4es ❑ No How?_ e'LL- L-0 Y'rnI I on jmv_V-V&-g--� Where? Were you unconscious? ❑ Yes ❑ No Fractures Cuts Abrasions t" Bruises L---'' Patient taken to 7 Hospital for treatment. Confined to hospital for Days Hours. Name of hospital doctor What are your present complaints: What treatments have you received? OTHER DOCTORS SEEN FOR THIS CONDITION: MD ❑ DC ❑ DO O DDS ❑ Doctor's Name Diagnosis X-rays Urinalysis Blood Tests Other Treatment: Pills Shots Traction Physiotherapy Results Length of time under his care Other Have you had any problems as the result of the injury? Were you off work? ❑ Yes ❑ No If so, how long Have you returned to your same job? ❑ Yes ❑ No If not,why HISTORY OF PRIOR INJURY, ILLNESS OR SURGERY: Name of other party Address City state Phone Their insurance company Insurance Agent ATTORNEY: Name bill Address Phone Litigation: Cl Yes ❑ No ❑ Maybe INSURANCE INFORMATION: Do you have any group, union or personal health and accident insurance? ❑ Yes ❑ No Name of Insurance Company Claim No. Address -- Agent Patient's Signature: c 051 ANGWON PRW"NG tza9r zV 7s4u PATIENT'S PAIN CHART Name: bS*^^@ Le&� Number' Please use all of the figures on boot Date: sides of this Page to shorn me exactlywherejUl Your pans are„ and where they radiate to. Shade or draw with blue pen. OnI the patient is to fill out this sheet. Please be as precise and detailed as possible_ Use: V t RIGHT LEFT s ✓ v RIGHI r LEFT RIGHT I.EI-'f RIGHT ' LEFT y RIGHT LEl T OVER CLAIM BOARD Of S PERUS RS DE M"rRA COSTA . C LMOE A BGARD AC10 JANUARY 18, 2000 Crim Against ft County, or District Governed by } NOTICE TO CLAIMANT the Board of Supervisors, Routing Endorsements, } and Beard Action All Section references are to } The copy of this docurart rreiled to you Is your California Government Codes. ) "Mice of the action taken on your claim by the -mal 'ZEBoard of Supervisors. (Pairegraph IV belowl, Oven purscant to Goverment Code Section 913 and N O y `=r t0 1999 515.4. Please rate all *Warnings". AM©UNT: $250,000-00 COLIN MARTINEZ CALIF' CLAIMANT:Ca'role Marasovic and Estate of Elizabeth Marasovic ATTORNEY: DATE RECEIVED: November 30, 1999 ADDRESS: 518 Kearney BY DELIVERY TO CLEM ON: Nommber Q, 1999 El Cerrito CA 94530 BY MAIL POSTMARKED. Han -11p1 i vered L FROM' Clerk of the Board of Supervisors M County Counsel Attached is a copy of the above-noted claim. November 30 1999 PHIL B & C Dated: By: Deputy IL FROM County Counsel TO: Clerk of the Board of Supervisors ( vis claim complies substantially with Sections 410 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 410.8). ( ) 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: r» Dated: BY: puty County Counsel M. PROM. aerkoftheBoard TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant (Section 411.3). IAV. BOARD 0RD13b 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. hated: / ` cyJ PIAL BATCHELOR, Clerk, 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 deposite in the mail to file a court action on this claim. See Government Code Section 445.6. 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 dor to immediately. "For Additional Warning See Reverse Side of This Notice. i AFFIDAVIT OF MAIMG I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage full; prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: j , 01'By: PHIL BATCLOR By ►�' Deputy Clerk CC: CW=ty Counsel County Adlninistwor Claim to-. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIOl'dS TO CLAIMANT ' A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100 ' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp Carole Marasovic ) Estateof Elizabeth Marasovic ) RECEIVED Against the County of Contra Costa or ) NOV 3 0 1999 District CLERK BOAR UPERV! ORS C0N1'RA 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$ 250,000.00and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) June 1 , 1999"a.m. June 1, 1999-June 7, 1999•-ongoing 2. Where did the damage or injury occur? (Include city and county) 518 Kearney, El Cerrito (Contra Costa County) ; Telephone calls made from Adult Protectl.ve Services office, Martinez( ContraCosta County) to Alta-Bates Hospital , Berkeley(Alameda County) y Telephone calls made from APS, Martinez 3. How did the damage or injury occur? (Clive full details; use extra paper if required) (Contra Costa County) to S hields Convalescent See attached. Center, Richmond (Contra Costa County) OBINPAIPO, 0, 127, 127SCO, 75, 0, 75, OWUlOA I How did the damage or injury occur? 1. 6n June 1, 1999,APS workers Christine Mulder and Rhonda Edwards elicited an El Cerrito police officer to break into Claimants' residence. They did so directly in violation of the AMt Protective SWd=s&I which states such an entry can only be made when access has been refined and with a court order. Not only had access not been denied but neither Claimant Carole Marasovic nor Elizabeth Marasovic had been contacted previously. There was no court order nor was there a basis for securing an order. Claimant Carole Marasovic had cared for Claimant Elizabeth Marasovic far 18 %years. Since Claimant Elizabeth Marasovic's diagnoses on February 6, 1999, Claimant Carole Marasovic cared for Claimant Elizabeth Marnsovic on a 24-hour basis,remaining with Elizabeth Marasovic at all times providing for all her physical,medical, and emotional needs. (Excluding those times Claimant Elizabeth Marasovic was in the hospital at which time Carole Marasovic would take brief breaks.) APS workersillegal trespass ocourred without any effort to determine Claimant Elizabeth Marasovic whereabouts. In fact,at the time she was already in the hospital for four days for her aortic aneurysm. During one of Claimant Carole Marasovic's breaks, she discovered an El Cerrito police officer emerging from Claimant's home and that the door and lock had been broken. APS workers Christine Mulder and Rhonda Edwards were present. Mulder told Claimant Carole Marmovic that she had asked the police to break into Claimant's residence because somewhere else in Contra Costa County,a son had abused his mother and they(APS)had arrived too late. 2. Claimant Carole Marasovic discussed her mother and their lengthy and mutually devoted relationship with APS workers Mulder and Edwards. She also invited both workers to meet with Claimant Elizabeth.Marasovic so that they could confirm that there was no abuse or neglect and that Claimant Elizabeth Marasovic would not want or need intervention by Adult Protective Services. Later that day,Claimant Carole Marasovic asked APS worker,Rhonda Edwards,by phone,if she wanted to meet with Claimant Elizabeth Marasovic. She said she didn't. Subsequently,Carole Marasovic called APS worker Christine Mulder and discussed at length her care for her mother and invited Mulder to meet with her mother, Claimant Elizabeth Marasovic, to confirm that there was no abuse or neglect. Mulder told Claimant Carole Marasovic that she did not need to meet with her mother because Adult Protective services was going to close the case. Since Adult Protective Services worker Mur had advised Claimant Carole Marasovic that the case would be closed, Claimant Carole Marasovic did not advise Claimant Elizabeth Marasovic of the illegal trespass by APS because she did not want to disrupt her recovery. A6 Can.June 3, 1999,late afternoon,Alta-Bates social worker Linda Bradford told Carole Marasovic that Claimant Elizabeth Marasovic was being placed in a nursing home and that Claimant Carole Marasovic had not told Bradford that"APS was involved". Claimant Carole Marasovic advised.Bradford that"APS had not even met with my mother"so that Bradford would know that APS did not have Claimant Elizabeth Marasovic's consent and that it would be contrary to her wishes for there to be an investigation since Claimant Carole and Elizabeth Marasovic were an exceptionally close mother and daughter far removed from any abuse or neglect. However Bradford ignored Claimant Carole Marasovic and refused to talk with Claimant Elizabeth Marasovic about what she wanted. The Alta-Bates hospital Mcn indicate that Rhonda Edwards had made repeated phone calls to Alta-Bates and misrepresented herself as Claimant Elizabeth Marasovic's"worker"despite that she had never met with her to determine what she wanted and to obtain consent to intervention. Had APS worker Edwards ever met with Claimant Elizabeth Marasovic she would have been bound to close the case as APS worker Mudler had told Claimant Carole Marasovic APS was doing. Claimant Carole Marasovic had a life-long commitment to care for Elizabeth Marasovic until her death. Had APS met with Claimant Elizabeth Marasovic,they would have known how pleased she was with the nearly two decades of care by her daughter and how apposed she was to nursing home placement. Had APS met with Claimant Elizabeth Marasovic,they would have known how proud she was that her daughter would care for her and how she believed it was sad itow that some families would place elderly and disabled persons in nursing homes. Had APS met with Claimant Elizabeth Marasovic, and conducted an independent investigation they would have discovered that Claimant Carole Marasovic had provided excellent care for her mother. Had APS met with Elizabeth Marasovic,they would have learned that she wanted to continue to be under the care of her daughter and that she wanted the investigation closed. APS is bound to follow the Adult Protective Services Act,which states that"the victim"(and there was no victim)" can consent or withdraw to the investigation at any time". APS never attempted to acquire"the victim's"consent,never conducted an independent investigation and instead, acted completely contrary to Claimant Elizabeth Marasovic's,a mentally alert person's,wishes. Due to APS's influence and misrepresentation as Elizabeth Marasovic `s worker and APB's defamatory statement,Elizabeth Marasovic was involuntarily transferred to a nursing home with deplorable conditions where she died 2 V2 days later. Claimant Elizabeth Marasovic learned of the planned discharge to a nursing home from Claimant Carole Marasovic on June 3, 1999,who then advised her of the APS involvement. Claimant Elizabeth Marasovic's recovery reversed and she suffered severe emotional distress at the prospect of nursing home placement and of the separation from the care of her daughter. _. w •J When told about APS as an agency investigating abuse and neglect,becoming involved, she said,"How could they say that?"9he stated that she wanted only her daughter, Claimant Carole Marasovic,to tape care of her. She asked that Claimant Carole Marasovic stop the nursing home placement. When told that care was being taken away from Claimant Carole Marasovic, Claimant Elizabeth Marasovic stated,"They are making a mistake. I cannot make it without you. You are my eyes and my soul."(Claimant Elizabeth Mwwvic was blind.) Claimant Elizabeth Marasovic continued to suffer severe emotional distress at the separation from her daughter. At the nursing home Elizabeth Marasovic was placed in a room with three roommates,one of whom would scream in violent rages which terrified Claimant Elizabeth Marasovic who as a blind woman,did not know if she was about to be attacked. Twenty-four hours of blaring rap music with lyrics (verbatim)such as, "I am going to kick your lily ass"was played in the room. Most staff`did not understand Claiman l zabeth Marasovic's medical condition although Claimant Carole MarasovicroMulss her mother's medical needs with them. A As her condition was aggravated by the home, Claimant Elizabeth Marasovic had her fifth bleeding episode. In the previous four episodespex daughter Carole Mamsovic had always been with her and assisted her. Claimant Carole Marasovic ran out into the hallway at the nursing home and told thegher mother was bleeding and needed an oxygen mask and an ambulance. Instead of calling an ambulance,three staff came in and stared. An ambulance was not called immediately as it had been in the previous two major episodes when Claimant Elizabeth Marasovic was under the care of her daughter. Staff did not give 4w Claimant Elizabeth Marasovic an oxygen mask to breathe,which had been done in the previous two episodesandwhich caused the bleeding to diminish. The RN on duty who did not know the nature of Claimant Elizabeth Marasovic's condition, and had not read the chart, compressed Claimant Elizabeth Marasovic's chest against her no DNR directive and medical orders despite the directive stating that resuscitation would probably kill Claimant Elizabeth Marasovic. Upon Claimant Carole Marasovic's statement that Claimant Elizabeth.Marasovic was not to be resuscitated,that it would kill her,the RN said,"Oh,there's a DNR order?" and slammed the door in Claimant Carole Marasovic's face. Later,the RN emerged telling her that her mother was dead. In the previous episodes,Claimant Carole Marasovic had accompanied her mother in the ambulance and been by her side,fVays`*Acr�`i�iPgi her mother. Claimant Elizabeth Marasovic would always tell her that that encouragement helped her survive. Claimant Elizabeth Marasovic would always tell her the worst part was being unable to breathe and that the oxygen would help her breathe so that the bleeding would stop. Claimant Elizabeth Marasovic suffered tremendous pain and suffering from the conditions in the nursing home as well as the maltreatment of her medical condition. She suffered severe emotional distress at her medical care being taken away from her daughter who was helping her survive. She suffered severe emotional distress at being placed in a nursing home. She suffered severe emotional distress at the intervention of Adult Protective Services who were threatening the family bond she valued and the presence of her daughter she loved so much and who laved her. Claimant Carole Marasovic suffered severe emotional distress by the APS trespass and subsequent intervention, which led to her mothers nursing home placement, and medical deterioration. Claimant Carole Marasovic witnessed the suffering of her mother through the transfer to a nursing home and stayed with her mother at the facility where she witnessed the deplorable conditions. Claimant Carole Marasovic was caused severe emotional distress through the maltreatment at the nursing facility and her mother's subsequent death. Both Claimants Elizabeth Marasovic and Carole Marasovic knew that Elizabeth Marasovic's survival was due to 1. Her tremendous will to live; 2. The strength of Claimant Elizabeth and Carole Marasovic's relationship and 3. The correct medical procedure. Had APS met with Claimant Elizabeth Marasovic,they would have known this too. Instead,no consent was obtained. APS acted contrary to Elizabeth Marasovic's wishes and in pain and maltreatment she died, after living her last few days in terror. Claimant Elizabeth Marasovic's last few days, and death,have left Claimant Carole Marasovic with long-term, if not permanent, severe emotional distress. t 6d-,i'rt1d . d"'W 1'Z I'df-a kC- G- /-Z-'1 Le-� Mai'`l Std Y l C ) %�'t 'T' se-a k r c4 a 1'�"Yldl��- ,f�j.,'�►'n �-_�(.'y('}`2 SC•."._Yf�T fwd 11 Gti. �1�_,.1i,�CJ 1�'� '�-G7 ��..-�' Z'CJl' .�`df l�'� (,��.S�T''� 'r S'e'nt 7Lt1 / �tlp/c /Ief AP,s !1 older ar. d c�r�d�q/! EQwards :S'c� 4o� tl� e� ti. Wh,,tI;articular act or omission on the part of county or district officers, servants, or employees caused the injury or damage?"SIA vi`d�fas''iep o C�c,t.Ada•/t 7'r� t �+'vim S`er r ces_r4 r4dv '+r;'c � y etwv"f3! e TJ�+ CrJa Irr�B►i7 f Y+ !^LlaelL�C'_ fitlilfitGG1°�r%r�5 �3EI@/'i� !` .5 orr3?c'ce r5 �{tr � 51/ l � 4! f G iU;"C , x� t1a,Tn�e - rl .. Vert f1 l .n.�,icIrrf ' a 1reY^r res�+YS. Via¢ 5. What are the nane$ofcounty or district officers, servants, or employees causing the damage or injury? �dtr���f� �.„✓�srats� �olr��� �'rr�fe�ve..cS+erd�c�Ss �,��,��! hr�/"i�.�.r"i C'�i�r'st��.>�1��(ey` �+�+^✓%sc�r• j 1n d ,4 rdle�^so s,y, .s�dd Ah P1 r1�(C�+ .�`e!I^✓t tit i k:71- rrra r�e�"7 a tx�l zst/1��s fit�'Y' j J^srrrYs i^ orrstb!$ Pr +e 04r- rq'PS worAc)is iCZhOlrw � ^Y s 6. What damage or injuries dog you claim resultedT(qqCrive full extent of injuries or uamages claimed. AAA two estimates for auto damage.) Trespass to property ; Damage to property; Intentional infliction of emotional distress; Nei 7L err :S6.eo-P />ri'vq, a'F IV, eo�f oy nvo-,- av ✓rola �jr af`s �. sorhw^i /J 7. How✓was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) oro)ber-f - elez., poce /,o"N 0,P e rvrd%`��r�� s rn �.-� .,�4 aistr�),#Iva-st-o-r- c� po,va_a-y? vt �r Jr ekrl- -e, )'IcX m*n f 17 ,1y'''J �¢' `oi'ma,� /z. efS�r �'1 »sovl� xeri'csl t�syc+n aA'v .,r' nn 8. Names and addresses of witnesses, doctors, and hospitals. i arils m .4 1,e7v-B Ey-,-4s fi6s�)f w/ vino( LSYhj',,-,,1a1s &,m Vim./es ee.t-�-~ r-� n fine e-aI/.r -Mads- by APS" vtbrxer) IRhanwa JE41✓m , 9. List the expenditures you made on account of this accident or injury. DATE ME AMM ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf. SEND NOTICES TO: (Attar�ev Name and Address of-Attmve5T ) Carole Marasovic ) Estate of Elizabeth Marasovic ) r— (Claimant's Signatur 518 Kearney ) /� �. s� � E1 Cerrito, Ca 94530 ) 518 Kearney (Address) E1 Cerrito, California 94530 (510)525-5840 ) Telephone No. )Telephone No. (510)525-5840 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($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 imprislnment and fine. _� . � » . � . » \. « ■ : . � \ � �\ , � � . � • ��: \ U ^ \ 'Ad * � � . e • : /� , . . . ■� \ � � � \ 4% � # ! � . .- . . / ` � r r. ;w.. •y 'i r� .�i i rr f x y t y 's a THE BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA Adopted this Order on January 18, 2000, by the following vote: AYES: Supervisors Gioia, Uilkema, DeSaulni,er, Canciamilla and Gerber NOES: None ABSENT: None ABSTAIN: None SUBJECT: Tolling Statute of Limitations on Claims by members of the Deputy Sheriffs' Association involving the Fair Labor Standards Act. This Board having previously approved tolling the statute of limitations on the members of the Deputy Sheriffs' Association claims for twelve months, and The County Counsel having recommended that the Board of Supervisors agree to further extend the tolling of the statute of limitations to April 15, 2000,pending settlement of the dispute, NOW, THEREFORE, it is by the Board ORDERED that: 1. The action of the County Counsel agreeing to toll the statute of limitation for filing suit under Fair Labor Standards Act regarding payment of non-sworn members under section 7(k) of the FLSA, delayed payments, and miscalculation of FLSA overtime compensation to April 15, 2000, is hereby ratified. 2. In the event of a settlement of the above-referenced dispute,the agreement to toll the statute of limitations may only be applicable to those members of the DSA who are bound by the settlement,provided however that the County Counsel is authorized to waive this requirement. I hereby certify that this is a true and correct copy of an action taken by the Board of Supervisors on the date shown. ATTESTED: January 18, 2000 Phil Batchelor, Clerk of the Board of Supervisors and County Administrator Contact: Edward Lane(335-1$13) cc: County Counsel BY , Deputy Sheriff-Coroner !j