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MINUTES - 12042001 - C.28
. CLAIIVI BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the �I�IId Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and NOV 2 0 2001 915.4. Please note all "Warnings". AMOUNT: $500,000 COUNTY COUNSEL MARTINEZ CALIF. CLAIMANT: Debbie & Benjamin Feary ATTORNEY: Gregory Stannard DATE RECEIVED: November 16, 2001 ADDRESS: 200 Corporate Pointe#125 BY DELIVERY TO CLERK ON: November 16, 2001 Culver City, CA 90230-8721 BY MAIL POSTMARKED: November 15, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. -- JOHN SWE Dated: November 16, 2001 By: Deputy 11. FROM: County Counsel TO: Clerk of the Board of Superviso,s (4_Tf�s 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (� 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: U M /1 ��,U� JOHN SWEETEN, CLERK, By �;lJU�I U �� l �'+�Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have 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 Icopy ,of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated:�.� 9/WPI /I �, ( JOHN SWEETEN, CLERK By a'[ /V- Deputy Clerk P Y •Jod sLulul-D 1101 uiulopluo 3qj of joafgns IOU suoilov of olquoilddu suoijujiLuil jo solmuls ;)ql .zapun sjg5p aniLm Ji saop .iou iod sLuielo l.iol uiu.io3ilLD npun siLl2ii s11 Jo Cut? aniBm IOU saop ulsoD B ijuoD jo Xjunoo oql •Luiulo m1noil ind .inoX of olquoilddr sosvo pun soInjuls ogioads oqj jlnsuoD •Luirlo oql jo ainluu z)ql uo 2uipuodop .ia2uol io .ialzoLls aq Xuw palg oq jsnw fins goigm utglim poind suoijullmil oql •Xlddt, Xuw juill spouod suoijuliwil alt'.redos oqj llu puulsjapun of luiluasso si uoijujlnsuoo lU231 PUB anijsnugxo IOU si Isil anoqu oql •swiujo slu2 d ii^iD iuzapo j io `uoi�ounfui .io sntuupuuw su Lions joila.i ogioods ion. suoiJou `uoiI-euuzapuoo as.zanui ui suoilQu su Lions Iod sLuilClD 1-101 LIiuzo. UD 3qj of loafgns IOU wr goiLlm swiulo of Xlddu IOU saop 2uiturm siq L LAW OFFICES OF GREGORY F. STANNARD GREGORY F. STANNARD 200 CORPORATE POINTE, SUITE 125 TELEPHONE (310) 642-6980 PETER J. KING CULVER CITY, CALIFORNIA 90230-8721 FACSIMILE (310) 642-6989 E-MAIL: gstannard@stannardlaw.com Via Federal Express RECEIVED November 15, 2001 Nov 1 s zoos CLERK BOARD OF SUPERVISORS Clerk of Board of Supervisors CONTRA COSTA CO. Room 106 County Administration Building 651 Pine Street Martinez, CA 94553 Re: Claim on behalf of Debbie Marie Feary and Benjamin Feary Our File No.: 9739 To Whom It May Concern: Enclosed please find a claim on behalf of Debbie Marie Feary and Benjamin Feary. Thank you for your cooperation. Very truly yours, LAW OFFICES OF GREGORY F. STANNARD By GREGO tSTANNARD GFS/rqw Enc. Claim to: BOARD OF SUPERVISORS OF CONTRA.COSTA COUNTY INSTRUCTIONS TO CLAIlVIANT 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 properry orb owing 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 anv 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.Ylartinez. CA 94-4543- 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 entityseparate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims. Penal Code Sec. ;: at the end of this form. RE: Claim by ) Reserved for Clerk's Filing Stamp r'RECEIVED �a.�- N0 U 1 6 2001 Against the County Contra Costa or CLERK BOARD OF SUPERVISORS -,--INTRA COSTA CO. District ) (Fill in Name) The undersi-ned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S�ou�Bt?b and in support of this claim represents as follows: 1. When did the damage or in occur? (Give exact Dace and Hour) �� �� X00 ( --- r0yj _ ------------- ----1-------f--�- aw - --- -------------- -5- ------------- ?. Where did the damage or injury occur? (include City'and Counc� 1 A --i-------- - ---- -----�---- 3. How did the damage or injun occur? (Give fulaias-. use extra paper if required 1 -V, awry, fra�o � wow' -h 0,1.4 9n Vas eD Ril., 4wo-ia�. r004'. U F Q 1�Qe" O'had Lias' -11 Qc� -6 pa3,9 Vo,L` JS �� Fr&o-+ OF V/ &4A Ct W WA 6-,4f6ti LWJ �1 4f'L' I,---- ----------- �----- 4. What particular act or omission on the pan of county or district officers, sen•ants, or employees caused the injury or damage? raid &5(S u owd (ear w<aLJP,uw, u-/ tvs wM#LeXOU.s S oLek- 45 c.e�.� — 04, UO.Sth TOGA' o (Over) aug par laamuosudmt q:)ns qloq Sq to `( 000`01S ) urllop pursnogl ual;uipaa-jxa lou 3o aug r Sq `uosud ams aql ut laamaosudun Sq so`aug par luamuosudmt Bans gzoq Sq io •( 000-IS ) urllop pursnogl auo outp :aaaza lou jo aug r q `lrae auo argi aloui Ion jo pouad a soj l!rf.ilunoa ;;q1 ai luamuosudmi .iq laqua algrgsiand sz tuuum io `laganon iunoaar `ll!q •mrela lualnpnr.ij,to asirj .iur -aumuaL J! amrs aq1 .ird so .Molar of pazuoglnu `iaaWo 10 p iroq laulmp 10 S113 .ilunoa :aur 01.10 `sang;o.10 psroq ams :%ur of luatu ird 1o;jo aaur.aollu ioj siaasald•pnri;ap of lualui giim'oq.a uosud .Clang„ :sap�,kwd apo] iruad aql jo Z., uonoaS 3JI10 N oti auoydaialn 0� n _7119 a� o aaoyda(a� IS /� wrN/d�p A?-E Q L C:Q ( ssalppv L �/ � yo (;mmrufvi s 1urmirl ) r DD �J7JroN Mv�d �Q�rQ M7 iatuouy jo ssalppF par. arum •Jirgaq sty ao uos;ad auios .iq jo (.�atuouF) :O L SaDllo:� Q 3S lurmtrla ay1.iq paaLis aq isnw mR:l:) aql,, :sapl.wjd :.•0I6'•aac ;)POD •.100 .L`:lOfkt :.ianfui to ivap;-jzr sigl;o iunozor ao aprm noe salnlipuadxa aql tst-I -6 ---------- ----------=---------------- ------- ----------------------------------------- Y"-FSS •siriidsoy par. simoop •sass;;wim}o sassalppr purr samr�-;- •g --- --- --- ---- --- ---- -------------- --------------------------------------------- ----- - �jJa'vr�� lil sv . n,qS (7a''ewep io.Cinfm anuaadsoad.Cue jo iunomr paiewpsa airy apniaul) -palndtuoa lunoarr pamtrla anogr aq1 sum .uog _ ----------------------- -------------- ----------------------7--- - ----------------- -- - PW� spas� r,mo �T���, sa.yl-�'=� �c 1 's 1 YJ�7) 'a aoe olne �S mq M � � c mw c toj smeucasa o3 tpeuv -pawn[saoeump to saunful jo ivaua Rua antf)) Zpallmm tamlo noSop saunfut 10 sa'"rtarp lrgb '9 ---------------------------------------------------- r ---------------------- ;,:i.tnfnt so aormrp aq1 Dulsnra saa,►oldma so`slur.uas�staag�o laulsip.lo .iaanoa 3o samru aq1 a.re 1rq� 'S F7Pi?N AMER I CAN OUTBACK (EML II I RA TM) PHONE NO. : 510 753 588/ Jun. 06 2081 03:37PM P3 • . JUN STATE OF f/1LIFORNLA4 TRA Ff IC COLLISION REPORT Paw / of. CHP 5°55 Page 1 (Rev.8-97) ON 042. .IUDIGML DIBTteCT IOCJI REPORT last s�EcvL CQNDrTvow w ,.rea IOLYrR I COIIMIY DEPORTING aBTwcT BEAT ,g-- ❑ MO, pAy TEAR 71M>:(1�1 MCIC r QEIOCTJi IA COLLMIC 1 OCCURRED ON •'. V JCu A4. (,/X) O DAT OF VWEK Tow AWAY PHortoGRAPNs Err_ now F M"PosT IW<*-TION Q IS M T W T F& 27 YES ❑ NO FEEr/WLr=S OF V STATE HWY REL O AT mWit E=-WITT{ ow-- �• a teeTNILES OF C',FOr l-40 D/ B�� ( c A YES NO PARTY DRQ LKOM MUMBET1 STATE CLASS SAFETY VEH.YEAR MAKENI PELX0LOR LICENSE m""R STATE F31UIP. YcniQ 122---« m�En K"W IrjW,,MIDDLE.LAST) AM -p- ® Env O SE AS DRIVER' rwm STREETADCAr d TRW L y A• awr+Fxs � SAME AS ORNER FXWD cmrsTATFJOP . . y--I �OF��E CH°�DF� OFFICER DRIVER ,CT}IER. VE?WLf ❑❑. LL`�z ffi C'ARRsIE�R...6 -Im_?s . 9S`pD Mb, /ZDa•s YwR(A,yCE My. CB5E /.!I PRIOR UEcPwj4CALDEFEGT✓8❑ NO�E'A�PP�PRB�ff•,f/ pQREFER OMILIfWrW. ' W14)OLE DEErnhCATM WMCBER: OTfEIHOME PFONE S L -- e2 -r cw ueF DAILY DescmeE vE+iewDie S►wE in D. .�m A'+AREApmIcyNumorm WHI�TYPE UNK NONE ❑MINOR .. - Q s,� �S•r� (� I aMOO. MAJOR❑ROLL-OVER DIR OF TRAVEL ON STREET OR H1G~Y SPE9D OMIT CA DOT V J C & R '� CAL•T TCPA'sC AC�MY DRIVERS LICENSE NW®✓� 3TATE MASS SAFETY VEN,YEAR M JJrOLOR UCErGE NUMBER STATE._ PART EQUIP. 2 S'�SS7/ �� c G— 0� Tor/c�2occA�✓i� . C9 ORIYn NAI@ lFf"T.Aemce•tAsn Qom/ Y v J NAL' CK SAME AS DRIVER PEDES STREET ADDRE95 .. tn411 owNEA•S ADDRESS SAME AS ORIVER 6sr .r� ftyr�� �I r/RiEO CnYYBTAYEILP . VEHICLE ❑ fes. C A y y�� DI*Po ON OF VEMICLE ON ORDERS OF: ?®OFFICER❑DRIVIER❑OTHER. '... MY. eF�E, rA1R CYea ItE7OHT V,;LCHT &RCZ 'T1+DY.ATe RACE Tt-nPCf 7t! - i 2S- / 7"'•�' �.� a .•. r! C•f QZti f-- /L Jt /2 MOR MECAuMICJLDEFECTS r+pgrPPARBcr RSERTOwLiatAnVE::;. ;'=: OTHER Now PHONE BUawess PHONE VEHICLE IDFJrTIFICATION 2/ r7 e ❑ S7'tj- {i ,- ��/ 9^/d• '� Q^ .. oB..a+Lr DMIRME VER11ME DAAuaE SHAM IM DWADFD ARF1. IEL'TLRAI6E CARRIER .. POLICY NUABER VEiYil4i TT ❑UNK ❑NONE E]MINOR G2OWi Arm xicil,.� �,r. co.. c �.r7ygo/y-�� I ID MOD. XMAJOR❑ROLLOVER DROP TRAVEL ON SSTyRFET OR HILI-m^y -., .. IPEEDUYR CA � J !/�/1 CrG As. 5–S_ CAL-T TOP PARTY DRI'rt"UOEMBE NUMBER VAW CLASS Cy,Ett;•Iy W04-YEAR MA0T.MOOE)rAXj0A MUSE KA®ER. ;. STATE EQUIP. . . . . .; 3 ----ee.5e Cry C Cry f'(a c/>-—--- ---- ---e-89..�A�l�a .l,lY/Y.P7/ C�D Mmn NAME OWMT..MODLE.LAsn --- -- - - - - ----- -- -- - ® /JE /E- /y/f/b/f' ,orWA J' O OtERS NAME ® SAME AS DRIVER x� STTLZLiT ADDRESS (, ❑ ! O�� To/ O c.✓f OY. UM ADDRESS B SAME AS DRIVER rFXWD GTYBTATErDP. . ❑ NT�O c y SYS'L4 f DISPOSITION OF WMICLa ON ORDERS OF; ®OFFICER❑ORrvER 0 OTHER s SFETR CYE.^, HEIGHT IAelGHT BIRT14DATE RACE Q J,.. j e W -� - /o o ' Mo. Def y� PRIOR MECHANICAL DEPECTS: E`O tf DJ -5--e /•r•S- S-- 2 � S (i.i NO►E APPARENT RE:ER TO NARRATIVE OTKIR HO%W PHONE ^� BUSINESS PHONEEH VEHICLE IOENTIFLCATION NUMBER: ❑ Z Jr / / – - �S - /G L'`e ^14,/mit` cNP Ufs ONLY DESCRIBE VE11K4-E DAMAGE SIMDC IN DAMAGED AREA IILSIR ANCZ CARRIER POLICY NUMBER VEHICLE rive ❑INK. ❑NONE ❑MINOR c J'4 o/ ❑MOD. NJ MAJOR❑ROLL-OVER 11 DLR OF TRAVEL ION STREET OR HIGHWAY SPEED UM1T / GA. DOT ••'. GL-7 TCPIPnr' Mrsu �----- /// PRIEPAROMMAW OISPATCHNOTIFIF•C) RE R'S NAME DATEREVIEWFO YES ❑NO ❑NIA c 1 ' . FR0� : AMERICAN OUTBACK {EMi''-RA TM} PHONE NO. 510 753 5B8� Jun' 06 2001 03:38PM P4 � . STATE Or CALIFORNIA 'IC COLLISION CODING Poo Z of// NUMBER YES n NO PROPERTY Af /a*7 DAMAGE EJECTED FROM vEHICLE SAFM EQUIPMENT sEA-nNG POSITION- OCCUPANTS L AIR FAG DEPLOYED NJCEA YCLE-14FLiACT w-0401 EJECTED N—VEH)CLE AM BAG NOT DEPLOYED FULLY EJECTEP 0 LAP BFLT NOT USED 2 3 1-DRIVEA E-SHOULDER HARNESS USED CHILD RESTRAINT PASSENGER 5 6 7 sTA11ON VJAGOVA REAR G-LAWSHOULDER HARNESS USED. .IN vEHICLE NOT USED y-YES 8 REAR OCC.TRK J-PASS11415 RESTRAINT USED S-to wxfaE USE UpwOvVN 7 9 POSITION UNKNOWN X,pASS(VE RESTRAINT NOT USED T-IN VEHICLE IMPROPER USE ITEMS MARKED eELOW FOLLOWED BY AN ASTERISK SHOULD gE EXpLAINED IN THE NARRATTVF_ OF PAMY ALT FAULT A tPNTROLS FUNCTIONING A PASSENGER CAR I STATION WAGON E,PICKLIPI WELMCKWTRAILER E MAKING LEFT TURN c OTHER THM TYPE OF COLLISION F : J$C D UNKNOVYW* X:-,Fk HEAD-0_?4 ---.F TRUCK OR TRUCK TRACTOR F MAKIMr, 'JI TRUCK TRACTOR IV T11I.R., 0) BACCK'ul- C REAR END H SCHOOL OUS m SLOWING I STOPPING WEATHER(MARK 170 2 jFEW) 0 BROADSIDE I OTHER BUS I PASSING OTHER VEHICLE CLQUDY I C RAINING_- G VEHICLE/PEDESTRIAN L BICYCLE— L ENTERINGTRAFFIC D SNOWNG H OTHER'� M OTHER VEHICLE M OTHER UNWE TURNING LIGHTING 13 PEDESTRIAN R A'J_A DAYLIGHT C OTHER MOTOR VEHICLE 2 3 OTHER ASSOCZATED FACTORIS) qrKE 1 F3 DUSK-DAWN Q MOTOR VEHICLE ON OTHER ROADWAY (4fARK I TO 2 IMMS7 I C oARX-MEET LIGHTS E PARKED MOTOR vEHICLE A '*C3 Tr; -No REET LIGHTS TRAIN D DARK DARK-STREET LIGHTS NOT G BICYCLE YES FUNCTIONING' ANIMAL: SOBRIETY-DRUG — H VC=nOn ll213 PHYSICAL A DRY FIXED OBJECT: A HAD NOT BEEN RT)—MNG ;lc-", J"k ' LDSLI=jR�YMUDDY,OILY,ETC.) I F IN WnON*.* c HBc)-NOT UNDER INFLUENCE' IMARK I TO 2 MEOWS) PCOESTRIANS ACTIONS H ENTERING/LEAVING RAMP E UNDER 0RUr.NRUENCS' A HOLES,DEEP RLM -A A NO PEDESTRIANS INVOLVED Ppemou-s COLLISION:77 F IMPAIRMENT-PHYSJCAL" LOOSE MATERIAL ON R CROSSING IN CROSSWALX J UNFAMILIJLR WITH ROAD G IMPAIRMENT NOT MOWN IC OBSTRUCTION ON ROADWAY- AT INTURSECTION DEFECTS/E VEN.EQUIP-: CITED Ni>T APPUCABL 10 CONSTRUCTION-REPAIR ZONE C CROBBINIG.IN CROSSWALK-NOT n YES SLEEPY/FATIGUED R Qtjr.(iD ROADWAY WIDTH AT INTERSECTION r NO SPEC3ALINFORNAMN IG OTHER-. E IN ROAD-INCLUDES SHOULDER rM OTKER- 4a ce'lc- �EAVJNG SCHOOL St IS 41 13 c--li Aoftog, _j 10 RUNAWAY VEF41CLE SKETCH MISCELLANEOUS DOT CRNR -19C CHP CT OTHER � FROM. : -+gMERICRN OUTBACK CEMI` -RA TM) PHONE NO. 510 753 588• Jun. 06 2001 03:30PM P5 INJURED I WITNESS/PASSENGERS CHP 56 Palle 3(Rev.8-91) OP1d42_- I P'm'j d 6A-M of=JJSION OW- DAY Y&M TIME a-M WNC• OFFICER I,p a sol > nwAs P1W EXTENT OF INJURY("X"ONE) INJURED WAS("X"ONE) ONLY ONLY AOL OflY FATµ wAa.F!s hO E] El fEl OTI�lr111iE1 COIml�11R K� If ow". IANUY► EaIUAY �► 0/PAW -,-- AAtll VIED, ticYCy.sT oYMeR FCIZR�D�Yl ,aDORE55 TRANaPORTED B►: TAKNX TO:_ /t. .fes r-nc/m�z r /`e✓ � c r-/o < . DESCRIBE INJURIES P/9/-00, 4eor/s. VICTIM of VIaErT ORW NOTPJm ❑� ❑ r1 ❑ ❑ ❑ ❑ ❑ ❑ ❑ w"ME I o,o,B.I ADDRESS TJREPf+UE (INJURED opt"TRANSPORtFD BY: TAKEN T* �!r T�H.r v i iglu✓ c�.c. c I DE=RIBE INJUIRIFS d.r✓ i,BtF p/!o. dT172•J�wpf c Ac - Yrs LACE I VICTIM Or VWLENT CR#&NOTIrRD NAME I D,O,B./ADDREBS TELEh+014L:-... .. 4,-1 .r �,E v✓/�/ .l7- y!C J/ ✓ T�iF�ct .� si1 L�a r t Yrl 9 (tWuRED ONLY)TRANSPORTED BY: TAXIEN TO: - - A. DESCRI INJURIES � j9i'i ❑ VICTIM OF VICLEW GRJA¢HOMED ❑� EDyJr1 ,- 70 D ❑ ❑ ❑ ❑ ❑ NAW I D.O.B.I ADORERS y TEU33S� r1 f I9Yo -:�ci//i orf,•/ �- J7 -S.r- Y!�,/ G. /IME c•7,✓ f G A 9•' (INJURED ONLY)TR!NBP IMTED Br. TAI8N To: _ .I O e'2 oJ0 C DESCRIBE?UURIES ' VIrnJr Or VIOLENT ORBIE NOTIFWD . ❑# ❑ i ❑ J ❑ ® ❑ 101)Q101 ❑ 101 �- NAME 10.o.B.I ADOPtS3. TELEANOW c / J�/M•Yolf/ - v y� l1/ ry>.. ,ac/�.r NAY. f �rT►o .rr c,i, rt (INJURED ONLY)TRAW3PORTFD Br. - TA)04 TO: . c JZAA . 0 DeGCRIDE NJUPJEC A ,cr t .A.i `- e Hepr VICTIM Of:vIDLJ:xr cR�NalrmJ{o ❑# ❑ �✓ F ❑ ❑ a ❑ El a ❑ r -s- NAME/D.O.ILI ADDRESS TELEPHONE I -f-lof'/t,r (IJUURED ONLY)TRAWRORTED BY: TAIEN TO: I /y•// R. .l4T 2 lee P/r c 776C- De-cJ:IB[INJUaIEI$ /'a.�„ 'Z 4o Nf c T,��?••s�is R if c� /.�� Thi ��%/,�„ LT /�/�i.t./c�-C/-......:-- ❑ MCTIM OF%AoLPIR cOJUS NOTIRED PR9PAReXZ NAME I.D.NUMDER MO. DAY YEAR REVIEWERS NAME No. GAY YEAR - 7 F.RbM : AMERICAN OUTBACK CEM' -RA TM) PHONE N0: 510 753 58E Sun. 06 2001 03:39PM P6 sTATF-of CALIFOF(WSA pvp" st •'� JUR D/WITNESS/PASSENGERS 7L1G Cam? QA7 `m O PATE OF CDLLCROri�: ti'!AR} Y � i' EXTENT OF INJURY{"x"ONE) INIt)FtFyt WA8{"x~ONE} rum >,car ..rsx e� wrweaB PAsa8rlam Wu sexrAiu sSS*TOvmatH �+' Conn Pit 014-T " Yea Mcrq,.or atMER nuunMtw ro. :mss. �A ONLY � M aWR'I B.,AWRE9eyr ' !Kv cls t Z tAC EL /a-l d- 9 2 s` iA[EII TC /Y—;S /�� >9.l-'! .l�►. (tN.NJR'GR ONLt?rRAt15P'OR'TID oescRlB+±trWR+EB � t t NAatE,D.a,a.,.000aESs •r/- /'s/Ir//l /Yo//fir l 11iO f1- ybp;- _pfd- 7f f i puuRED DNIn T I By: R�'C.7118E IN.A/RIFS , -------------- ❑ vICTIM Or VOMENT 6r94E NOTTF= El m tN"W.14.D.B.,,voms-^ tN+ypEOONCY)TR h*P0ATED9*: w - 9 2.rte 2.T"-a- 9AJ 1 DEECRIBE;KlUAlES ❑VICTUA CV V 0LeWC*tW?jOnF*D ❑# o ❑ o o ❑ ❑ o ❑ ❑ o NAME 10,0,B.!ADDRESS TAOMM M: (I"R;tFD CNLY1 TRAN.°RORTSD BY: . .OESCrc19E IKA.iRIES . vmTtm OF VralE#rr csoW Nk7i*= ❑# El ❑. _ ❑ ❑ ❑ El ❑ EJ ❑ 11 , NAME 10,0.&1 ADDRES5 TAXER TO: . 11N,URPD ONLY)TRRANSPOfTMO BY. DEXRIEE WURIES . ❑V=Tt"Or VXXF+T C )bw NOTW" ❑ ❑ ❑ ❑ a ❑ El ❑ ❑ ❑ ❑ NAME 10.D.B.I ADDRESS rAwF,m TO: omuwRw ONLY)TRAIjuPOA7EO 6'r OERCRIBE UCA.IRIES I ©vlcnm OF vrOL"ff claw NOTFYED'' I.D.NUMBER Yo. DAY YEAR RGVIEWER"a NArE No. cwY YEAR PREPARCRS NAME . ry_ rs�r�csYs t /a/7 FROM AMERICAN OUTBACK CEMLiI'-RA TMS PHONE NO. 510 753 5BBr Jun. 06 2001 03:40PM P7 STATE OF CALIFORNIA I lKIIAM .&I EIQuE LFMFNT pj°'�E - —1; OF.IIICIDENT TIINE NAC NUMBER OFFICER I.D. �� OS/T9/O1 1540 9320 010179 ! � N _ VASCO RD_ S. OF I CAMINO DIABLO 1 V-1 1 1 1 I . . 1 . V-21 J ALTHOUGH IMPACTS 2 AND d ONLY SHOW GUARDRAIL MERE THEY OCCURRED. 1 GUARDRAIL BORDERED ALONG THE OUTGIDE OF THE ENTIRE SCENE ON BOTH SIDES OF THE ROAD. 1 _ V-1 I 1 J f 1 1 . I 1 / IV-2 V-3 J 1 1 1 / . 1 _ 1 1 V-3 1 / 1 f / S/B I' N/B SKETCH PF"AItER'S NAME I.D.NUMBER DATE REVIEWER'S NAME DATE M MITCHELL 10179 05/29/01 FROM 8MER I CRN OUTBACK (EMI,1''cRR TM) PHONE NO. 5107 753 5e8,' Jun. 06 2001 03:40PM P8 STATE OF CALIFORNIA FACTUAL DIAGRAM CHP sss P�4 eY s`m Opt oat PAGE OF ZZ _ DATE OF 1jr NCIDEN7 TIME NCI C NUMBER OFFICER I.D. NUMB =/y- v/ /s`-YO 9320 ro/,> ALL MEASUREMENTS ARE APPROXIMATE AND NOT TO SCALE UNLESS STATED(SCALE= } VASCO RID Fac#ual Diagram . (Not To Scale) a ft. 1 z tt 12 ft. 8 R, METAL5/� METAL' N/B GUARDRAIL 2 GUARDRAIL ♦^.1 DIRT AND GRASS '^�^ DIRT AND GRASS FIELD FIELD 4q.4, i PAINTED WHITE PAINTED WHITE LINE LINE I? I 7 i PAINTED YELLOW LINES AND V REFLECTORS CAMINO DIABLO PREPARED BY LD, NUMBER DATE REVIEWER'S NAME DATE MIKE L. TERRY 15772 05/22/2001 FROM AMERICAN OUTBACK (EMI uIGRA TM) PHONE NO. 510 753 588' Jun. 0b 2001 03:40PM P9 FAGTUAL'DIAGRAM CAGE)-,) PAGE: ,7 OF-/- Urfq nF ro1U510" 1�rmo(12+001 MCIC 4u-a(A oFFiCEw i.0 HSl�NEp Ufa g OtY /� rH o ,$�'.�o /O/I VEHICLE POINTS OF REST oaa A£fEaEwc£woSrYT FE£7 yip >ecowo ra£�EN£HCE voi4T ._ r 6-1 P S ( 'a,04 rbrl. ov, A M I Al C Qas - It.b +.I Iz " LI 1L 3► tti 1 `' W PHYSICAL EVIDENCE `✓ is Ar, fba-T Oli �Q04 O` rLlliy� ! F047TC L-00 .fit N to FOOT wl► "` IS LtS FOOT LD►4 A N La 1'0oT W, Q •A4XA CD IS A Four 144 k -7100 OF w L~ Rb Zpk%L . A Mt 4Z I"b$V W t D iZ.t +�{Izft V NF-AStARENt !JT FOR 0, G}�"'+Q PkM 4%-JE%3 A*T CXwl'F-iL iAA" LOCATIONS OF PHYSICAL EVIDENCE X FRET DSR RE"EWCE PWPirr PEST OIR' SECOMD Rrr-wmCE Pois r I. Sb 0 S EQDl�`1 0f C46411lb erp4ig L%.-mg oP VASco Vb X300 It E Ic �• 3 IS 15 sse� S 41 ►a . E 531'1 S `� . •• . . Zr.o Sb4D S ,t .•MEOni ears"AMC AMO 1.0.NUMBER UATF REvSEWER's HAM£ DArc l FF2Cif1 AMERICRN OUTBACK (EML"'GRA' TM). PHONE NO. 510 753 588/ Jun. 06 2001 03:41PM P10 STATE OF CALIFORNIA ''l `'*``" ' NARRATIV /SUP_P�EMENTAI, - - PAGE ' DATE OF INCIDENT ' ;`• ;.�i 6'' TIME NCIC NUMBER OFFICER I.D. 45/l9%Ol 1540 9320 010179 1 FACTS: -' 2 NOTIFICATION: 3 At 1546 hours, I received a radio call of a traffic.collision with an ambulance sent to it. I 4 responded from C Street north.of West 18 th Street in Antioch arriving on scene at 1603 5 hours. All speeds, time and measurements are approximate_ Measurements were by roll 6 meter and patrol vehicle odometer. 7 8 SCENE: 9 Vasco Road at this location, is a flat and asphalt road with a curve built into it. The opposing 10 directions are separated from each other by painted broken yellow lines. To the outside of 11 both directions and separated from them by painted white edge lines, are shoulders. Metal 12 guardrails border along the outside of the shoulders followed by downhill dirt embankments: 13 Vasco,Road,is located in a rural area of eastern Contra Costa County- For further on the 14 scene see factual diagram on page 6. 15 16 VEHICL.ESIPARTIES: 17. All vehicles involved were found on their wheels. V-1 was found in the southbound lane and . . 18 shoulder facing in an easterly direction. V-2 was also found in the southbound lane and 19 shoulder but facing in a northeasterly direction. V-3 was found in the northbound lane facing 20 in a northwesterly direction. See factual diagram on page 6 and legend on page 7 for their - 21 general configurations in the road as well as their measurements. 22 23 All parties were located in the drivers seat of their respective vehicles with P-2 and P-3 being 24 treated by medical personnel. P-1 (Smith) was identified out at the scene by her California 25 driver license. P-2 (Sumliyoshi)identified himself to C.H.P. Officer S. Joiner at John Muir 26 Hospital in Walnut Creek with his California driver license. P-3 (Feary)was identified by . . 27 her California driver license given to me by her husband at Sutter/Delta Hospital in Antioch 28 29 PHYSICAL EVIDENCE: 30 See factual diagrarn on page 6 and legend on page 7 for the description andmeasurements of 31 all physical evidence obtained at the scene by C.H.P. Officer M_ Terry, #15772. 32 33 STATEMENTS. IN ESSENCE: 34 P-I (Smith)related that she was northbound on Vasco Road at Los Vaqueros Road in Alameda 35 County when this incident started- Near that location she said that the one northbound lane 36 becomes two. She had moved into the N-I lane to pass around another mini van and as she was 37 starting to pass by it, the other driver cut in front of her causing P-l to,brake to avoid a collision. 38 Now behind the other mini van, P-1 said they traveled a short distance before the other driver 39 "slammed"on her brakes and came to a stop causing her(P-1)to do the same to again, avoid a 40 collision. At this time, they had both been traveling around 4S to 50 m.p.h. and were right at PREPARER'S NAME I.D.'NUMBER DATE REVIEWFR'S NAME DATE M MITCHELL 10179 05/29/01 41- FROM AMERICAN OUTBACK CEMI11 11:RA TM) PHONE NO. 510 753 500``,' Jun. 06 2001 03:42PM P11 STATE OF CALIFORNIA V 9 DATE OF INCIDENT TIME NCIC NUMBER OFFICER LD, NUMBER 05119/01 1540 9320 0 i 0179 1 about.the Alameda/Contra Costa County line. After five to six seconds, the other driver 2 continued northbound with P-1 still behind her at a distance of five to six vehicle lengths. Now. 3 in a single northbound lane, P-1 called her fiancee, witriess Gartleman, on a cell phone and told 4 him that someone was `playing chicken"with her and that she was "backing off." Now at the 5 section where the collision occurred, P-I said she had pulled out and into the southbound lane to 6 pass the other vehicle adding that there were no southbound vehicles approaching her. As she 7 sped up to pass, she said the other driver would do the same. She would then attempt to drop S back but said the other driver would also drop back. This occurred three to four times and P-1 9 said the other driver would not let her get in front or fall back behind.and into the northbound 10 lane. P-I then observed a white southbound vehicle approaching at 200 to 300 feet and at an 11 approximate speed of 45 to 50 m.p,h_ She knew she was going to get struck but said there was 12 nothing she could do as the driver of the mini van would stili not let her move back into the 13 northbound large. P-1 said her foot was on the brake pedal when her vehicle was struck head-on 14 by the southbound vehicle. The impact spun her vehicle around before it struck the southbound 15 guardrail and came to rest. P-1 said she never saw the impact between V-2 and V-3. I asked P-1 16 how long it had been from the time she had pulled out to pass until the impact. Although she 17 was not really certain, she had guessed about twenty seconds. She described the driver of the lg other mini van as a female adult wearing some kind of glasses. The vehicle she said was an early 19 nineties baby blue Plymouth Voyager with wood paneling on the sides and with California plates. 20 1 asked P-1 if there had been any kind of an altercation between herself and the other driver 21 earlier and she said no. 22 23 P-2(Sumiyoshi) related to C_H.P. Officer S_ Joiner at John Muir Hospital, that he was 24 southbound on Vasco Road traveling at 40 m_p.h. when he observed a truck cross over the 25 double yellow lines and hit his vehicle head-on. That impact had spun his vehicle around before 26 it was struck again. P-2 said he did not have tirne to take evasive action prior to being struck by 27 the truck. 28 29 P-3.(Feary)related to me at Sutter/Delta Hospital, that she was northbound on Vasco Road 30 traveling at about'45 m_p.h. and four to five vehicles behind V-1. (Four to five other vehicles 31 were between her vehicle and V-1). All of the vehicles in front of her were traveling at the same 32 speed when suddenly, the driver of V-1 pulled out and into the southbound lane to pass. At that 33 time,P-3 stated that there was a line of southbound vehicles approaching at a distance of what . 34 she said was"maybe three car lengths"north of V-1. P-3 did not have any idea of the speed of 35 southbound traffic but she said that when V-1 pulled out to pass, it had started to overtake what 36 P-3 thought was a light blue van bugger than V-1. She said that V-I's driver then tried to move 37. to the right but was unable to get back into the northbound lane. P-3 knew a collision was 39 imminent so she started braking and tried to move to the northbound shoulder. She then 39 observed V-1 get struck head-on by a southbound vehicle and the next thing she knew was that 40 V-3's air bags had gone off. P-3 said she never saw what had hit her. I asked P-3 if she had seen PREPARER'S NAMP I.D.NUMBER DATE REVIEWER'S N.a.ME DATE M MITCHELL 10179 05/29/01 FPQM AMERICAN OUTBACK CEMI" -RA TMS PHONE NO. 510 753 582 Jun. 06 2001 03:42PM P12 STATE OF CALIFORNIA 1 11/E/3LE!eJ ENT L a r /o .. DATE OF INCIDENT TIME NCIC NU'MBF,R OFFICER I.D. NUM ER 05/19/01 1540 9320. 010179 -1 the other van speeding up and slowing down as P-1 had stated and she said she had not. 2 However, she added that when P-1 pulled out to pass, it was already unsafe and that P-1 had 3' insufficient clearance to do so. R-3 said she had been on Vasco Road from Livermore and bad 4 not noticed V-1 until just prior to the collision. I asked P-3 if she could tell me anything more 5 about the light blue van that V-1 had started to overtake during the passing maneuver but she was 6 unable to do so. 7 8 Passenzer Steffeck related that he was seated in the right front of V-3. P-3 he said was 9 northbound on Vasco Road traveling at 60 to 65 m.p.h. and behind V-1 30 feet. He had looked 10 away briefly and the next thing he saw was that V-1 had pulled out and into the southbound lane: 11 -It had been out there a few seconds when he observed its brake lights Come on. V-1 then started . 12 to drop back and into the northbound lane when it was struck head-on by what he thought was 13 V-2_ Steffeck hadn't really noticed southbound traffic approaching until just prior to the impact 14 and therefore, was unable to tell how fast V-2 was traveling at. When the first impact occurred, 15 Steffeck said that one of the two vehicles had spun around and struck V-3_ He stated that when .16 V-1 had pulled out and into the southbound lane, it had only moved up along side of the vehicle 17 it was passing and never forward of it. At that point, he said P-3 was already on her brakes and 18 slowing down. 19 20 Witness Mohan&related that he was northbound on Vasco Road traveling at about 50 m.p.h. 21 . and south of the collision scene,when a black mini van had passed him traveling at 22 approximately 60 to 65 m_p.h. over the broken yellow lines. Shortly thereafter, he came up on 23 the scene of the collision. . 24 25 Witness Gartleman related to me at Sutter/Delta Hospital that P-1 had called him earlier that 26 afternoon but he did not know what time that had been. During their conversation, PA had 27 stated to Gartleman that"I'm in a good mood except for this asshole in front of me in a van 28 cutting me off. Barring this idiot in front of me, I'll be home in twenty to thirty minutes." That. 29 was it and Gartleman said that P-1 seemed happy never stating anything else about the other 30 driver's actions. 31 32 OPINIONS/CONCLUSION: 33 SUMMARY: 34 Because there were no independent witnesses to this collision, I can neither prove or disprove 35 the validity of P-1's statement. However, this is what I believed occurred_ 36 Prior to this collision occurring,P-1 (Smith)was northbound on Vasco Road south of 37 Camino Diablo traveling between 45 and 65 m.p.h. 38 P-3 (Peary)was behind her around four to five vehicle lengths traveling between the same 39 speeds_ PREPARER'S NAME I.D.NUMBER DATE REvIEWER'S NAME DATE M MITCHELL 10179 .05/29/01 r� Ft OM : AMERICAN OUTBACK CEMI +'ERR TMS PHONE NO. 510 753 588' Jun. 06 2001 03:43PM P13 STATE OF CALIFORNIA NARRATNF//s PPLEMENTAL DATE OF INCFDENT TIME NCIC NUMBER OFFICER LD, NUM ER 05/19/01 1540 9320 010179 1 P-2 (Sumiyoshi)was southbound on Vasco Road south of Camino Diablo but north of V-1 2 and V-3, traveling between 40 and 50 m_p.h. 3 P-1 wanted to pass other northbound traffic and had pulled out and into the southbound.lane. 4 to do so. When she did this, she either failed to see southbound traffic approaching her or she 5 misjudged its speed and distance. Whatever it was, P-1 pulled out into the southbound lane 6 with insufficient clearance to pass and shortly afteir doing so, she realized this. She applied 7 her brakes and started to drop back but was unable to get back into an opening in the 8 northbound lane. The left front of V-1 then struck the left front of V-2 head-ori. V-2 9 continued forward and down the left side of V-1 before it entered the northbound lane 10 heading towards V-3. P-3 was aware that a collision was imminent when P-1 had first pulledA 11 out.to pass so she applied her brakes and started moving to the right to avoid being involved 12 in it. However, as she was doing this, the front of her vehicle was struck head-on by V-2. 13 V-3 continued forward and to the-right where itstruck the guardrail along the outside of the 14 northbound lane with its front end before corl<iing to rest back out in the northbound lane. 15 The impact between V-2 and V-3 spun V-2 partially around in a counter clockwise motion 16 before it came to rest in the southbound lane and shoulder. After the initial impact between 17 V-1 and V-2, V-1 swerved off to the left while at the same time, it started to come around in 18 a clockwise motion before its back end struck the guardrail along the outside of the 19 southbound lane. After it struck the guardrail, V-1 calve to rest in the southbound lane and 20 shoulder. 21 22 AREA OF IMPACT. 23 The area of impact (V-1 vs. V-2) was one mile south.of the south edge prolongation of 24 Camino Diablo and 9 feet east of the west roadway edge of Vasco Road. This was based on 25 statements and physical evidence. 26 27 CAUSE: 28 P-1 (Smith)caused this collision because of her violation of 21751 V.C. (passing without 29 sufficient clearance). 30 ' 31 RECOMMENDATIONS: 32 Recommend a complaint be filed against P-1 (Smith)for 21751 V.C. 33 PREPARER'S NAME I.D.NUMBER DATE REVIEWERS NAME DATE M MITCHELL 10179 05/29/01 �l List of Debbie Feary Health Care Providers Dr. Anderson, One Shrader Street, 4th Floor, San Francisco, California 94117 Kenneth Hsu, M.D., One Shrader Street, 4" FI., San Francisco, California 94117 Sutter Delta Medical Center, 3901 Lone Tree Way, Antioch, California 94509 M � c, O 6> _ r r • r N 40 C If- O W d') 0) O 4 � i0 p Z' crU � d) tt1 r- '� � N G O N N U. N � r �P to Q •� o v o � d 2 2 4 N ti Y C: v 0 0 co � v y � U V ` s E N .• Q. N c� Z CLAIM / w4BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". U17 AMOUNT: Unknown � CLAIMANT: Contra Costa Water District NOV 13 2001 COUNTY COUNSEL ATTORNEY: Craig Judson DATE RECEIVED: November 8, 2001 MARTINEZ,CALIF. ADDRESS: 500 Ygnacio Valley Rd#325 BY DELIVERY TO CLERK ON: November 8, 2001 Walnut Creek, CA 94596 BY MAIL POSTMARKED: November 7, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET - Au&� Dated: November 13, 2001 By: Deputy !� II.. FROM: County Counsel TO: Clerk of the Board of Supervisors , This claim complies substantially with Sections 910 and 910.2. IV ( } 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: V f Dated: By. Deputy County Counsel III. FROM: Clerk of the Board TO: C L Ft y Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated CeJy0Z�11 '` . 0 1 JOHN SWEETEN, CLERK, By 1/l -(y/V�/ �1 , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: MQ JVVA�I H , N JOHN SWEETEN, CLERK By�����` l v`' Deputy Clerk f 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. CLAIM FOR CONTRACTUAL INDEMNITY AGAINST COUNTY Of CONTRA COSTA (Government Code 5 910) RECEVVED To the Clerk of the Board of Supervisors Contra Costa County NOV 8 2001 651 Pine Street CLERK BOARD OF SUPERVISORS Martinez, Ca. 94553 CONTRA COS-1,P,Co. Claimant's Name: CONTRA COSTA WATER DISTRICT Claimant's Address: c/o Craig L. Judson, Esq. Bold, Polisner, Maddow, Nelson & Judson A Professional Corporation 500 Ygnacio Valley Road, Suite 325 Walnut Creek, CA 94596 Date of Incident: . July 8, 2000 Amount of Claim: In excess of the jurisdictional minimum of the Superior Court ($25,000) Location of Incident: Vasco Road, Contra Costa County Names of Public Employees Responsible For,Claimant's Injuries: Unknown How Loss, Injury, or Damage Occurred: Claimant has been named as a defendant in a lawsuit filed by Karen Krowl-Denham and Timothy Denham against County of Contra Costa, Superior Court case number C01-02410 (see copy attached). Pursuant to the Cooperative Agreement executed in 1994, Contra Costa County agreed to defend and indemnify Contra Costa Water District for all claims and lawsuits arising out of the use of Vasco Road after acceptance by the County of Contra Costa. CLAIM FOR CONTRACTUAL INDEMNITY Against County of Contra Costa Claimant: Contra Costa Water District Page 1 Nature Of Injuries To Claimant: Contractual indemnity and tender of defense of this Complaint. Expenses To Date: Legal expenses not exceeding $2,000 incurred in defending this case. Total Estimated Expense: $50,000 Request for Notice: All notices should be sent to Claimant's attorney at the above address: Dated: November 6, 2001 / CGL70J � CRAIG DSON, Esq. Atto n Claimant CCWD CLAIM FOR CONTRACTUAL INDEMNITY Against County of Contra Costa Claimant: Contra Costa Water District Page 2 • 982.1(1 ATTORNEY OR PARTY WITHOUT ATTORNEY(Name,state nor number,and address): FOR COURT USE ONLY L. Christian Spieller (SBN) 083929 S•herida A. Stroble (SBN) 202717 HS Law Group (39549-17-P) 210 North Fourth Street, Suite 201 San- Jose, CA 95112 , i TELEPHONE NO: 408-295-7034 FAX NO.(Optional): 408-295-5799 EMAIL ADDRESS(Optional): 1 c s@ h s ap c c om ATTORNEY FOR(Name): Karen Krowl-Denham & Timothy Denham NAMEOFCDURT: Contra Costa County Superior Court STREETADDRESS: 725 Court Street MAILING ADDRESS: P.0. BOX 911 CITY ANDZIPCODE:Martinez, CA 94553 E:--- '...;`.. . BRANCH NAME:Martinez PLAINTIFF: Karen Krowl-Denham and Timothy Denham DEFENDANT: County of Contra Costa( Elvis Lam, Hertz Rent-A- Car and GoR�R� Cos}, wG�-jQr2 �i'S�K r�� n DOES 1 TO 5 0 COMPLAINT— Personal Injury, Property Damage, Wrongful Death 0 AMENDED (Number): FIRST Type (check all that apply): MOTOR VEHICLE OTHER(specify): Property Damage = Wrongful Death =] Personal Injury [x� Other Damages (specify): General Negligence, Loss of Consortium, Government Claim Jurisdiction (check all that apply): ACTION IS A LIMITED CIVIL CASE CASE NUMBER: Amount demanded 0 does not exceed$10,000 C01 02410 exceeds= ACTION IS AN UNLIMITED IVIL CASE10,000, but does not exceed $25,000 ACTION IS RECLASSIFIED by this amended complaint from limited to unlimited �I from unlimited to limited 1. PLAINTIFF(name): KAREN KROWL-DENHAM and TIMOTHY DENHAM alleges causes of action against DEFENDANT (name):county of Contra Costa, Elvis Lam, Hertz Rent-A-Car. & Contra 2. This pleading, including attachments and exhibits,consists of the following number of pages: 11 Costa Water District 3. Each plaintiff named above is a competent adult (see attachment, page 4 ) a. = except plaintiff(name): (1) a corporation qualified to do business in California (2) an unincorporated entity(describe): (3) a public entity(describe): (4) a minor an adult (a) for whom a guardian or conservator of the estate or a guardian ad [item has been appointed (b) 0 other (specify): (5) = other(specify): b. [] except plaintiff(name): (1) a corporation qualified to do business in California (2) an unincorporated entity(describe): (3) 0 a public entity describe): (4) a minor an adult (a) for whom a guardian or conservator of the estate or a guardian ad litem has been appointed (b) 0 other(specify): (5) = other(specify): Information about additional plaintiffs who are not competent adults is shown in Complaint—Attachment 3. (Continued On reverse) Page one of three Form Approved for Optional Use Code of Civil Procedure§425.12 Judicial Council of California COMPLAINT—Personal Injury,Property Damage,Wrongful Death Linksoujow 982.1(1)[Rev.January 1,200 1) a SHORTfiITLE: Krowl-Denham v. County of Contra Costa, et al . CASE NUMBER: CO1 02410 4. Plaintiff(name): KAREN KROWL-DENHAM and TIMOTHY DENHAM is doing business under the fictitious name of(specify): and has complied with the fictitious business name laws. 5. Each defendant named above is a natural person a. [�-C] except defendant(name): County of Contra c. F-x] except defendant(name):Contra Costa Costa Water District (1) a business organization,form unknown (1) a business organization,form unknown (2) a corporation (2) [] a corporation (3) an unincorporated entity(describe): (3) an unincorporated entity(describe): (4) Exl a public entity(describe): County (4) [X a public entity(describe): County Water District (5) [] other(specify): (5) =other(specify): b. x[� except defendant(name): Hertz Rent-A- d. except defendant(name): Car (1) x0 a business organization,form unknown (1) a business organization, form unknown (2) [] a corporation (2) a corporation (3) 0 an unincorporated entity(describe): (3) an unincorporated entity(describe): (4) 0 a public entity(describe): (4) a public entity(describe): (5) other(specify): (5) other(specify): (� Information about additional defendants who are not natural persons is contained in Complaint—Attachment 5. 6. The true names and capacities of defendants sued as Does are unknown to plaintiff, 7. 0 Defendants who are joined pursuant to Code of Civil Procedure section 382 are (names): 8. This court is the proper court because a. —xx I at least one defendant now resides in its jurisdictional area. b. the principal place of business of a defendant corporation or unincorporated association is in its jurisdictional area. c. injury to person or damage to personal property occurred in its jurisdictional area. d. 0 other(specify): 9.1 x-1 Plaintiff is required to comply with a claims statute, and plaintiffs served County of Contra a. r� plaintiff has complied with applicable claims statutes, or Costa and Contra Costa Water District b. plaintiff is excused from complying because (specify): pursuant to Government Code Section 910 , with claims for personal injury . Both were denied. (Continued on page three) 982.1(1)[Rev.January 1,2001] COMPLAINT—Personal Injury, Property Damage,Wrongful Death Pago two o1 three SHORT TITLE: Krow1–Denham v. County of Contra Costa, et al. CASE NUMBER: C01 02410 10.'The following causes of action are attached and the statements above apply to each (each complaint must have one or more causes of action attached): a. Motor vehicle b. [x] General Negligence c. [] Intentional Tort d. [_] Products Liability e. .Premises Liability f. Other(specify): 11. Plaintiff has suffered a. Lx] wage loss b. = loss of use of property c. [:Rj hospital and medical expenses d. [] general damage e. [x] property damage f. [r_] loss of earning capacity g. Lx-] other damage (specify): Loss of Consortium as to Timothy Denham 12. The damages claimed for wrongful death and the relationships of plaintiff to the deceased are a. listed in Complaint—Attachment 12. b. as follows: 13. The relief sought in this complaint is within the jurisdiction of this court. 14. PLAINTIFF PRAYS for judgment for costs of suit; for such relief as is fair,just,and equitable; and for a. FX I compensatory damages (1) x� (unlimited civil cases)according to proof. (2) = (limited civil cases)in the amount of$ b. other(specify): Loss of Consortium damages as to Timothy Denham 15. 0 The paragraphs of this complaint alleged on information and belief are as follows(specify paragraph numbers): Date: August 23,' 2001 L. Christian Spieller (TYPE OR PRINT NAME) (SIGNATURE-OF PLAINTIFF OR ATTORNEY) 982A(1)IRev.January 1,2001) COMPLAINT—Personal Injury, Property Damage,Wrongful Death Page three o1 three SHORT TITLE: KROWL—DENHAM v. COUNTY OF CONTRA COSTA, et CASE NUMBER: al . C01=02410 1 ` 2I 3 4 Pursuant to C.C.P. Section 472, Plaintiffs amend their Complaint ' 5 (which was filed July 3, 2001, but not served) to name Contra Costa Water 6 District as a defendant. 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 (Required for verified pleading) The items on this page stated on information and belief (specify item numbers, not line numbers): 27 This page may be used with any Judicial Council form or any other paper filed with this court. Page 4 Form Approved by the - ADDITIONAL-PAGE Judicial Council of California Attach to Judicial Council Form or Other Court Paper CRC 201, 501 MC-020 New January 1,19871 p Optional Form SHORTTITLE: Krowl—Denham v. Contra Costa County, et al . CASE NUMBER. C01-02410 FIRST CAUSE OF ACTION - Motor Vehicle Page 5 (number) First Amended ATTACHMENT TO I—x 1 Complaint =Cross-Complaint (Use a separate cause of action form for each cause of action.) Plaintiff(name): Karen Krowl=Denham and Timothy Denham MV-1. Plaintiff alleges the acts of defendants were negligent; the acts were the legal (proximate)cause of injuries and damages to plaintiff; the acts occurred on (date): July 8, 2000 at(place): The vicinity of Vasco Road, in the unincorporated portion of the County of Contra Costa, approximately 5. 3 miles south of Camino Diablo Road. MV-2. DEFENDANTS a.[x The defendants who operated a motor vehicle are (names):Elvis Lam =x Does 1 to 5 b.[x]The defendants who employed the persons who operated a motor vehicle in the course of their employment are (names): Elvis Lam [ Does 6 to 10 c.[x]The defendants who owned the motor vehicle which was operated with their permission are (names): Hertz Rent-A—Car . =x Does 11 to 15 d.al The defendants who entrusted the motor vehicle are (names): Hertz Rent—A—Car Does 16 to 20 e. x-]The defendants who were the agents and employees of the other defendants and acted within the scope of the agency were (names): Elvis Lam Does 21 to 25 f. The defendants who are liable to plaintiffs for other reasons and the reasons for the liability are listed in Attachment MV-2f =as follows: [=Does to FoalCouncil of CAUSE OF ACTION - Motor Vehicle Judicial Council of California Effective January 1,1982 Los&Sc unoa CCP 425.12 Rule 982.1(2) v Optional Forth SHORT TITLE: CASE NUMBER: Krowl-Denham v. County of Contra Costa, et al . C01-02410 SECOND CAUSE OF ACTION - General Negligence Page 6 (number) First -Amended ATTACHMENT TO El Complaint CJCross-Complaint (Use a separate cause of action form for each cause of action.) GN-1. Plaintiff(name): Karen Krowl-Denham and Timothy Denham alleges that defendant(name): County of Contra Costa, Elvis Lam, Contra Costa Water District and Hertz Rent-A-Car [K] Does 2 6 to 5 n was the legal (proximate)cause of damages to plaintiff. By the following acts or omissions to act, .defendant negligently caused the damage to plaintiff on (date): July 8, 2000 at (place): The vicinity of that section of Vasco Rd, in the unincorp. portion of the County of Contra Costa, appr. 5. 3 mi . so.Camino Diablo Rd. (description of reasons for liability): On or about July_ 8, 2000, the County of Contra Costa and Contra Costa Water District owned, repaired and/or maintained, and otherwise established and held control over that portion of Vasco Road in the unincorporated area of Contra Costa County approximately 5. 3 miles south of its intersection with Camino Diablo Road in such a way that it created a dangerous condition of public property. Said condition of the property created a substantial risk of injury when that property or adjacent property. was used with due care and in a manner that was reasonably foreseeable and could have been prevented, remedied or guarded against but the County of Contra Costa and the Contra Costa Water District failed to take steps to do so. On or about July 8, 2000, during the period of the County of Contra Costa and Contra Costa Water District' s aforementioned involvement with this matter, Plaintiff Karen Krowl-Denham was operating her vehicle in a legal manner northbound on Vasco Road approaching the area described above . At or about the date and place described above, Karen Krowl-Denham was involved in a traffic collision with a vehicle operated by Elvis Lam and owned by Hertz Rent-A-Car and supplied to Lam and/or others . The traffic collision occurred, at least in part, due to the 'fault of the County of Contra Costa and Contra Costa Water District in that they owned, supervised, operated, designed, constructed, striped, regulated, reconfigured, repaired and/or maintained, and otherwise established and held control over that section of roadway. The County of Contra Costa and Contra Costa Water District negligently designed, constructed, owned, controlled, regulated, supervised, operated, repaired, reconfigured and/or maintained the roadway by, but not limited to, (a) Failing to design, construct, modify and/or reconfigure the roadway with appropriate horizontal and vertical alignments; striping; surface. and crown Form Approved by the Judicial Council of California CAUSE OF ACTION - General Negligence LBGkLk1u,nC*4S CCP 425.12 Effective January 1,1982 Rule 982.1(3) m Optional Form -SHORTTITLE: Krowl-Denham v. County of Contra Costa, et CASENUMBER: Fal . C01-02410 1 Continuation - SECOND CAUSE OF ACTION - GENERAL NEGLIGENCE 2 conditions; shoulder and border conditions, including edges; super- elevation; direction of 3 pitch and degree of slope; and/or sight distance; 4 (b) Failing to install adequate, appropriate traffic signs and/or electronic signal 5 devices warning drivers of the dangerous and defective condition of the roadway; and/or 6 (c) Posting an unsafe maximum speed for the roadway condition and prevailing traffic 7 conditions; 8 (d) Failing to plan for, alter or make allowances for adjacent property situated near 9 the site at which this collision occurred, such that the users of the roadway could not 10 adequately see, prepare for or anticipate oncoming vehicles that pose a potential hazard to 11 them in conjunction with the other roadway attributes then foreseeably in effect. 12 The County of Contra Costa and Contra Costa Water District's negligence caused a 13 dangerous and defective condition in the roadway which was a trap for unwary motorists and 14 was not reasonably apparent to and, in the exercise of due care, could not be anticipated by 15 those motorists. This dangerous and defective condition created a reasonably foreseeable and 16 substantial risk of injury to occupants of vehicles being operated on the roadway. 17 The County of Contra Costa and Contra Costa Water District had advance notice of, and 18 knew, or in the exercise of ordinary and reasonable care, should have known of the aforesaid 19 dangerous and defective conditions, but failed to correct same. The dangerous and defective 20 condition of the roadway had existed, and the County of Contra Costa and Contra Costa Water 21 District had notice of that dangerous and defective condition, for a sufficient period of 22 time prior to the subject accident so that the .County of Contra Costa and Contra Costa Water 23 District in the exercise of due care, should have discovered the dangerous condition and 24 acted to remedy same. 25 26 (Required for verified pleading) The items on this page stated on information and belief (specify item numbers, not line numbers): 27 F his page may be used with any Judicial Council form or any other paper filed with this court. Page 7 Form Approved by the. ADDITIONAL PAGE Judicial Council of California Attach to Judicial Council Form or Other Court Paper ��i M CRC 201. 501 MC-020INew January 1.19871 P Optional Form SHORT TITLE: Krowl-Denham v. County of Contra Costa, et al . CASE NUMBER: C01-02410 THIRD CAUSE-OF ACTION - Premises Liability Page R (number) First Amended ATTACHMENTTO F.,�(:]Complaint I-JCross-Complaint (Use a separate cause of action form for each cause of action.) Prem.L-1. Plaintiff(name): Karen Krowl-Denham and Timothy Denham alleges the acts of defendants were the legal (proximate)cause of damages to plaintiff. On (date): July 8, 2000 plaintiff was injured on the following premises in the following fashion(description of premises and circumstances of injury): On or about July B, 2000, the County of Contra Costa and.Contra Costa Water District owned supervised, operated designed, constructed, striped, regulated, reconfigured, repaired and/or maintained, and otherwise established and held control over that portion of Vasco Road in the unincorporated area of Contra Costa County approximately 5.3 miles south of its intersection with Camino Diablo Road in such a way that it created a dangerous condition of public_ property. Said condition of the property created a substantial risk of injury when that property or adjacent property was used with due care and in a manner that was reasonably foreseeable and could have been prevented,remedied or guarded against but the County of Contra Costa and Contra Costa Water District failed to take steps to do so. (Continued on page 9). Prem.L-2: �� Count One-Negligence The defendants who negligently owned, maintained, managed and operated the described premises were (names): County of Contra Costa, Contra Costa Water District, and LX I Does 2 5 to 30 Prem.L-3. (—J Count Two-Willful Failure to Warn [Civil Code section 846] The defendant owners who willfully or maliciously failed to guard or warn against a dangerous condition, use, structure, or activity were (names): []Does to Plaintiff, a recreational user, was O an invited guest E::] a paying guest. Prem.L-4. Count Three-Dangerous Condition of Public Property The defendants who owned public property on which a dangerous condition existed were (names): County of Contra Costa. Contra Costa Water District and , [:7 Does 31 to 35 a. ®The defendant public entity had = actual 0 constructive notice of the existence of the dangerous condition in sufficient time prior to the injury to have corrected it. b. C The condition was created by employees of the defendant public entity. Prem.L=5. a. Allegations about Other Defendants The defendants who were the agents and employees of the other defendants and acted within the scope of the agency were (names): Does to b. The defendants who are liable to plaintiffs for other reasons and the reasons for their liability are Ci described in attachment Prem.L-5.b as follows (names): Form Approved by the Judicial Council ofCallfomia CAUSE OF ACTION - Premises Liability CCP 425.12 Effective January 1,1982 Rule 982.1(5) Optional Form 'SHORT TITLE: Krowl-Denham v. County of Contra Costa, et CASE NUMBER: al . C01-02410 1 Conrinuation - THIRD CAUSE OF ACTION - PREMISES LIABILITY 2 On or about July 8, 2000, during the period of the County of Contra Costa and 3 Contra Costa Water District' s aforementioned involvement with this matter, 4 Plaintiff Karen Krowl-Denham was operating her vehicle in a legal manner northbound 5 on Vasco Road approaching the area described above. At or about the date and place 6 described above, Karen Krowl-Denham was involved in a traffic collision with a 7 vehicle operated by Elvis Lam and owned by Ilertz Rent-A-Car and supplied to Lam 8 and/or others. The traffic collision occurred, at least in part, due to the fault 9 of the County of Contra Costa and Contra Costa Water District in that they owned, 10 supervised, operated, designed, constructed, striped, regulated, reconfigured, 11 repaired and/or maintained, and otherwise established and held control over. that 12 section of roadway. 13 The County of Contra Costa and Contra Costa Water District negligently 14 designed, constructed, owned, controlled, regulated, supervised, operated, 15 repaired, reconfigured and/or maintained the roadway by, but not limited to, 16 (a) Failing to design, construct, modify and/or reconfigure the roadway 17 with appropriate horizontal and vertical alignments; striping; surface and crown 18 conditions; shoulder and border conditions, including edges;super-elevation; 19 direction of pitch and degree of slope; and/or sight distance; 20 (b) Failing to install adequate, appropriate traffic signs and/or electric 21 signal devices warning drivers of the dangerous and defective condition of the 22 roadway; and/or 23 (c) Posting an unsafe maximum speed for the roadway condition and 24 prevailing traffic conditions; 25 26 (Required for verified pleading) The items on this page stated on information and belief (specify item numbers, not tine numbers): 27 This page may be used with any Judicial Council form or any other paper tiled with this court. Page 9 Form Approved by the ADDITIONAL PAGE Judicial Council of California Attach to Judicial Council Form or Other Court Paper �%aZX''6 CRC 201, MC-020[New January 1,19871 sol Optional Form SHORTTITLE: Krowl-Denham v. Country of Contra Costa, CASE NUMBER: et al . C01-02410 IlContinuation - THIRD CAUSE OF ACTION - PREMISES LIABILITY 2I (d) Failing to plan for, alter or make allowances for adjacent 3 property situated near the site at which this collision occurred, such that 4 the users of the roadway could not adequately see, prepare for or anticipate 5 oncoming vehicles that pose a potential hazard to them in conjunction with 6 the other roadway attributes then foreseeably in effect . 7 The Contra Costa County and Contra Costa Water District ' s negligence 8 caused a dangerous and defective condition in the roadway which was a trap 9 for unwary motorists and was not reasonably apparent to and, in the exercise 10 of due care, could not be anticipated by those motorists . This dangerous 11 and defective condition created a reasonably foreseeable and substantial 12 risk of injury to occupants of vehicles being operated on the roadway. 13 The County of -Contra Costa and Contra Costa Water District had advance 14 notice of, and knew, or in the exercise of ordinary and reasonable care, 15 should have known of the aforesaid dangerous and defective conditions, but 16 failed to correct same. The dangerous and defective condition of the 17 roadway had existed, .and the County of Contra Costa and Contra Costa Water 18 District .had notice of that dangerous and defective condition, for a 19 sufficient period of time prior to the subject accident so that the County 20 of Contra Costa and Contra Costa Water District, in the exercise of due 21 care, should have discovered the dangerous condition and acted to remedy 22 same. 23 24 25 26 (Required for verified pleading) The items on this page stated on information and belief (specify item numbers, not line numbers): 27 This page may be used with any Judicial Council form or any other paper filed with this court. Page 10 Form Approved by the ADDITIONAL PAGE Judicial Council of California Attach to Judicial Council Form or Other Court Pa er �kumch6 CRC 201, 501 MC-020INew January 1,1987] p A Optional Foran BOLD, POLISNER, MADDOW, NELSON & .JUDSON A PROFESSIONAL CORPORATION ROBERT B. MADDOW 500 YGNACIO VALLEY ROAD, SUITE 325 OF COUNSEL CARL P. A. NELSON JEFFREY D. POLISNER CRAIG L. JUDSON WALNUT CREEK, CALIFORNIA 94596-3840 THOMAS N. STEWART, III TELEPHONE (925) 933-7777 FREDERICK BOLD, JR. (RETIRED) TELEFAX (925) 933-7804 E-MAIL bpmnj@prodlgy.net November 7, 2001 John Sweeten Clerk, Board of Supervisors Contra Costa County 651 Pine Street, Room 106 Martinez, Ca. 94553 Re: Claim for Contractual Indemnity Dear Mr. Sweeten: Enclosed please find Claim for Contractual Indemnity against County of Contra Costa by Claimant Contra Costa Water District. Please stamp the date of receipt on the enclosed copy of the Clainz and return it to me in the enclosed envelope. Thank you. Do not hesitate to contact me if you have any questions about this matter. Yours very truly, CRAIG L. JUDSON CLJ:jhj Enc. cc: Timothy J. Ryan i OW M Z Cl) C] LO ad cm Z Zw O O iz � U) 110 Cl) ¢ 0) "Ott —4 o. W O ch '� CC O0 LO U >- Y �� Out O JWp W Ct} A; tl zJw w o +�� ¢ � O U U N U) O 5 Q) cd r. zf co 514 U LU Z Z pC (7 Q) O O N CL N P4 U N N CL �4 4-) 4-3 8. ® Or-4 0Ln fO m ~ f ��.......__.......v_.._ .__��.___�_ __.._._ _-�-i-_.._�__. _. _._ .-_.. _-_� ` I i I i I I I I � -- I . . I I I I i i i ' i i ' i i I I i ------------- --------------------------I-- A i' CLAM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $188.97 OCT 3 0 2001 CLAIMANT: Charles Dodt MARTINEZ CALIF ATTORNEY: None DATE RECEIVED: October.29, 2001 ADDRESS: 1116 Temple Dr BY DELIVERY TO CLERK ON: October 29, 2001 Pacheco, CA 94553 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE Dated: October 29 , 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (-),this claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County.Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered initsitts minutes for this date. Dated: �A b I JOHN SWEETEN CLERK B �r�=k1�t �!� �, y �V , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in.the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: `J I JOHN SWEETEN, CLERK By (��� 1 U�U 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. a 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY LNSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal propem or growing crops and which accrue on or after January 1. 1988, must be presented not later than sia 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 a-ainst each public entity. E. Fraud. See penalty for, ,lent claims. Penal C F';... he end of this form. RE: Claim b} ) Reservedfor Clerk's Filing Stamp RECEIVED Against the County of Contra Costa OCT 2 9 2001 or CLERK BOARD OF SUPERVISORS District CONTRA COSTA CO. (Fill in Name) The undersigned claimant hereby makes claim against the Counn, of Contra Costa or the above named District in the sum of S 97 and in support of this claim represents as follows: 1. When did the damage or injure occur? (Give exact Date and Hour) 2. 3 -t. Z41 — ---------- ----------------- ---- _____1__--_____-____-________- 2. Where did the damage or injury occur? (Include C!Iv and Counn �Cte eco s�dd. �ZJ'wee i L/lut 1JV9nN< Jo�,�l, 4,.t O(Cv.e �.. ) ae k¢ / I.a/E�/c+ �Jj7. �o�-�•CJ --------------------------------------------------- ----------- -------CG-------------- 3. Hour' did the damage or injure. occur? (Give full details.use extra paper if required --------------------------------------------------------- --------------------------- 4. What particular act or omission on the part of county or district officers, sen-ants, or employees caused the injury or damage? N o /�a f, d% �•t:F., c a r y i r e, t�U u✓ ?/c. road �. o;`t .� a /Jl p (UC L ,Io wAtrc os ke wu4.1d rev 4-- - Over b, d.: d yr eel: aug par wamuostxdmi Bans gjoq +q -jo `( 0004OlS ) ssrilop pursnogl uaj'Dulpaa:)xa jou jo aug r .iq `uosud aims aq1 ul jaamuosudmt .iq io `aug par juamuosudmt Bans gjoq .iq to ( 000gS ) unilop pursnogj auo ouipaaaza jou jo aug r .iq-`arae ;)uo urgj a-lom jou jo pouad r loj i!rf .iiunoo aqj ul juawuosudmt .iq lagjza algrgsiund st `ulju.0 to `xaq;)non `1unojar iliq •wcrlo jualnpnrlj xo asirj .iur •auinuaL jE aturs aqj .ird to .i&ollr of pazuogjnr `n3juo to psroq jaujsip to .ijta `.ilunoa .iur of io `saogjo to psroq ajrjs Aur of juaw.ird Ioj to aaur.Aollu uoj swasaxd pnrsjap of juajat q11++ oq.a uossad .i.tan3„ :sap�%oxd apo irua l ayj jo aolloaS 3JI10 N 71� 'oti auogdalaZ o4 auoydalal ( ssaxPPF•) ( a.1mutitis s•jurujlriJ ) -fp oQ- .iatuouF jo ssalppt pur aturk 4:jirgaq s q uo uossad awos .iq to (.iausouF) 'oi S3JI o.Ni (i\3S .iurujtr.I:)agj..iq pauLis aq jsnw mrrl:)aq,l,,, :sapl.ioid Z•0I6 •aac-apeJ •A00 Y � Y' Y Y .: Y 1f � � f if X Y �t �t JF Y } :f YY C fG iX � M.� ?F 4 % � F �'� K '� f F'Y F at w• Y f � F 4 X.a[ Y :.c at . Lx:10t t' i,\aD 3.Lvu :.ilnfui io juaplaar sigj jo junoaar uo aprm n6e saimipuadxa aqj jsT-j •6 ------------------------------------------------------------------------------------- d/ tv sirjidsoy par •s-louop �sassaujl.A jo sassaippr pup. sawr.),, •8 ----------------------- ------- --------------------------------------------=---------- 1'3au/ r (P I,/ /'-/ok/ ('aoewep xo.Un(tn anwadsojd.itm to iunowe patewnsa atp apnpul) ;pajndmoa junomr pawirla anoqu aqj Sr." .»og _ (aoewep olne toj sa7eun3sa o,&tpuny 'pauneh saoeturp to saunftn jo watza Mv a&!f) zpajin&-.m'miry noe op sauGnfui .to sat' jrgA& -9 ------------------ yLo;j� ia►ii,;'TL�I%�----C- er �Ni�rn]� -------- aM x ;,:i.infm so aDruirp agj oulsnra saarioldma so`sjur.uas`slaag}o jaujsip so .ilunoa jo samra aqj alr jrg� 'S CONCORD 10.50 BURNETT AVENUE CONCORD, CA 94520-5713 Name R Address Phone: (925) 68/-5500 Room 135 Fax: (925) 363-5443 Arrive Date 10/02/01 C DODT Dept. Date 10/04/01 1116 TEMPLE DR Folio# 3194 Room Rate 79.50 Account 2-CBANK PACHECO CA 94553 Mkt/Seg 4-ENT Page 1 lndependenth ownedhi If VS/'//P PROPERHES n el opo ated be IPI;V•.5/l1l'/'ROPE'/?171:5 DATE CODE REFERENCE ID DESCRIPTION CHARGE PAYMENT . BALANCE 10/02 636 1002000 LRT MICRO /REFRIG $ 5.00 $ .00 $ 5.00 10/02 114 1002001 AUD DISCOUNT ROOM $ 79.50 $ .00 $ 84.50 10/02 811 1002002 AUD OCCUPANCY TAX $ 7.95 $ .00 $ 92.45 10/03 211 2453747 IMK BREAKFAST $ 8.32 $ .00 $ 100.77 10/03 411 118 XXX 925-827-0225 $ .75 $ .00 $ 101.52 10/03 114 1003000 AUD DISCOUNT ROOM $ 79.50 $ .00 $ 181.02 10/03 811 1003001 AUD OCCUPANCY TAX $ 7.95 $ .00 $ 188.97 10/04 914 .10040.00 • '. DGC ISA/MASTERCARD $ .00 $ -188.97 $ .00 ***TOTAL*** $ .00 ACCOUNT NO. DATE OF CHARGE I.D. xxxxxxxxxxxxxxxx xx/xx/xx 1XXX CARD MEMBER NAME FOLIO NO./CHECK NO. ESTABLISHMENTNO.cC LOCATION ;,n,.,.,ln'\,n;xri,I .u. "„',—,.IH,,,ss,ru,:"t,•.r+m_\r AUTHORIZATION XXXXXXXXXXXXXXXXXXXX XXXXXX XXXXXXXXXXXXXXXXXXXXXXXXX X'XXXXXXXXXXXXXXXXXXXXXXX XXXXXXXXXXXXXXX, XX XXXXX PURCHASE&SERVICES XXXXXXXX.XX CARD MEMBERS SIGNATURE TOTAL AMOUNT XXXXXXXX.XX C l!1':t'n.l.'I I.1.,1\1 •It ::;1'•'IS11 RI'11I1i15:1111SI1.11.1.— ItI:III 1111,1-P.RIM—1111 .1 t',1 11111'I \11 r TO: Clerk,Board of Supervisors Contra Costa County Room 106 County Administration Building 651 Pine St. Martinez, CA 94553 October 26, 2001 This letter is in explanation of the claim being filed against the County of Contra Costa. On October 1,2001, a construction crew began repaving and striping work on Pacheco Boulevard between Blum Road and Second Avenue South, in the city of Pacheco. This area is very close to the residence of my wife; Linda Dodt, and myself: The address of our house is 1116 Temple Drive,Pacheco, CA 94553. This roadwork began at about 8 P.M. on the above date. Since our house is located only about fifty feet from some parts of Pacheco Boulevard, the noise and light generated by the roadwork prevented us from sleeping when we retired at about 10 P.M., The sounds of heavy machinery being operated, vehicles in constant motion, and in particular the high-pitched beeping of back=up signals on the trucks kept us awake until the construction activity stopped at about 5 A.M. on.the morning of October 2. The situation was worsened by the fact that it was a hot night, making it impossible for us to close our bedroom windows and lessen the noise in any way. We telephoned the County Public Works Department early on October 2 in the hopes of finding out what was going on. By evening, our call had not been returned. A hand:written sign on the street informed us that the construction would continue from 9 P.M.to 5 A.M., October V through October P, 2001. Facing the prospect of two more sleeple§§nights, we were forced to relocate to a nearby hotel,the Holiday Inn at 1050 Burnett Avenue, Concord, CA 94520,for the next two nights. On Wednesday, October P, our phone call was returned by Kim Jeffries of the Public Works Department. She informed us that a private contractor was doing the roadwork and that we would have to file a claim against the County of Contra Costa in order to recover our expenses from the contractor. We were referred to Penny Bailey of the Risk Management Department,- who sent us the attached form. Our total out-of-pocket expenses included two nights' lodging at the hotel, one breakfast, and a phone call. An invoice for the amount of$188.97 is attached. The additional mileage on our two vehicles was negligible and we are not seeking reimbursement at this time: Sincerely, Charles Dodt 1116 Temple Drive Pacheco, CA 94553 (925)827-0225 •t T 3:- J bar �'' - 10, vwr . .., '! a... •.i.'. ...;w'... :;fir .. ! •I ,. •i'i�. r•Y•.. .. ,'.1 ' r'r � Y .. r. .r. ONO, , i ,. As n . r!,'l.r'.It .. ., :i'. o CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown 09SM-11, CLAIMANT: James A. Scott OCT 3 0 2001 ATTORNEY: None DATE RECEIVED: October 29, 2001 COUNTY COUNSEL MARTINEZ,CALIF. ADDRESS: 1342 Maryland Dr BY DELIVERY TO CLERK ON: October 29, 2001 Concord, CA 94521 BY MAIL POSTMARKED: Hand Delivered I. FROW Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE 1 r" /� 1 - ' 'I _ . � Dated: October 29 , 2001 By: Deputy� / - � ` 11F II. FROM: County Counsel TO: Clerk of the Board of Supervis rs (L.�-rliis 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (�() 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:UA-yy1�QLI H, ()I JOHN SWEETEN, CLERK, By' i WN+0�' , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: H JOHN SWEETEN, CLERK By ! ,'I ��� r� 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. 'Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100th day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (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 RECEIIf F D_ Against the County of Contra Costa or ) M \ ) OCT Z 9 2001 �-t D ic,� (I� -v �Coo District) ill in name CLERK BOAR OF SUPERVISORS ) ) CONTRA COSTA CO. ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ '(\S Nod in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) �Ul� 61 D-0d I c!. -36 4 ,-)-n• U 2. Where did the damage or injury occur? (Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? 11. 6o Un rc,r� vc Covr T 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) �`n \S n5cr ���h�s�� d L',h�,rv�u�• D 0 b� it�b 03 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 1 8. Names and addresses of witnesses, doctors, and hospitals. ! I �o 0 cx� S�� coo r.eFn CVn,, FO 1C'U0 t,+n LA , 94S-19 1'yV-4lDr. VktT 9 rl 3�-6 9. List the expenditures you made on account of this accident or injury. DATE TD JE AMOUNT 0 1 3 0 v q. Y,-., , % 3 ©a 9,Cv\d Fes- ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) J-Am --� r� . SCO-T 13 4 SCv-T34 ) (Claimant's Signature) Mil i?-v 6,y-j u-, (Address) C-A r ) Telephone NoO-2Sl Telephone No. 2-S�� ��TZ-. l G *s***«*•*********•.***s***s*****ss**�***s****s******�****�**s*�**s*s*««*****s***#«****#*** NOTTCE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill, account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. o � C_1 Q-r ��, ���, Q-0(i r s l , c Cnn 11 Q., !r'-e- aS 6N ('Csu)i or � V C.C�"D� 4 � �1Jt3ti� t t'1 ��c-,rr,��� 1p i.•t ��-L.. yk 0 f (' J v v-N cT C�ttnY�h c4. r r U c� '�O j `- c) t C, o- ho-C) beAL-0 Ci kr --J-C,�\ C,8 To 1 ) ;,YY'\ l 1 0-C)— G r1 d CJ r1 }ham rCi l c S 1` nc+ fit, E > Cl oc VO e f a/ Curr Se d e, Ux1� Usk % C,, �t� C�-�.�r ►��. tnn } Ike, cAz-�,L CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown 0 C T 3- 1 -.2001 COUNTY COUNSEL CLAIMANT: Edward Hollow MARTINEZ CALIF. ATTORNEY: None DATE RECEIVED: October 30, 2001 ADDRESS: 1812-1A Cole Ave BY DELIVERY TO CLERK ON: October 30, 2001 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN' SWEET ` Dated: October 30 , 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered inC its minutes for this date. Dated: C�rl/1/1 (] JOHN SWEETEN, CLERK, By �T1 � iG� , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid ^certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. ` Dated: �X&4,11 L 4,D1 JOHN SWEETEN, CLERK By�yl u� � 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMAJA T A. Claims relating to causes of action for death or for injury to person or to personal property or rowing 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 tate accrual of the cause of action. (Gov. Code §911.2) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street._!'fartinex, CA 94533. 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 engin•. E. Fraud. See penalty for fraudulent claims. Penal Code Sec 72 at the end of this form, it x x x.x x x x x RE: Claim by. ) Reserved for Clerk's Filing Stamp ot�.oui s�� RECEIVED ; Against the County of 3 of Contra Costa Q 2001 or CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) (Fill in Name) The undersigned claimant hereby makes claim acrainst the County of Contra Costa or the above named Districtin the sum of S and in support of this claim represents as follows. 1. When did the damage or injury occur`' (Give exact Date and Hour) \Ac o•) OCT. %-13 Lc asst OFC 000-01'. 1 `• PM ----------------------------_-------------------------------------------------------- 2. Where did the damage or injnn•Oeear' (bfclude City and Councy) � rte` J. How did a damage or injury occur? Give fad details:use extra pa r if aired 1 -`��� T. v�AS 'gCtO Crc�O�� 'tV'� O t� ��O W ,� 'M�✓O'N1� CC*T 4 Ce CCt�t,.� X01 �a -`coo -it --'t�--v'�0 -'C'�-- �•�.._ ._O'�_4'�_Q__ S.- ---------- 4. What particular aci or omission on the part of county or district officers, servants, or employees caused the injury or damage? d6k1q . wwxWOfpe: Q4 Cap Oar 'C �C'SZV Com. 4pri©'d i2.b i ALL �i 1N3W9eNUW ASI 8 00D b I:V I TO F—t-E-l.0O ' 4 .1... _ , .'� a .• �. 111i . •. ''f� y, - / i., S L.4^�• � • .. .• `�1��, '��►Z� S 1Q'� Com'- ►��'� ®��� �1•'�1L' � ��a `�'t VIE y co*4 cv--Cztt�s .r a }f.,.' ., � • .f • •- n r<� 'r ... _ .? • t ,y, yi .. r C, � /+', ._,;y •q1- y•• �. .. ' .v. , y., y.��- ♦ t � f'� ,F�' .f `'l, 'r1 � • � y j ix � •- ' .. r ♦. , .. • F ° - • ...,.f '.L ems' +{ 'Y�, r 4 •y f '� M ��.. � � . ... �,, • � r I c0"d -1tti01 5. What are the names of counts or district officers,servants,or employees causing the damage or injury Jov►N 6. What damages or injuries do you claim resulted? (Give NU extent of injuries or damages chimed. Attach two estimates for auto �.e------------------------------------------------------------------------------------- How was the above claimed amount computed, (Include the estimated amount of any prospective injury or damage.) ---------------------------------------------------------------------------- -------- - S. Name.+ and addresses of witnesses,doctors,and hospitals 9. List the expenditures you made on account of this accident or injury: D.ATE ITEM ,otM % a P. 9t!�L 'GZ�c�1 ea 1 �- 1i4'Q'1� 'a0 �� a ya * t x x x x � x n * :t x t, t. x k e• rt w * x w ,r * x # * Yr * w x. Ye K x k x * x * a * * * x y * * x x Gov. Code Sec. 910.provides: "The claim must be signed by the claimant SEND NOTICES TO: (Attorne-t1 or by some person on his behalf." Name and Address of Attorney ( laim�a►nt -nature) (Address) Telephone No. Telephone tioci � Q04 ®J NOTICE Section ?Z of the Penal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer, or to any-- county, city or district board or officer, authorized to allow or pas the same if genuine, any false or fraudulent claim,bill, account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one Year, by a fine of not exceeding one thousand dollars( S1,000 ),or by both such imprisonment and nine,or by imprisonment in the state prison,bs a fine of not exceeding ten thousand dollars ( 524,440 ), or by both such imprisonment and fine. c /EO'd Tc.bT S2£ SF6 D43Wr-lkl4Uq ,ASld 'M) bT:bT TOOE.-t:Z-1'_)0 ', 1i. !r. _��n �L _ � .. .. .. � .. • .• � .. .. . �4� i .M V�n .. � n .. a .. .. ... - .. � - � A . .. . .. . _ FR Otl LEX,1 G-OF-PLEASAhFiOK FAX t4O. : 9Z57340602 Oct. 24 2001 03:54PM P1 1=INVOICE 2^FIND 3=EDIT 7=EXIT O=RETURN HELP LEX PARTS lbTVOICII%TG WORKING INVOICE 10/24/01 Page I Employee . . . 603 R/O #= Pay Type 01 Stock # : Ptd: _ Cust. A/R #: Customer Name . Csst. Code: A T PP.RT NU"ER OTY PC DESCRIPTION jdIST _ NET _ EXTENDED i • 7553124050 1: 03` MOULDING, WNDSHLD, 34 . 09 34 .09 34:09 1 5611124150 1. 01 GLASS, .WINDSHIELD 642 .27 642 .27 642 .27 1 - 0 PART DETAIL Sub Total 676.36 Bin Stats: Sales Tax 54.11 MC . . QOH . . QOO . . Miscellaneous .00 Res tr V.-Ml Back Deposit .00 Total Due. . . . . . . . . . 730-47 Roll-. .UD/Down 6; Inventory 10: Mi.sc Chgs Help: Options Cmd/FS: 'Will Call 9: Active 11 : Customer Home: Menu Sar PRT315A -� 2)o 41 Co 2 •�� g .+ .t _.. ' OCT-26-2001—26-2001 04:GS SIFEX 1 TE 6=7 52�5 777 D620 F.S-1 Z01 1 I►. s"601—ner beemlce i pl71 J?P )oAUil [7aJa7-L �►l 7. ?S�'� 5.,;,J>:r`' "]i 1.J Y• dw.• Keyea by; . -1452271 CPL'- -r`,_...�1�,'�DL!�E. i,?OF!! .a: Zf HALLOWAY a HOME PASS tYEAR �. MAK MODEL ._90nI STYLE MILEAGE 197 ' • NUC �-C 00 E DOOR COUPE .:7 i LENUC� � . SELL 1 Rid ;= MISCFCW E42.07 Replace wi rh ij(�a4 :,ISS F-DRE IGN WINDSHIELD Vi 1` M 14 C•+iOL-1, C) Reoj,aa with cow M1SQ-mQLD!mr,' M YSCMOLD WON � N.r�VL' .TOTOL .15,0= SALES TWO, ! 3 UAL ` This ESTIMATE ] 5 good fCe 10 daYs Ti'GSf{ L{SC' uety i':v d above. 7E P4 e,►-Ir tom_. 9n tNJ CALL_ TO SCHEDULE bJgRK 1 G+e o raga-f1Si'P (2727) x"* z a� w� e TGTAL P.01 44.9 Y1 v 46 c� ` CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the RPI: Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $250,000 NOV 01 2001 COUNTY COUNSEL CLAIMANT: Cynthia Campbell-BoMRTINEZ,CALIF. ATTORNEY: Matthew Rinaldi DATE RECEIVED: October 31, 2001 ADDRESS: 171 12`h St#100 BY DELIVERY TO CLERK ON: October 31, 2001 Oakland, CA 94607 BY MAIL POSTMARKED: October 30, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETEN , - /f Dated: October 31 , 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (0/This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify thatt,this, is a true and correct copy of the Board's Order/entered in its minutes for this date. Dated: Q,YD'1I y , ( JOHN SWEETEN, CLERK, By /V{/" � , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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:�p ,;I,qq 4, 6� JOHN SWEETEN, CLERK By ,�G{�/' / 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. I 1 Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims-relating to causes of action for death or for injury to person or to personal property orb owing crops and which accrue on or before December 31, 1987, must be. presented not later than the 100th day after the accrual of the cause of-action. Claims relating to causes of action for death. or for injury to person or to personal property or bowing 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 Roori, 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 Cynthia Campbell—Boone , ) RECEIVED Against the County of Contra CnstaOCT 3 1 2001 or CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S 2 5 0, 0 0 0 .QrPd in support of this claim represents as follows: .1. When did the damage or injury occur'' (Give exact Date and Hour) Zvi.,.?✓ 2, 001 nn,� . £fi t-,M:�,:�t- IZ'� Pm E.��- --------------------------=----------------------------------=----------------------- 2. Where did the damage or injury occur.' (Include City and County) e Richmond Social Services , 1305 McDonald Ave. , Richmond, Contra Costa County ------------------------------------------------------------------------------------- 3. How did the damage or injury occur:' . '(Give full details;use extra paper if regdired) Claimant slipped and fell at. the facilities of Richmond Social Services on a. substance, believed to. be . possibly yogurt, that was on the floor. ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? Richmond Social Services employees knew the substance was on the floor, were apparently planning_ to take some 'stens to clean un the substance on the floor, but at the time of Ms . .Cam)-Dbell—Cam) accident they had not taken any steps to clean up the floor, had not taken any stens to put .up warning signs, warning tape or warning cones and had not yet taken any steps to make the area safe for pedestrians . (Over) •aug pus muamuostudmt gaps qloq nq 10 `( 000'ots slullop pussnogl ual,uutpaaaxa lou jo auU u ,Cq `uosud ams aql ut luamuosudmt gq 10`aug pas luamuosudmt Bans qloq ,iq 10 `( 000�IS ) slullop puusnoqu auo 2utpaaaxa uou jo autj u Sq `lsae auo asgl aloin IOU jo pouad u 1oj 1pf.ilunoz aql ut luamuosudm! ,iq mglp alqugstund s! `2uilues 10 `laganOA `lunooas `ll!q `m!ep lualnpnelj 10 asluj .iuu aumuaU ji amus aql :iud so mop ou pazuoglnu `1a:)Ujo 10 p1Boq puusip to :i p `,ilunoo :iur Ol 10 `1aauj0 10 p1E0q aluls :iar Ol luaweud 10j 10 aJllE,11011s loj sluasaad°pnv zjap of lualui gIpiloq.M uoslad ,WA,3,, :s4p!Ao1d apo Isua l aql jo ZL uo!loaS a D i i o x T66Z-9�,,Z . (OTS) 'ONauogdala•l• 166Z-98Z -.(OTS) 'oNauogdalal. L09�6 VD 'PUPT.xPO (ssa1PP`d) OOT# '40a.z4S u4ZT TLT. .. -- . .-. .. L09�6 KO 'puPTXP0 (alnuuuyts s,luswm ) 0 0 T agTng '4aaaS tI74Z TT L T NOS'daD �? =09 TpTPUTd •f Maggquw :iaulouv jo ssalppv pus amsN �•jfugaq siq uo uoslad awos .iq 10 (:iau.ioub) =0 L S30I.LON u�NIaS luum!ulo aql.iq pau°!s aq usnm m!elo agjL, :sap!,to1d Z-016 -JaS apo0 'AO0 •aai.TJL uoz�Psuaduzoo , s.TaxzoM s ,.TajioTdtua -Tau ulo-TJ s4z Jauaq uo-rqusuaduroo . , s.Tax.TOM buTATaoa.T uoaq sPu auoog-TTagduiPO • sw ' a4Pp 0,1 wa u ING :.unfu!10 muaptms stgl jo iunoaau uo apsm non saliuipuadxa aql jq'I. 6 ------------------------------------------------------------------------------------- T08V6. .V0 .'puOiuuoig ' •anV uznatq 106 '@4U@UPulzaa .aaszPY !SOL66 `d0 'AaT@Xaag 'OZT# ";DAV tjdPxbaTas OS8Z' 'sagpToossv TPozpaw .sagpq PgTv •slsl!dsog pus`slolaop `sassauu!,a jo sassalppr pus sawsN g --=---------------------------------------------------------------------------------- •BUTTej_qns PUP uTPa atuaTqxa Tod . uoz4P-4ndwoo. sP TTaM sP sesuadxa TPotpaul PUP sabPM 4sOq (a3culep 10.Liniu[angaads(ld Sue jo yunouie paimusa ain apnlaul) z palndm0a lunotur patamp aAogL,aqu sum.%iog L ------------ � •pPotl MogTa qubz.T @11'44 -o a.Tn-4oP.T-4 TPTPP-z �tIbz z .puP goPq-'xoau o0-4paTurtT .fou �nq buzpnTouz .;Ipoq jo. apzs .-4ubT.z oiiquo o-4 A n. u (.aaeunposne loj saleurgsa oey yaeuy paumta saoewcp!o saunftq jo iva{Ia Mg aA!o) 4pallnsa l mnilJ nog Op mun fui 10 m3 mvp lggM '9 • --------------------------------------------------------------------- O� LIMOLI}[ �oN Z,Unfui to anEmup aql',IIIsnt,saa ioldma 10`slus.uas`sla:)tjjo laLllstp 10 Aluno,3 jo samvu alp an lugM •S i'It J Ot E tJ z N CD > 0 z Ca k� Lu Q � � (7 Al Ln O I f3 n � Om o N Kl O ___--- m oO o N (D 01 f-h Lr ft In C} (t C) �3' p � (D 0 N Ln ,o CD �:S UJ uJ Ln � O r• rn H- rn ti rt ho CD 44 to � ¢t K !V W ti a fi A Q -moi � r•H. 0 m ,^f O Vt n w F'- ' n CD PJ LW &` A y \ / ;' 1 '� ---- - - i �. � � ,, r ��� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given tIUI Pursuant to Government Code Section 913 and NOV O 12001 915.4. Please note all "Warnings". AMOUNT: $347.36 COUNTY COUNSEL CALIF. CLAIMANT: Alireza Akhbari MARTINEZ, ' ATTORNEY: None DATE RECEIVED: October 31, 2001 ADDRESS: 1948 Buttner Rd BY DELIVERY TO CLERK ON: October 31, 2001 Pleasant Hill, CA 94523 BY MAIL POSTMARKED: October 30.2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. + JOHN SWEETEN II% Dated: October 31 , 2001 By: Deputy /U II. FROM: County Counsel TO: Clerk of the Board of Supervisors (- This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: �� �� By: Deputy County Counsel III. FROM: Clerk of the Board . TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER_ : By unanimous vote of the Supervisors present: (Y� 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:\w ` /yJ.1�W, q , U( JOHN SWEETEN, CLERK, By��/1, U►�l`H`� , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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:�0 117,1 LM q , Q JOHN SWEETEN, CLERK By 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. Claim to: BOARD OF SUPERVISORS OF CONTRA.COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims,relating to causes of action for death or for injury to person or to personal propem, or owing 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 bowing crops and which accrue on or after January 1. 1988, must be presented not later. than sia''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. ) %$. 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 entire. E. Fraud. See penalty for fraudulent claims. Penal Code Sec. 7'_ at the end of this form. RE: Claim by. ) Reserved for Clerk's Filing Stamp jq APH13Ael Against the Count.- of Contra.Costa .. .s; - c ....,:- .. .. .... . 7001 District ) - J CLERK 13o OF SUPERVISORS NTR (Fill in 'COA COSTA CO. .Name) . ., _ � -.. , The undersigned claimant here v makes claim against the County of Contra Costa or the above named District in the sum of S, 4� and in support of this claim represents as follows: 1. When did the damage or in occurs (Give exact Date and Hour) --------------------- :. Where did the damage or in jun occur' (Include City and Counn 1 ----- '�_(IT _5 --- sT�e�F/r_ v_v,41NJ e)� ----------------------------- 3. How did the damage or injure- occur:' (Give full details:use extra paper required REPAVUA c,�,4-��s �� , &"er ,P"c. _ t� eoe� woke � �.t1 �'� v s i/ .:w� - W-e 7- ------------------------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, sen ants, or employees caused the injury or damage.' j (over) -aug par ivamuosudmt gJns gloq :Cq io `( 000•oIS ) ssrllop pursnogl ual loutpaaJza lou jo aug r Sq °uosud ams aq1 ui luamuosudmi :t-q .ro .;)Uu par luamuosudmt gJns gloq .Cq io •( Oo°tS ) urilop pursnogl auo nuipaaoxa lou ;o aug r. nq -.rrae auo urge a.rom lou jo pouad r lo; Itrf .ilunoa aql ui luamuosudmt Sq laglta algrgsiund si tutlu.e io •iagJnon 41unoxm `iliq •mrula lualnpnr.r} to aslr; .Cur �aurnua'o 3t amrs aql .Cud fo .aollu of pazuoglnr `.iaJg3o to psroq 1Julstp to .CuJ `.Clunoa :Cur of to `.rang;o to psroq ams :Cur of luamerd ioj jo aauvmollr sol sluaswd 4pnr.1jap of lualul gll,b•oqm uoslad .Clang„ :saps-.old apo Iruad aql;o Zl; uorlaaS 3JI10 N 'oti auogdalas •ok auogdalal 6,-0 /)7,, cn/ X1-209 (ainlruarS s,lur.ruiriJ ) .Cau-louy jo ssalppv Pur. amr-Ni �iryaq 'siq uo uosaad amos..Cq io (:Cau roup) =0 L S3JI LO; ,QIv3S lurmiriJ aq1.Cq Pau,Gis aq lsnur uririJ aql,, :sapt.io id Z'016 'Jac apcD •A00 . Wall 31VU :.Cjnfui to luaprJJr sigl jo 1unoJJr uo aprm no; sa.inlipuad%a aql isi-I '6 -------------- •sirlidsoq pur •sjonop �sassault.M}o sassalppr. pup. Satur.Nj -g - -- --- ---------=---- -------------- --------------------------------------------------- P �o>N�_ a�✓a/Y r�o� � res r10� ( anewep jo.ianful anuoadsoad.sue Jo mnowe paiewnsa a43 apnlaul) ;paindmoJ lunomr pamiriJ anogr ag1 sr.b .vog . -. .. -• •. - .. �'aoCluEl1 O1RC 1oj sa�eutgsa oe►7 t{�eu� -pautiela'saoewcp,'Io saunful}o:ivatsa Mg aelo) Zpalinsal mtrl-a noe,op saunfur lo sa;rmrp 1rg b-".'9 Liinfui io aormrp aql 2utsnn saaeoldma ao•slur.uas si;;:)Wo 1Julslp ao :C1unoo,lo samru aql am lrglA 'S Date: 1124/01 10:42 AM Estimate ID: 278 Estimate Version: 0 Preliminary Profile ID: Mitchell RK COLLISION 2241 Monument Blvd.#G Concord,CA 94520 (925)689-8444 Fax: (925)691-8923 Damage Assessed By: MITCHELL MITCHELL Deductible: UNKNOWN Owner Alireza Akhbari Address: 1948 Buttner Rd.Pleasant Hill,CA 94523 Telephone: Work Phone: (510)618-5109 Home Phone: (925)939-3665 Mitchell Service: 918489 Description: 1994 Buick Regal Gran Sport Vehicle Production Date: 9193 Body Style: 4D Sed Drive Train: 3.8L Inj 6 Cyl AO VIN: 2G4WF55L5R1416454 License: 3FFD769 CA Mileage: 10,751 Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 900500 REF* ADD'L LABOR OP REMOVE BLACK SILER FRT BUMPER Existing 1.7* 2 900500 REF * ADD'L LABOR OP REMOVE BLACK SILER RT FRT FENDER Existing 1.2* 3 900500 REF* ADD'L LABOR OP REMOVE BLACK SILER RT ROCKET PANEL Existing 1.3* 4 933017 REF ADD'L OPR COLOR SAND&BUFF 1.4* 5--At31'Cr_ 'k9BiI.- 496_T 1 W-60" 6 AUTO ADD'L COST HAZARDOUS WASTE DISPOSAL 12.18 ' -Judgement Item Add'I Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals 11. Part Replacement Summary Amount Refinish 5.6 58.00 0.00 0.00 324.80 Total Replacement Parts Amount 0.00 Non-Taxable Labor . 324.80 Labor Summary 5.6 324.80 Ill. Additional Costs Amount IV. Adjustments Amount Taxable Costs 129.78 Customer Responsibility 0.00 Sales Tax @ 8.000% 10.38 Total Additional Costs 140.16 ESTIMATE RECALL NUMBER: 1/24/01 10:32:55 278 UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC_00_A Copyright(C)1994-2000 Mitchell International Page 1 of 2 UltraMate Version: 4.6.004 All Rights Reserved Date: 1/24/01 10:42 AM Estimate ID: 278 Estimate Version: 0 Preliminary Profile ID: Mitchell I. Total Labor: 324.80 II. Total Replacement Parts: 0.00 III. Total Additional Costs: 140.16 Gross Total: 464.96 IV. Total Adjustments: 0.0 Net Total: 4 .96 This is-a preliminary estimate. 3q ,7 ,3& ./ 3(0 Additional changes to the estimate may be required for the actual repair. / Customer Signature ESTIMATE RECALL NUMBER: 1/24/01 10:32:55 278 UltraMate is a Trademark of Mitchell International Mitchell Data Version: DEC_00_A Copyright(C)1994-2000 Mitchell International Page 2 of 2 UltraMate Version: 4.6.004 All Rights Reserved O ti lit y CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuan -t - o�efni} Min de ec ie. 915.4. 1� � e�n�o e all s". 91 ED AMOUNT: $5,000 NOV 0 5 2001 NOV 0 8 2001 C,UUN Fy COUNSEL CLERK 60ARt7 OF SUPERVISORS CLAIMANT: Maria Arca MARTINEZ,CALIF. CONTRA CO;;TA CO. ATTORNEY: None DATE RECEIVED: November 1, 2001, 2001 ADDRESS: 200 Village Dr#411 BY DELIVERY TO CLERK ON: November 1, 2001 Brentwood, CA 94513 BY MAIL POSTMARKED: Risk Management 10/26/01 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET ,, k (k)J,, Dated: November 1, 2001 By: Deputy / �y 11. FROM: County Counsel TO: Clerk of the Board of Supervisors l ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ()0 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)�LQ V YUIWA JOHN SWEETEN, CLERK, By . , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: Igo G,/I� y ,D I JOHN SWEETEN, CLERK By AV` II U Deputy Clerk n 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100`h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January I, 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-auainst 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 Against the County of Contra Costa or District) (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S 1000-Do and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) t---------------A�v -=------------------------=--------------- 2. Where did the damage or injury occur? (Include City and County) -- �1 �--- (9-,%-t---��w a.---C= ----��-�- ' ---- -- ---- --- 3. How did the damllge Or Injury OCCUr. (Give full dctrils;use extra paper if required) L'►'►s� t-t�+-� 0 01� -i Auf 1 n--- 44— 1.4- - ll�o�-e N Le" b� I, V v-d t, ��- �;� k�vt to a vim:- tee.. °v-4t- �,ugj vri �zn c,�_ Co. � 7i; --------------------------- ---- - ---= ------= ----- ------------------- 4., What particular act or omission on_the part of county or district officers, servants, or employees caused the injury or damage? j 1, LL� �► . ^. .� �: q„�, Cance, `er �� i., -jug pur ;uauluos!1dm! y3ns g;oq Sq .10 °(000`01$) s.irllop pursnoy; ua;llu!paxna ;ou;o auU p :iq luosud a;r.;s ag; u! ;uawuos!.tdun Sq ao'aug pup ivautuosudw! Bans y;o(l Sq .fo 1( 00011$ ) sarllop pursnoy; auo 5u!paa3ma ;ou;o aug p Sq •.IraS auo ury; aaoul )ou fo pol.rad 9 aoJ l!9lS;uno3 ag; u! ;uawuosudm! ,Cq 1ay;ra algryslund sl •2u!;!a.iA to I.raganon ';unoam `ll!q •tumij ;ualnpnpa3 to )slpj S11p. °au!nua:j! aturs ay; :it d .10 .itollp of pall log;nr I[a3lljo to p 1roq pulsIp 10 :1.;13 IS;uno3 iu9 of.Io'.iaa!jjo to p Iroq a;r;s ,iup o;;uaulsrd foj io a3ur,4Aollp io3 s;uasa.ld`pnuij;)p o;;ua;u!y;!m logm uosaa(I :il;)AA„ :Sap!noad apo lr11ad ayi 3o ZL uo!;3as a31IL0K M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M M MM M M M -ON auoydalal 'oNlauogdalal (ssa.Ippd) (a.lnipO!S s jurw!pla) ZZ Sau.Ioiiy,10 ss;)APPV Pur awp.N «'1lryaq s!g uo uos lad awos Sq ao (Sau.lo;;d) :01SULLON Q�VdS ;ur.1u!rl3 aq;Sq paw'hs aq;sntu aurp agZ„ :sap1:►o.1d Z-016 ':)3S;)POJ :too iv loi�� in�a cl ajLv(l --------------------------------Slnfu! Io;uap!33es!gi3o , no33r11oaprulnoSsaln;!puadraay;is!I 6 ri rU!�r O r1 . •slr;ldsoq pup Isco;3op'sassau;Lt130 SaSSa.Ippp. pup. saulrN� "Y''`rr - • ��-..y -H �-� mac,+ �v ---.�o��-a� rye' _X, � ( JJUXUUp.[o.Linfin aupadso.id.im}o;unom pa;cml;sa ay;apnlanl) Lpa;ndnlOJ;unotur paullrla aAogp. ;)q;59,11.aoH 'L ------------------------------------------------------------------------------------- IN�VGSVNW3 OZ z: d 9Z 130.1100Z (•agcump o;ne iq{sa;eul!;sa 0e4Ll yae;;a •paunela sageutc .io sa)unfuf3o;ua;xa lln3 ae!O) 4pa;lnSa.1 1111913 nOS op Sal.fnfut �SaUmirp ;pyM '9 C t�NTURi-------- --- -- -- -- - - - - - ------ -----------Mnoo visob vj,,Nc�'��r'0 4S.1nfu1.lo a2umpp ay;;u!sn93 saaSo1d111a.Io•s;u9,uas ls.1a3!j;o;au;s!p.Io:i;uno3 3o sampu aq;aar ;9qM S PATENT ACCT.# CA EMERGENCY PHYSIW*DELTA MARIA ARCA 000010739 • •.1601 CUMMINS DR. , S21 ' MODESTO, CA 95358-6403 STATEMENT DATE PAY THIS AMOUNT PAST DUE DATE ADDRESS SERVICE REQUESTED 9/17/01 163.00 10/08/01 IF SERVI('E:S WERE RENDERKU AT THE; HOSPITAL,THIS I111A, IS SEPARATE; FROM YOUR IfoSPITAL BII,L. QDDG3©a�©Qe 236�m (�M(Bm unumaQ pno MCE)OU �e MARIA ARCA 200 VILLAGE DR #k4H CA EMERGENCY PHYSICIANS *DELTA BRENTWOOD, CA 94513 1601 CUMMINS DR. , STE.D-21 MODESTO, CA 95358-6403 Please 0 if address or insurance information has changed. Make changeson reverse side. .. . . ... PIPME Why PLEASE MAKE COPY OF ENTIRE PAGE IF NEEDED FOR INSURANCE UL; OO 1 THERE IS A$10.00 SERVICE CHARGE FOR ALL RETURNED CHECKS. BILLING OFFICE HOURS: 8 AM-5 PM Tax ID.#► 942494000 Phone ► 800 49.8-7157 Attending Physician ► VUKSINICH, MATTHEW M. Referring Doctor ► VUKSINICH, MATTHEW M.D. Account Number ► 000010739 Service Provider ► CEP * SUTTER DELTA MED CTR Patient Name P. MARIA ARCA Statement Date ► 9/17/01 DATE POS DIAGNOSIS DESCRIPTION OF SERVICES AMOUNT 08/31/01 4' 7242 99283 ' LEVEL 3 EMERGENCY, PHYS CHARGE 145.00 08/31/01 4 7242 99052 NIGHT (10:00 P.M. - 8:00 A.M.) 18.00 PAYMENP OF THIS ACCOUN IS YOUR RESPONSIBILITY. IF YOU HAVE INSURANCE, PLEASE CONTACT THIS 07FICE THANK YOU y EMPLOYERPRIMARY INJURY DATE ADMISSION DATE DISCHARGE DATE BALANCE DUE 'INSURANCE UNEMP ** SELF PAY/NO IN 8/31/01 163.00 POS (Place of Service Codes) 1 = Inpatient Hospital 2 - Outpatient Hospital 3 - Doctor's Office 4 - Emergency Room ' AUTHOR AUTHORIZATION - I hereby authorize the provider shown a reverse side of this I hereby authorizftarect my insurance carrier to pay directly form to release to my insurance company any medical information to the provider shown on the reverse side of this form,any benefits. necessary to process this claim. due me under my insurance plan. I agree to pay the balance of expenses not paid under this plan. X x AUTHORIZED SIGNATURE AUTHORIZED SIGNATURE COMPLETE THE FOLLOWING INFORMATION ONLY IF REQUESTED ON THE FRONT OF THIS STATEMENT. Insurance(.;ompaoy— —__-_ _-- --___--- Employer of Insured-___ -- ----- ---__--- Clain Office Address_—___ ------------------ (12elation of Patient to Insured)__--------- Policy Number_ _ -------- — RETURN INSURANCE INFORMATION TO OUR OFFICE __ ___ ___ ___ _ __ 'T' Group Number — IN TIIF ENCI,OSED ENVELOPE. Narne of Insured ~-- Social Security Number__ ARE YOU CONFUSED BECAUSE YOU RECEIVED SEVERAL BILLS FOR YOUR EMERGENCY ROOM VISIT? THE HOSPITAL'S BILL IS SEPARATE FROM THE EMERGENCY PHYSICIAN'S BILL lsi— ROUTINECOST —� HOSPITAL'S EMERGENCY FEE PHYSICIAN'S FEE The routine cost for emergency services has a minimum of two fees. Each fee.is billed separately by the provider of the services. The hospital's fees cover the cost of providing the nurses, technicians, equipment and supplies involved in the performance of your service. The physician's fee(s) are for medical care rendered in the emergency department. The emergency physician is an _ independent physician, not an employee of the hospital and therefore bills separately for his/her professional services. You may receive additional bills from other physicians who provided services during your visit. PLACE OF SERVICE CODES (POS) 11 OFFICE 53 COMMUNITY MENTAL HEALTH CENTER 12 HOME 54 INTERMEDIATE CARE FACILITY/MENTALLY RETARDED 21 INPATIENT HOSPITAL 55 RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY 22 OUTPATIENT HOSPITAL 56 PSYCHIATRIC RESIDENTIAL TREATMENT CENTER 23 EMERGENCY ROOM- HOSPITAL 61 " COMPREHENSIVE iNPATiENT-REHABiLlWl i i0id"FACiLi7t - 24 AMBULATORY SURGICAL CENTER 62 COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY 25 BIRTHING CENTER 65 END STAGE RENAL TREATMENT FACILITY 26 MILITARY TREATMENT FACILITY 71 STATE OR LOCAL PUBLIC HEALTH CLINIC 31 SKILLED NURSING FACILITY 72 RURAL HEALTH CLINIC 32 NURSING FACILITY 81 INDEPENDENT LABORATORY 33 CUSTODIAL CARE FACILITY 99 OTHER UNLISTED FACILITY 34 HOSPICE 41 AMBULANCE- LAND �S'N 42 AMBULANCE-AIR OR WATER iN3W3��y��!W 51 INPATIENT PSYCHIATRIC FACILITY 52 PSYCHIATRIC FACILITY PARTIAL HOSPITALIZATION nn77 Z d INSTRUCTIONS FOR FILING HEALTH INSURANCE CLAIMS' 1. PLEASE COMPLETE A CLAIM FORM FROM YOUR MEDICAL INSURANCE PLAN WITH THE REQUIRE®i bRMATION-, 2. SIGN THE APPROPRIATE AUTHORIZATIONS BELOW. �`�` 3. ATTACH THIS COPY OF YOUR STATEMENT TO YOUR MEDICAL CLAIM FORM. 4. FORWARD THE FORMS TO YOUR INSURANCE COMPANY'S PROCESSING OFFICE. If you require another statement for a second insurance company, please photocopy both sides of this statement. NOTE: When filing secondary insurance, some carriers require a copy of the explanation of benefits (EOB) from the primary carrier. uAY'�a lia1�2 -- k Ad- -;l� _. ... I _ . .A Mt. cu�w _ a► �;ronao flul vrrm ----------t- vy- Alt- O:t -- ��r►_c�.-7`v__�.c�---e2�t-- �,.�---fin ---�- -_._- ----- - I.t it 04S1cQc_ s�Ifi � , _..�1u_ _ V.cn tc_ . ate, _._¢l.�. . -�^'h°--.- -lf ........ l� W4 Ig�' ►� •l�so _ BW0 31 r. 1ta, / rr+�'�w✓ .- - - - --°"-'� , b/.c1CoCr'n_ . _. ► �. , O$Vlt �' S1►` o - ..�, a .. r �y. •: .r �1 .. "�A. .. F;,%.� .r v R C' ri�• .JY + .. r . , r, ':SN s 13 __ mw ��,_ 4.00� x► . -- 6j, 04 **44 c'14' -_-- - --- --- �.- w,� _� �w.t�-_lam ►� . .t eur►_ 140044 1-4 V_ r:r iY 1 : : ++�f Y • u I ..:... .. .. � • 7 is to i _ J 3,. V r W _ .. a { , r4 . .�1.i�IftO�:H•��•�gin' `"..)��';��} —•- Ca _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: , Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and law-C1311W11015.4. Please note all "Warnings". AMOUNT: Unknown O C T 2 6 2001 COUNTY COUNSEL CLAIMANT: Larry Lee Stambaugh MARTINEZ CALIF. ATTORNEY: None DATE RECEIVED: October 26, 2001 ADDRESS: P.O. Box 273555 BY DELIVERY TO CLERK ON: ' October 26, 2001 Concord, CA BY MAIL POSTMARKED: Hand Delivered I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEEW, ' Dated: October 26, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of SupervisorsW ( ) This claim complies substantially with Sections 910 and 910.2. (• his 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: l0 0��1 D� By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (Y,) 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: �'`AVI JW q , 01 JOHN SWEETEN, CLERK, Byi� � �11� o , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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. I Dated: bk uAm GWA �,N JOHN SWEETEN, CLERK By ���;1�-� y( Deputy Clerk '6 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. SILVANO B.MOCHESI DEPUTIES: PHILLIPS.ALTHOFF COUNTY COUNSEL S --L JANICE L.AMENTA NORAG.BARLOW SHARON L. ANDERSON /' y , B.REBECCA BYRNES ' !- _�. ANDREA W.CASSIDY ASSISTANT COUNTY COUNSEL / i � MONIKA L.COOPER CONTRA COSTi4'COUNTY VICKIE L.DAWES GREGORY C.HARVEY OFFICE OF THECOUMT. - I OUNSEL MARKES.ESTIS ASSISTANT COUNTY COUNSEL ` , 1!SI LILLIANT.FUJII 1(7_,COUyN jTYyADMINISTRAIONOUI I Qom` JANET L.HOLMES DENNIS C.GRAVES 6 1 PILI E=STR EET9fh'F apR KEVIN T.KERR �/ BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MA --J'NEZ;-CALIF.1.4 45 5 229 EDWARD V.LANE,JR. GAYLE MUCaGLI y\' BEATRICE LIU �,\�\ �,P` MARY ANN MASON OFFICE MANAGERU,q�A:_ � PAUL R.MUNIZ VALERIEJ.RANCHE PHONE (925) 335-1800 NOTICE OF =NS3FFICIENCY STEVEN P.RETTIG DAVID F.SCHMIDT FAX (925) 646-1078 AND/OR DIANAJ.SILVER JACQUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELAJ.ZAID TO: Larry Lee Stambaugh c/o General Delivery PO Box 273555 Concord, California RE: CLAIM OF: Larry Lee Stambaugh 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: [ ] I. 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. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [XX] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [XX] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000)-, the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ 17. Other: Page 1 'T 'i ri 17, SILVANO B. MARCHESI COUNTY COUNSEL By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013x,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,scaled and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: October—,2001,at Martinez,California. "7 cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSURIC1ENCY OF CLAIM:GOVT.CODE§§910,910.2,920.4,910.8) Page 2 • -- SHARON HYMES- i U.S. POSTAGE OCT 1 0 2001 SAN FRANOCISCO.CA NON-NEGOTIABLE,, SEP929. 01 Registered Notice—Acquiescence/Admissions �eos dV� AMOUNT $100 By/Respond to: 0000 00052956-05 Larry-Lee: Stambaugh-"All Rights Reserved" ( :�: S�Q -._ .._...__...._...-- Private Citizen/non-fiduciary Address used`without prejudice to rights" In Care Of: general delivery _•��.� Post Office Box#273555y Concord, (Non-Domestic, in the real)California. No Zip Code Used 22 September 2001 Registered# RR 936 666 197 US For/To: Department of the Treasury of the United States Secretary of the Treasury of the United States-Title 31 USC § 301 Main Treasury Building 15th St. &Pennsylvania Avenue NW Washington,District of Columbia. 20220 Department of the Treasury of the United States Commissioner of Internal Revenue of the-26 USC § 7802(a) 1111 Constitution Avenue NW Washington,District of Columbia. 20002-6433 Aron: Intemal Revenue Service of Puerto Rico-27 CFR§ 250.11 O ` Department of the Treasury of the Fresno Service Center Fresno,California. [93888] �� State of California �l Franchise Tax Board P.O. Box 1673 Sacramento, California. [95812] RE: All prior correspondence of the past few years and specifically my R_gistered"COUNTERCLAIM via AFFIDAVIT OF TRUTH"-Your failure to sign in/for verification all alleged liabilities per Rule of Law. SuL•ject: Your Failure and\or Refusal to respond pursuant to Federal Rules and the Mule of Acquiescence, hereby noticed and recorded as your tacit admissions and agreement. Notice to the Agent is notice to the Principal-Notice to the Principal is notice to the Agent. Dear Addressee(s): ADMINISTRATIVE NOTICE This is an administrative Notice, to the Internal Revenue Service and its subordinately connected, State of California, Franchise Tax Board (FTB) personnel, Actors, who are involved with this matter / action, that:.you are herein-Noticed, and have first hand knowledge, and are bound by, and will be held to the provisions of the 1999.Act of Congress, "Reorganization of Structure and Management of the Internal Revenue Service and Treasury.Directive 27-14 dated: January 14, 1999". Notice: The foregoing mentioned document is incorporated herein and made a part hereof by reference thereto. "BURDEN OF PROOF" 1 of 2 Netiee—acquies=ce/ag ement/admissims REGISTERED 4 RR 936 666 197 US �, . .' �., ...�i . .. .- _ . ..... . _ ... � .. ;� ,. .. r , �/i�l:. - _ �' - [Notice,to the agent is notice to the principal—Notice to the principal is notice to the agent. ] As of this date, the noticed agencies (above) have failed and/or refused to respond to, or rebut, or refute the information contained in my prior correspondence and specifically in my Registered "Counterclaim via Affidavit of Truth" [ postal dated July 30, 2001 ], cited above and incorporated herein and made a part hereof.reference thereto. Said refusal is subject to the purview of Federal Rules and the Rule of Acquiescence. In accordance to said rules, your refusal to respond to me, Larry-Lee: Stambaugh, a live flesh and blood man on the land, an inhabitant of the California Republic (NOT connected with or affiliated with CA the fictional Federal-Zone), location (address) as noticed and specifically requested in my correspondence, is evidence to/of your agreement with the information presented in said correspondence(letters). Respective of the foregoing, the agencies noticed above; and I, have obviously come to a meeting of the minds and are in.weement `that' based upon the noticed public record and the information prior presented: (1) 1 am not(deny being)a citizen of the United States(U.S.),subject to the jurisdiction of the federal government nor to its sub-corporation,the State of California,in as such as Declaration has been made,under penalty of perjury,that I was bom within the territorial jurisdiction of the Illinois Republic and now living on the land within the California Republic. See EX PARTE—FRANK KNOWLES,5 Cal. 300,California Supreme Court(1855). (2) I am not(deny being)liable in my private capacity for any claims of revenue due the corporate U.S. (United States)and/or its sub-corporation, STATE OF CALIFORNIA,via their collection agents IRS/FTB or any agents thereof,because I am not(deny being)a fiduciary to the Fictional Entity/statutory person/franchisee/Trade Name:LARRY L STAMBAUGH. See referenced letters—Affidavit of Truth with attached IRS Form 56 made a part hereof by reference thereto. In substantiation and verification of the information above, no agent of any agency has signed, pursuant of the rule of law, in verification of the alleged (Fraudulent) claims/debts contained in the alleged documents, i. e. "Notice(s)" of alleged liability. It is apparent that b your refusal to sign your own.paper(s)' in verification of their truthfulness, accuracy and completeness, you are]mowing and fully aware that you could have been individually and personally charged with the crimes of FRAUD and PERJURY. Notice: Rule of Law — Califomia Civil Code, California Code of Civil Procedure and the Uniform Commercial Code(UCC). Since the subject matter has been resolved by your `failure to respond' /_acquiescence,there is no need for any firture correspondence from neither you or your agency, nor any sub-agent thereof. ANY fixture mailing [determined improper] from your or your agency will be returned unopened based upon your `failure to respond' / acquiescence and our total agreement, hereby noticed. In addition, no other (repeated)correspondence regarding these matters will be necessary(or forthcoming)from me. GRACE of an additional thirty (30) days is hereby given by me for the purpose of allowing you and your agents sufficient time and opportunity to: (1) return any and all pLWtV (including but not limited to money [Orders/drafts/checks, labor funds, bank funds] or signature or land or liberty)taken or received by you, ab initio to date, regarding me, and (2) immediately remove anvtall "Notice(s) of tax Liens" from County Records regarding me (i.e. via use of Trade Name, under color of law). Notice: refer to my request for the return of property—Registered"Counterclaim via Affidavit of Trudi",supra. This letter is also NOTICE to you, that in relation to your fraudulent actions and the refusal to return my property, a TORT Claim for damages will be of necessity forthcomurg. This "Action"will be filed with the Director of Torts,Civil Division,United States Department of Justice. Respectfiilly presented,and sealed by my hand on this twenty-second day of the ninth month of the year two thousand one of our LORD and Savior Jesus the Christ—YAHSHUA. _ o D na /Secured Party, Creditor Larrybaugh—Private Citizen/non-Fi ci cc: Mailing list attached hereto and made a part hereof. Attachments: Enclosures: 2 of 2 Nodoe—aoquiescmee/agemnea I admimiws REGISTERED #RR 936 666 197 US MAILING LIST: Sec asterisk( * )Notes—end of list. Contra Costa County SHERIFF. Warren E. Rupf 651 Pine Street. 7'h Floor Martinez. California. 194553] State of California ATTORNEY GENERAL 1300"1" street Sacramento, California. 195814] Contra Costa County DISTRICT ATTORNEY 725 Court Street. 4'h Floor Martinez. California. 194553] State of California SUPREME COURT CLERK 303 2nd Street/South Tower, 8`h Floor San Francisco, California. 194107] Contra Costa County CLERK-RECORDER S. L. Weir ** 524 Main Street Martinez. California. 1945531 State of California Office of the Controller 300 Capital Mall, I8t"Floor, Suite 1850 Sacramento, California. 1958141 Contra Costa County _ BOARD of SUPERVISORS 651 Pine Street, Rm 106 Martinez, California. [94553] State of California FTB Exe. Office,Mr. Gerald Goldberg 9645 Butterfield Way Sacramento, California. 1958271 Contra Costa County SUPERIOR COURT Presiding Judge 649 Main Street Martinez, California. [94553] Contra Costa County SUPERIOR COURT Clerk,Ken Tome 725 Court Street Martinez,California. 1945531 Contra Costa County Clerk of the Court 2970 Willow Pass Road Concord California. 194519] Department of the Treasury of Puerto Rico Internal Revenue Service of Puerto Rico Director/Ogden Service Center 1160 West 1200 South Ogden,Utah. 184201] I of 2 Mailing List--Notice RR 936 666 197 lit r - � . _ .. --�!� [ mailing list—continued] Contra Costa County RISK MANAGEMENT,Ron Harvey 2530 Arnold Drive Martinez. California. [94553] Department of the Treasury of Puerto Rico Internal Revenue Service of Puerto Rico District Director 1301 Clay Street, So Tower, 16"i Floor Oakland, California. 1946121 United States Bankruptcy Court Clerk of the Court <**> 1300 Clay Street, 3"d Floor Oakland California. 1946121 District court of the United States Clerk of the Court <*> 1301 Clav Street. 4d'Floor Oakland, California. 194612] United States of America ATTORNEY GENERAL,John Ashcroft 950 Pennsvlvania Avenue NW Washington,District of Columbia. [20.530] The Ninth District Court of the United States CHIEF JUSTICE,Mary M. Schroeder U.S. Court House, Suite 610 401 West Washington Street, SPC54 Phoenix, Arizona. [85003-2156] NOTES: Case# 148451-8, and#C 92-02468, and#940338-7 and#84529 [Bonded action,Conversion of Quid Tale property], and# 171820-4, and[Sheriff's Incident/Case] #96023945,and[Sheriff'"Abatement"] #737 180 090 Certified, and BOND#96 30329 Registered#R 641 974 436, and[Justices'Court case]#LLS-VP-950522-01 All `•`Notice(s)of[Tai)Uen(s)"—State and Federal <*> Case#C 94 1833 DLJ, #C 94 1834 [vRw] DLJ, #C 94 1835 [vRw] DLJ,and#C 95 0608 DLJ, and#C 96 04074 CW <**> Case#94-41220 TP,and#9542758 JP,and#954489 AJ -------------- Blind copy—note: 2 of 2 Mailing List-Notice RR 936 666 197 US CONCORD CA NAIN.POST OFFICE CONCORD, California 94520057720 PROOF OF SERVICE 07/30/2001 (800)275-8777 0302:19 PH Seles Receipt Product Sale unit final / t Description 4tv Price Price l the8 yce+. ytbaalamdomiciledinthe Cq,iNoC04 county of California state,I am over the age of eighteen years and not a Petry to the PVI 1 $1.00 $1.00 within attiontmatter,ard: PYI 1 $1.00 $1.00 PVI 1 $1.00 $1.00 PVI 1 $1.00 $1.00 That on_?"3 d �.'1�tSil 1 served the enclosed domments(RatBy: PVI 1 $3.00 51.00 I-Y-L -Suwbm*b�dt3mlxd as: PVI 1 $1.40 $1.00 PVT 1 $1.00 $1.00 PVT 1 $1.40 51.44 1. COUNTERCLAIM viu AFFIDAVIT OF TRUTH orad Notice _ WASHINGTON OC.20220 $1.95 dated_ 2t Iely ZOOT with attadtmmt(s}: First-Class Return Re $7.50 (1) covyUMI nslsciaetodabterLARRY LEE STAMBAUGK RInsud rcd Value $100. $7 (2) copy-l�Qfevideo . IIIS�x 6 Article-Values $100.00 p&FI785`PRIVA1IELAN- [2)tbsD4XXp&p-62"C nSxu'; Label Serial N: RR936666166USmoocusteni Issue PVI: $I0.95 l (3) CMSTRUC7M,1E.bKMCEBYAFFIDAVIT,withatt&dW (4) WWRANt Mt7F LAN st>achmes part of Affidavh WASHINGTON DC 20002 $1.72 (S) 'AFMAMofDanialo[Ccapmtio4Txist� f t rct-C t ess 2. Form 36-Notice Co-ning FidM y Rei"whip with=aid: Issue PVI: $1.72• (1) AFFIDAVIT-fiduciary tob wvvh wuchmem Pages 79.go,and E1 relative to`Reform Act of 1998, Total: $20.67 3. ProofofService Paid by: { Cash $21.00 That I placed a true and correct OM thereot enclosed in a staled envelope, Change Dust 40.33 postage prepaid,via Rtgtered Mal 0 RR 936-40_10 Return Receipt re:p:e W WA Fust Class Mai,in United States Post Office boated st Gras,cyrd B 111 M: 1000300771176 t CAlifornia and addressed as set forth billow for: Clark: 11 --Thank You for your business I Rqpacrcd) (Fust Coss Mail) Depnssmes dtbe Tssssmy d the IToilext Stales )l c of the Treasury ofthe United Stats socretarYMum,Tm d the Trcasary d the-Titk)I USC$301 Cammewooer d lawn-t RevCow d ,05 the-26 [D 7a02(s) °�T y B'a of I t t i Can�tion Avam NW . Peamylvms Ave ma Nw Washiogiro4 Diaries d C*hanb a.200026433 Washiagtoq,Distna ofCommbw 20220. : Exemied on 7-oro-91 at 4� .Cafit2lms „fiegistened Na. �x� 6 ys I declare,under the of G4 D Ply Mury:that the foregoing s true and Donees Rea F" s s Gr "mov, s a.n,n s 0 70 5igntd.By ) o> rtimp. s na>ti:aaa s - JUL 3 tom «°'..�. C UO.W aaar Doses- wvsa.s o*, NEE ..a r a u .o at tie t'✓ �l i s tc �(� 5-5-r C-ux a�t �ara(Q, tl lJ /� fl` a ve PS Foran 3806. rpt for Reglstavd MaR cecri . ,aava 2000 rs..aaonneas+da R.WM) PROOF OF SERVICE I,the undersigned, hereby certify that I am domiciled in the Cohlecl(�Za_4 county of California state, I am over the age of eighteen years and not a party to the within action/matter,and: That on aq Sebfe wkar,Z061, 1 served the enclosed documents (For/By: Larry-Lee:Stambaugh), described as: I_ Registered NOTICE—Acquiescence/Admissions, and record and request dated 22 September 2001 with attachment(s): (1) MAILING LIST for"cc"addresses,with Notes""of cases' # 2. copy Proof of Service of 30 July 2001 - COUNTERCLAIM via AFFIDAVIT OF TRUTH, Registered,with postal receipts. 3_ Proof of Service That I placed a true and correct copy thereot enclosed in a sealed envelope, postage prepaid,via Registered Mail # RR 936 666 197 US Return Receipt requested and First Class Mail, in United States Post Office located at 5 all fid 11 e_S:.D California and addressed as set forth below for: [Registered] [First Class Mail] Department of the Treasuzy of the United States Department of the Treasury of the United States Secretary of the Treasury of the—Title 31 USC§301 Commissioner of Internal Revenue of the—26 USC§7802(a) Main Treasury Building 1111 Constitution Avenue NW 15'b St.&Pennsylvania Avenue NW Washington,District of Columbia 20002-6433 Washington,District of Columbia. 20220 [Atta:-Fiust Class Mail] [Ann:-First Class Mail l Internal Revenue Service of Puerto Rico—27 CFR§250.11 State of California Dept of the Treasury of the Franchise Tax Board Fresno Service Center P.O.Box 1673 Fresno,California [93888] Saamnmto,California [95812 1 Executed on 0l9 —�J , at SQ lZ ! MA G j 5 C,0 , California. I declare;under the penalty of perjury, that the-foregoing is true and correct. Signed By: � �l Gary-Neil: Brisbou Uo 3361 Citrus Avenue Walnut Creek,California state. 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II�U'O1.E�II3 '0]SI�NYa� NYS., Page 2 — Proof of Service — "cc" Mailing List Contra-Costa Countv State of California SHERIFF,Warren E. Rupf ATTORNEY GENERAL 651 Pine Street.7h Floor 1300"I" street Martinez, California 1945.531 Sacramento,'California."[95814] Contra Costa County State of California DISTRICT ATTORNEY SUPREME COURT CLERK 725 Court Street,4'h Floor 303 2"d Street/South Tower, 8`h Floor Martinez, California. [94553] San Francisco,California. [94107] Contra Costa County State of California CLERK-RECORDER, S. L. Weir Office of the Controller 524 Main Street 300 Capital Mall, 18''Floor, Suite 1850 Martinez, California. [94553] Sacramento, California. [95814] Contra Costa County State of California BOARD of SUPERVISORS FTB Exe. Office,Mr. Gerald Goldberg 651 Pine Street,Rm 106 9645 Butterfield Way Martinez, California. [94553] Sacramento, California. [95827] Contra Costa County Contra Costa County SUPERIOR COURT Presiding Judge SUPERIOR COURT Clerk,Ken Torre 649 MainStreet 725 Court Street Martinez, California. [94553] Martinez, California. [94553] Contra Costa County Department of the Treasury of Puerto Rico Clerk of the Court Internal Revenue Service of Puerto Rico 2970 Willow Pass Road Director/Ogden Service Center Concord, California. [94519] -1160 West.1200 South . Ogden,Utah:: [84201] Contra Costa County Department of the Treasury of Puerto Rico RISK MANAGEMENT,Ron Harvey Internal Revenue Service of Puerto Rico 2530 Arnold Drive District Director Martinez, California. [94553] 1301 Clay Street, So Tower, 16`h Floor Oakland, California. [94612] United States Bankruptcy Court District court of the United States Clerk of the Court Clerk of the Court 1300 Clay Street, 3`d Floor 1301 Clay Street,4`h Floor Oakland, California. [94612] Oakland, California. 1946.121 . . C i r c:,.,- f7 United States of America The Ninth.$is>'r "Court of the United States ATTORNEY GENERAL,John Ashcroft CHIEF JUSTICE, Mary M. Schroeder 950 Pennsvivania Avenue NW U.S. Court House, Suite 610 Washington, District of Columbia. [20530] 401 West Washington Street, SPC54 Phoenix, Arizona. [85003-2156] ----------------------------------- ----------------------- ---------- Blind copy—To: First Class--oc"copy �(A C: for/By Larry-Lee: Y ,° 1 n L :xr�-.vie1 -kEL-.1 .tidoo,x„-net J�i3 Z 30 I aged AaseD :sawef-IlapuaM ` :Ag paugis -loouoo put, and si Suiogaio3 aq}jugl`A.mfiod3o Ailt,uad oqI lapun `ait,loop I t,nuo3.1ro It, as o1�� / uo palnooxg ([polsul pu!lg] ,aossalppv Moo puilg„ of painuil lou Inq gulpnloui ) (3oaiaq Z aSud uo paisq/polou st, oassalppr pro ) :io3 molaq gpo3 Ias st, passaippr pue PTuiojTpD o-5 Tt jE palt,00l aog;0 lsod salt,iS Paliun agl ut `IreY�I ssElD 1s.n3 t,in `ptt,daid a9elsod `adolanua paras a ui posoloua `3oaiagl Adoo Ioauoo :g arul E paould I ltgi aoi uos 30 3ooid Z :[tiessaoau se pexieuu pue papunoid`o3ui `Adoo pTIS ] pue (b) Adoo Idiaoal Ielsod qunn`Palals'sa-810oZ'NUJQId5S6Z 30 aovuaS 30 30oid 30 Adoo (£) sidmal lmod Adoo qvm `paialsiSal `H,).f12I,i,30,I.IAdca.3.3v Eu Vgiv D'd9 Xn0J ou—OS I OOZ Xinf 0£ 30--DwOS 30300ld kd0o (Z) # Saseo jo««„ sayoN qum`sassaippe«oo„lo3.LSI'I OM IPv w (I) :(s)Iuawgot,uE gILPA I00Z 6Z lagw;)j aS pairp jvjSOd Isonbai pue piooai put, `suoissnupd aouaosaunbod - g3I.LOrI paiaistsa-d ,Cdoo «oo„ I :st paquosap `(g2nuqums :aoj-.ulrj ..41/1o3) sluaumoop pasoluI aua agl pans ` �� -20 uo lt,gZ :put, `1a�Eua�uoi�ot, utgluA ag} of land u lou put, SnQ,, uaalgata 3o a8E 0g1 rano UM I `aleIs enu03ilt,D 30 fjunoo a� aql ut paponuop Lot, I itgi Atiao Xgaiaq `pauSisiapun aqj `I 33IAHAS 3O AOOHd U.S�osTAGE NON-1VEG077ABLE SAN FRANCISCO.CA 9413? Registered NoticeP29,'—Acquiescence/Admissions d n�F: SETO i i By/Respond to: �.L' `k�. 0 A $100 ' Sharon-Elizabeth: Stambaugh—"All Rights Reserved" fir [; t, .1 0 0052 56-05 Private Citizen/non-fiduciary L + 29 Address used"without prejudice to rights" In Care Of. general deliver)/ Post Office Box'#273555 +; Concord, (Non-Domestic,in the real)California. No Zip Code Used 22 September 2001 Registered# RR 936 666 206 US For/To: Department of the Treasury of the United States Secretary of the Treasury of the United States—Title 31 USC §301 Main Treasury Building 15"St: &.Pennsylvania Avenue NW Washington,District of Columbia. 20220 Department of the Treasury of the United States Commissioner of Internal Revenue of the—26 USC § 7802(a) 1111 Constitution Avenue NW Washington,District of Columbia. 20002-6433 Attn: Internal Revenue Service of Puerto Rico-27 CFR§ 250.11 :� =• — Department of the Treasury of the Fresno Service Center Fresno,California. 1938881 . ..:State ofCalifom_ is Franchise Tax Board P.O. Box 1673 Sacramento,California. [95812 J RE: All prior correspondence of the past few years and specifically my Registered"COUNTERCLAIM via AFFIDAVIT OF TRUTH"—Your failure to sign in/for verification all alleged liabilities per Rule of Law. Subject: Your Failure andbr Refusal to respond pursuant to Federal Rules and the-Rule of Acquiescence,- hereby noticed and recorded as your tacit admissions and agreement. Notice to the Agent is notice to the Principal—Notice to the Principal is notice to the Agent. Dear Addressee(s): ADMINISTRATIVE NOTICE _ This is.an administrative Notice, to the Internal Revenue Service and its subordinately connected, State of California, Franchise Tax'Board (FTB) personnel, Actors, who are involved with this matter / action, that you are,herein Noticed, and have first hand knowledge, and are bound by, and will be held to ' the provisions:of the 1999 Act of Congress, "Reorganization of Structure and Management of the Internal Revenue Service and Treasury Directive 27-14 dated: January 14, 1999". Notice: The foregoing mentioned document is incorporated herein and made a part hereof by reference thereto. "BURDEN OF PROOF" I of 2 NWce—aoquiesoence/aVvemed/admissiaos REGISTERED k RR 936 666 206 US [Notice to the agent is notice to the principal—Notice to the principal is notice to the agent. ] As of this date, the noticed agencies (above)have failed and/or refused to respond to, or rebut, or refute the information contained in my prior correspondence and specifically in my Registered "Counterclaim via Affidavit of Truth" [ postal dated July 30, 20011, cited above and incorporated herein and made a part hereof by reference thereto. Said refusal is subject to the purview of Federal Rules and the Rule of Acquiescence. In accordance to said rules, your refusal to respond to me, Sharon-Elizabeth: Stambaugh, a live flesh and blood woman on the land, an inhabitant of the California Republic (NOT connected or affiliated with CA the fictional Federal-Zone), location/address as noticed and specifically requested in my correspondence, is evidence to/of your agreement with the information presented in said correspondence(letters). Respective of the foregoing, the agencies noticed above, and I, have obviously come to a meeting of the minds and are in agreement `that' based upon the noticed public record and the information prior presented: (1) 1 am not(deny being)a citizen of the United States(U.S.),subject to the jurisdiction of the federal government nor to its sub-corporation,the State of California,in as such as Declaration has been made, under penalty of perjury,that I was born within the territorial jurisdiction of the California Republic and am living on the land there within. See EX PARTE—FRANK KNOWLES,5 Cal. 300,California Supreme Court(1855). (2) 1 am not(deny being)liable in my private capacity for any claims of revenue due the corporate U.S. (United States)and/or its sub-corporation, STATE OF CALIFORNIA,via their collection agents IRS/FTB or any agents thereof,because I am not(deny being)a fiduciary to the Fictional Entity/statutory person/franchisee/Trade Name: SHARON E STAMBAUGH. See referenced letters—Affidavit of Truth with attached IRS Form 56 made a part hereof by reference thereto. • In substantiation and verification of the information above, no agent of any agency has signed, pursuant of the rule of law, in verification of the alleged (Fraudulent) claims/debts contained in the alleged documents, is e. "Notice(s)" of alleged liability. It is apparent that b your refusal to sign your own.'paper(s)' in verification of their truthfulness, accuracy and completeness, you are knowing and fully aware that you could have been individually and personally charged with the crimes of FRAUD and PERJURY. Notice: Rule of Law — California Civil Code, California Code of Civil Procedure and the Uniform Commercial Code(UCC). Since the subject matter has been resolved by your `failure to respond' /acquiescence, there is no need for any future correspondence from neither you or your agency, nor any sub-agent thereof. ANY future mailing [determined improper] from youxor your agency will be returned unopened based upon your `failure to respond' / acquiescence and our total agreement, hereby noticed. In addition, no other (repeated)correspondence regarding these matters will be necessary(or forthcoming)from me. GRACE of an additional thirty (30) days is hereby given by me for the purpose of allowing you and your agents sufficient time and opportunity to: (1) return any and all pL (including but not limited to money [Orders/drafts/checks, labor funds, bank funds] or signature or land or liberty)taken or received by you, ab initio to date, regarding me, and (2) immediately remove any/all "Notice(s) of tax , Liens" from County Records regarding me (i.e. via use of Trade Name, under color of law). Notice: refer to my request for the return of property—Registered"Counterclaim via Affidavit of Truth",supra. This letter is also NOTICE to you,.that in relation to your fraudulent actions and the refusal to return my property, a TORT Claim for damages will be of necessity forthcoming. This "Action"will be filed with the Director of Torts,Civil Division,United States Department of Justice. Respectfully presented,and sealed by my hand on this twenty-second day of the ninth month of the year two thousand one of our LORD aW Savior Jesus the Christ—YAHSHUA. /Secured Party,Creditor Sharon-Elizabeth: Sta@pugh—Private Citizen/non-Fi cc: Mailing list attached hereto and made a part hereof. Attac, iments: Enclosures: 2 of 2 Notice—aequiesc mce/agmemea/admissions REGISTERED #RR 936 666 206 US MAILING LIST: See asterisk( * )Notes—end of list. Contra Costa County SHERIFF, Warren E. Rupf 651 Pine Street. 7h Floor Martinez, California. [94553] State of California ATTORNEY GENERAL 1300"1" street Sacramento, California. [95814] Contra Costa County DISTRICT ATTORNEY 725 Court Street,4t'Floor Martinez, California. [94553] State of California SUPREME COURT CLERK 3032 nd Street/South Tower,8`h Floor San Francisco, California. 194107] Contra Costa County CLERK-RECORDER, S. L. Weir ** 524 Main Street Martinez, California. [94553] State of California Office of the Controller 300 Capital Mall, 18'h Floor, Suite 1850 Sacramento, California. [95814] Contra Costa County = BOARD of SUPERVISORS 651 Pine Street, Rm 106 Martinez, California. [94553] State of California FTB Exe. Office,Mr. Gerald Goldberg 9645 Butterfield War• Sacramento, California. [95827] Contra Costa County SUPERIOR COURT Presiding Judge 649 Main Street Martinez, California. [94553] Contra Costa County SUPERIOR COURT Clerk_Ken Tonne 725 Court Street Martinez,California. [94553] Contra Costa County Clerk of the Court 2970 Willow Pass Road Concord, California. [94519] Department of the Treasury of Puerto Rico Internal Revenue Service of Puerto Rico Director/Ogden Service Center 1160 West 1200 South Ogden, Utah. [84201] 1 of 2 Mailing Lia-Notice _'RR 936 666 206 US Ron Harvey mailing list-continued] ®CT 1 6 2001 Contra Costa'County. RISK MANAGEMENT,'Ron Harvev 2530 Arnold Drive Martinez, Califonua. [94553] Department of the Treasury of Puerto Rico Internal Revenue Service of Puerto Rico District Director 1301 Clay Street. So Tower, 16`s Floor Oakland, California. [94612] United States Bankruptcy Court Clerk of the Court <**> 1300 Clay Street, 3'd Floor Oakland, California. 194612] District court of the United States Clerk of the Court <*> 1301 Clay Street,4h Floor Oakland, California. [94612] United States of America ATTORNEY GENERAL, John Ashcroft 950 Pennsylvania Avenue NW Washington,District of Columbia. [20530] C>rc The Ninth Piste-Court of the United States CHIEF JUSTICE,Mary M. Schroeder U.S. Court House. Suite 610 40I'West Washington Street, SPC54 Phoenix,Arizona. [85003-2156] NOTES: Case# 84529 [Bonded action,Conversion of Quiet Title property], and[Sheriff's Incident/Case] #96023945,and [Sheriff "Abatement"] #737 180 090 Certified, and BOND#96 30329 Registered#R 641 974 436,and[Justices' Court case]#LLS-VP-950522-01 All"Notice(s)of[Tax] Lien(s)"—State and Federal <*> Case#C 94 1833 DLJ,#C 94 1834 [vRw]DLJ, #C 94 1835 [vRw]DLJ,and#C 95 0608 DLJ, and#C 96 04074 CW <**> Case#94-41220 TP,and#95-42758 JP,and#95-4489 AJ ------------- Blind copy-note: .� _ NO i c,e Ye�aY T�,,ti Frga4, cortverf,►oh-t�e4 ��0�4�'� ®� 2 of 2 'tiS l Vo� c , Mailing Lia-Notice pp R RR 936 666 206 US a �� 1 CONCORD CA MAIN POST OffICE ly CONCORD, California 945205710 PROOF OF SERVICE 07/30/2001 (800)275.8777 43:49:02 PM �i Sales Receipt Product Sale Unit final y, Description Oty Price Price Ithe undemgned,herebycertify that Iamftiniciledinthe rra��.SiQ. PVI i $1.00 $1.00 county of California state,I am over the age of 4aghteen years and not a party to it) PVI 1 $1.00 $1.00 within acion/matter,and: j s PVI I $1.00 $1,00 PVI i $1.00 $1.00 That on 7" Q —;Z00 I I semtd the enclosed documents(Forit3y: 1 51.04 $1.00 a Fsi,�IraA t p 00 S1.00 1 51. Esbam Stambaugh);described as: PVI i DO $1.40 PVI 1 $1.00 $1.95 1. COUNTERCLAIM TRUTH and AFFIDAVIT OF TRUand Notice WASHINGTON DC 20220 dated 21 July 2001 with amachmmt(s): first-Class 51.50 Return Receipt 57,54 Registered (i) copy UCCA relative tor}eftarSHARON ELIZABETH TAMSAU( Insured Value $100.00 (2) copy various pages of evidl nce: (11 Stance at Lsrge,62'`Cmgress, Article Value $100.00 page)795'PRIVATE LA%V"; 121 the INDEX page=62"Cmgrm'; Labe( Serial #: RR93666617OUS E: (3)Q.7g t7CATE by Seemsary of Stare,Calif.-DOTARS am-e:eissom Issue PVI: $10.95 i (3) CONS7RUCTIVENOTICEMYAFFIDAVff,with=Acbed C) (4) MEMORANDUM OF LAV:aatiaachmma pan of Affidavit f 1.72 (5) AFFIDAVIT of Denial of Corporation Ezisteoce WASHINGTON CC 20002 ?� first-Class 2. Form 56-Notice Concerning:Fiduciary Relationship with arched Issue PVI: $1.72 (1) AFFIDAVIT-fiduciarymbunalwirhattachments _ Pages 79,$0,and 81 relmd"to'Reform Act of 1998' $20.61 ; Intal: j 3. Proof of Service y! Paid by: $21.00 it Cash i placed a irue crud correct copy ` _$0.33 That th=eoC enclosed in a sealed envelope, Change Due: postage prepaid,via Registered Mai(M RR 936 666 170 US Remrn Receipt requested j l ' and First Class Mail,in United Suuw Post Office located at, Gvr+G Y"c( t. Bi l I N: 1000300771184 California and addressed as set forth below for: Cleric: 11 fid IFuat+ass Mev) Thank you for your business -- ( Department of the Treasury of the Uauted Sures C?garttmmt e1 the Trnsury of the United Stasis i ?'l So=wy of the Treasury of the-Title 31 USC 1301 CommLimo es of rowed Revenue of the-26 USC S 7832(a) Main Treamey Building 11 I 1 CormtitWoo Avenue NW j I3d SL&Pennsylvanh Avenue N21' Wtavhingpon,Diana of Calumba. 20002•W37 ! ..z�::'G:�Y,,:•r- ..:ii,;,'+ti. ,.�_.'w �xe:.:;r".Ss'r>.�=._Gin: :ba#: Washington,Diwia of['•,a+nhim 20220 ` Executed on. 7-aC-^'61 at Go>u•C0'r_j California. I Registered No. J1 L �'�7 tamp t �^ �tJCO/? I declare,under the penalty of perjury,that the foregoing is true and correct. Dbwry Reg Fee S' ~moi = • Rene s 0070 Signed By: I Remo e p Rastr tieC S r�}¢1 v Lr4 �YrDddl-3anr� Reoeiveu nr. 07/3012001 i n Y le Cnarnmer Must Dechre 60 aaaur V . . Fue VaAM S .!Op M� fir l►+r.r.H _ -- ,. ex er deG;� 3S of ti' ice— AA / A I-i ~ " 5"YStd lots' PS Form 3806, i dor Ft"Wlesred LUM 't: June 20M (see koom ftn on Fhvww) PROOF OF SERVICE 1,the undersigned, hereby certify that I am domiciled in the G04x, Gfl b-1 - county of California state, I am over the age of eighteen years and not a party to the within action/matter; and: That on 5vielIx—Ler AN, I served the enclosed documents (For/By: Sharon-Elizabeth: Stambaugh), described as: 1. Registered NOTICE—Acquiescence/Admissions, and record and request dated 22 September 2001 with attachment(s): (1) MAILING LIST for"cc"addresses,with Notes "*"of cases' # 2. copy Proof of Service of 30 July 2001 — COUNTERCLAIM via AFFIDAVIT OF TRUTH,Registered,with postal receipts. 3. Proof of Service That I placed a true and correct copy thereof, enclosed im a sealed envelope, ,postage prepaid, via Registered Mail # RR 936 666 206 US Return Receipt requested and First Class Mail,in United States Post Office located at Sa-h Fpn e-s c- , California and addressed as set forth below for: [Registered] [First Class Mail 1 Department of the Treasury of the United States Department of the Treasury of the United States Secretary of the Treasury of the—Title 31 USC§301 Commissioner of Internal Revenue of the—26 USC§7802(a) Main Treasury Building 1111 Constitution Avenue NW 15th St_&Pennsylvania Avenue NW Washington,District of Coluanbia_ 20002-6433 Washington,District of Columbia 20220 [Attn:-First Class Mail 1 [Atter-First Class Mail 1 Internal Revenue Service of Puerto Rico—27 CFR§250.11 State of California Department of the Treasury of the Franchise Tax Board Fresno Service Center P.O.Box 1673 Fresno,California. [93888] Sacramento„California (95812] Executed on at California. I declare,tinder the penalty of perjury,that the foregoing is true and correct. Signed By: V —, ' G/ry-Neil: Brisboi . c/o 3361 Citrus Avenue Walnut Creek, California state. r'c r �� _._._.._._.._..: sseulsnq anon jol no,t Nupyl SO :)NeIJ S99110000001 :#L H8 •woo•sdsn•Am Ip-outluo pup nspa 'Molnb s,11 ;uelndwoo .inoX ao t j 4t46lj ssu l l 1po rnoA puss not 5491 eulluO 6ulllpp IsodION 60101$- :sn0 e6up43 00'LZ$ 4sp3 :Aq plpd l (asranaa uo uopeuuoYu(sag) OOOZ eunr (Adoojawojsn ) view paia;Si6 io; as `908£WJO=l Sd 16'91$oq 1p3°1. Q o . b �-S 01/VSd -0i7 Ob'E$.. Lft E$... i . . .:6p ld m.lp j otiC .� O rn 19'0$ F _ =IAd anssl ( v v .� 3^a ssp l]-3u l3 s LS'0$ Z18S6 VJ O1N3NVH3VS ;o fiL T m ° LS'0$ =Illd•enssl ' '-- me , 's LS'0$ 888£6 VJ ONSH8 99 3 ` bar& LS'O$ =IAd anssl eoueinsul � ©Q a 1�aa mss) ieKoa ub ssp l]-;sl t 3 Powtull s uu;aPul eoueinsu Co $ enleA Iln� ' �;�. 1e490d e�Etoep�snv4jewolsno LS'0$ EEb9-Z000Z JO N019NIHSVAI 08'6$ =IAd enssl ueiwS**ul b Aq pameoed e AJOA1 to : ° 1plje5 legpl sn90Z9999Upy sso 00'001$ : enLvA elolzjV ldiaoay a6ie ' 0.9 : enjvA peinsuldip wnlay 6ullpyH 00100 $ OS'L$ pale;s l6ey Ind $ e� �d OS'i$ ;dleoey Lun;ea _� ! ;• 9Q WN ssp l]-3sa 1p dwelS_a3�Q oN pa�alsl6aa 08'0$ OZZOZ JO N019NIHSVM 00'1$ 0011$ 1 Iha 00.1$ 0011$ 1 IAe eoPd eoljd 440 uol;dlloseO 1pu.l3: Uun BIBS jonpouk _ . ;dleoeb .seJiS 4.ti '7: -Nd.LO:8Z:Zt LUS-SWO08) i00Z/6Z/6t - ' 8666ZEib6.. - plu:lo4 i o?3'103*SI3WHA WS .: --- VZNId 3MOH53HIfl - �' PROOF OF SERVICE I, the undersigned, hereby certify that I am domiciled in the L0�^Tr0. 62 5 k county of California state, I am over the age of eighteen years and not a party to the within action/matter, and: That on QGt. �02 ��0/ a I served the enclosed documents (For/By: Sharon-Elizabeth: Stambaugh), described as: 1. "cc" copy Registered NOTICE—Acquiescence/ Admissions, and record and request POSTAL dated September 29, 2001 with attachment(s): (1) MAILING LIST for"cc"addresses,with Notes"•"of cases' # (2) copy Proof of Service of 30 July 2001 go—no COUNTERCLAIM via AFFIDAVIT OF TRUTH, Registered,with copy postal receipts (3) copy of Proof of Service of 29 September 2001 , Registered,with postal receipt copy (4) and [Blind copy, info,provided and marked as necessary]: 2. Proof of Service That I placed a true & correct copy thereof, enclosed in a sealed envelope, postage prepaid, via First Class Mail, in the United States Post Office located at 6-0a GEY� , California and addressed as set forth below for: ( each addressee as noted/listed on page 2 hereof') ( including but not limited to `Blind copy addressee" [Blind listed]) Executed on lo� 06,tD A P_r+ � ���I , at �1 o h_c...Vr �. , California. I declare, under the penalty of perjury, that the foregoing is true and correct. Signed By: 2 Wendell-J es: Casey Page 1 of 2 First class--a"wpy for/By Sharon-Elizabeth: Asa Q�p :q�agezr�g--qs.( -j :j J :oZ-.(do:)pull$ ---------- ----------- ----------------------------------------------- 195IZ-£00981 'Euoz!j aluwgl t'SJdS '}aans uoiVulgseM 1saM I0b [O£SOZI Tl IOD jo toulslG t0l&TgseM 019 a1TnS `asnoH uno'J -S-fl ANN onuany E[uE.+I.lsuuad 096 sapaozg3s 'L+I.Uuw `gDlLSflf amm go-iogsy triof "ry-dgN20 A9N'd0.LL`d salelS Pol!ufl aql jo unoD llmx!3 tllu!fq agjL eoumv jo solels palrufl IZ19b6l T'W0.ITM `Put'I-VO 1ZI9t'61 'enuPS73 'PuEREO iool3 mt yawns fell IO£I iooL3 P,£ `taanS SUID 00£I lino,aql jo)VOID unoD aq1 jo)VOID salElS pallufl oql jo unoo louls!G unoD SzidnnFmg s31E1S palTufl IZI9tt61 'EluloPIeD 'PuErAEO YooL3 T91 '.lOmO ,os `lawns nula IO£I 1£S9b61 'El OPIeD 'zauluEW iolaanG 13='G anuG ploidy 0£9Z cold ouand jo aouuaS onuatiag Imalul bmuH uold`JN3W30VNvW)ISRI oold ouand jo,tmseal,L oql jo.luaucuudoG uunoD MOD eiluoD Ii0Zb81 gmfl,uap80 glnoS OOZI 1soM 0911 161 Ml 'Enu0j"D `pjoouoD lalua'J aol.uaS uaPI�O/I01=1(j PEOd ssed MOIPM OL6Z ward ouand jo aoLun anumxd Imalul lino,oql jo xIaIJ oold oliond jo,nns=jL aql jo luauiuEdoa 4unoj MOD esluoo I£5Sb61 TTWOPIRD 'zauTIXW I£SSb6l 'enuojlle:) `zauruElnl laailS lino, SZL WAS UmW 6t•9 auol ua-A`xlai�.LwoD uoruadfis a8pnf 9uiplsaad.L-dn0D 2IORigdfiS fiunoj MOD mluoj �unoJ MOD eiluoD ILZ8S61 T u.iojlieD `oluoumoes I£S9b61 'eru 0JTleD `zauRwW keM Plogimng St•96 901 urld'1aai1S Auld 199 '3iagPIOD PIV'aJ 'a0iA0 'OX3 q i3 SdOSItlIEMS j0 GdOG enuop'D jo atUls f4unOD MOD ealuoJ IbI8561 'Llmo•;rleD 'oluauieioeS I£SSb61 'EnuoP.TUD 'zaurueW OS8i ol!nS `10OU p8l 'IieW Im!dE3 00£ hails MEW t•ZS 1011011u03 aql jo 00w0 iTaM 'Z'S `2i3G2I0�32i-�I2I3IJ enuopleD jo ails nlunoj MOD uiluoj ILOI t'61 T!uJ0JgeD 'ooscoael3 ueS I£SSb61 'EnLlOjile� `zaurueyv iooL3,,,g 'i;)Aio,L.glnoS/laanS o„Z £0£ iool3 ,t,I=S lino, SZL ?RI3"Io JUn03 MAJ3ddnS AaNuo.LLy.LJI2I.LSIG enuojlleD jo aels )luno,also'elluoo IbI8561 'erui0PM'oluau>E.3t'S I£SSfi61 7nuojlieD'zauT11EW Mils..I„00£I Goold 41L 12311S wind 159 Tv-daN20 Agl�Idojly jdnd .3 uauEM 'AARIHHS eru-10iin jo a1Els uunoD also,enuOD Isil 2tnPW «00„ — 2Ow2S 3O3001d Z aOBd I : gA d 6 _ A r - 45 9- vi r to Ca ell cn F. . to I O C I n 51 W � t� � - �� `1 . . � h ' \\ � . �\ ,,�\\\ `.,` �l .� J. ,� �,: ...... j - ....... � % ..._ �. ..,.._ ....._. ....._ ., �� � :::� : _ �.� :...� �`� , ' i f X11 tO n'^_'i�•� � �•_J vi M n�! I 1� ,a E ' F x i� ifs + CZ � o � 1 100 LA Ln CD o O t 1 �/'� J� �1 1f ,.% \ \\ ' i `\ t't t ` i• ,� .. •~~` j � ._... � :::. �. �' r .._. ....... `� .::: � ..,., 1 ::::::: .�.... f;' 4 ��� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to GovernmentC n 913 and EA D 915.4. Please note all "Wa in AMOUNT: $319.00 NOV 6 2001 NOV 0 8 2001 COUNTY COUNSEL CLAIMANT: Linda Garner MARTINEZ CALIF. CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. ATTORNEY: None DATE RECEIVED: November 5, 2001, 2001 ADDRESS: 94 Bonita PI BY DELIVERY TO CLERK ON: November 5, 2001 Rodeo, Ca 94572 BY MAIL POSTMARKED: November 2, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. , JOHN SWEET r Dated: November 5, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisor ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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: Af Dated: By: t,IX Deputy County Counsel 111. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (y� 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'wCQ//Y1 Ls/1 F JOHN SWEETEN, CLERK, By& , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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. l� Dated: L21QW JOHN SWEETEN, CLERK ByDeputy Clerk This warning does not apply to claims which are not subject to the California Tort Claims Actsuch 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100`h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1. 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. ( Govt. Code §911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County ?administration Building,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. at the end of this form. YC RE: Claim by ) Reserved for Clerk's Filing Stamp o cv0-PUr ) RECEIVED Against the County of Contra Costa or NOV 5 2001 District CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. (Fill in Name) The undersigned claimant herebv makes claim against the County of Contra Costa or the above named District in the sum of S Z 19. 67 and in support of this claim represents as follows: 1. When did the damage or in jury occur" !Give exact Date and Hour) ---------- - ------ -► - ,_ Df-------------------------------------- G'� _ - _. Where did the damage r injury occurs (Include City and Count ) ------------------ oc_ eo6)--------------------------------- --------- 3. How did the damage or injun. occur:' f Give full details: use extra paper if required 6-0 a llbr6 � /,�ocl%�•��`f es &f"Qf, M. 01" d t�P y Jrouz-ftnuqh � �AtIn ----------- r- �?� l/.a)�_' 4. ...What particular act or omission on the part of county or district officers, servants, or employees caused th���r1. , injury'or damage' �J! �tul, (Over) ��cC'-F,�ire�� aug pur luamuosuduu gans gloq •+q 10 `( 000`0IS) slrllop pursnogl uai Jouipaaaxa lou 3o aug r .{q 'uosud aims aq1 ui luauiuosudtu .:q 10 aug par luauzuosudun qans gloq .:q ao ( 000-IS ) slrllop pursnogl auo 'Dutpaaaza lou 3o aug r eq lrae auo urgl aloui iou 3o.pouad r 1o3 ltrf .uunoo aql ui luamuosudmt Sq iaglta algrgsiund si tuilu.41 10 '.1agDnon �lunoaar `Ipq 'Lump lualnpnrl;.lo aslr3 .iur.�auinua;3i auirs aql .ird 10 molly of pazuoglnr la-awo 10 plroq lauistp to .uta -.ilunoa .,.ur of 10 `1aag;o 10 plroq girls .iur of luaw.ird 1oj 10 aaur.+�ollr 103 sluas;ud -pnrl;ap of lualai glt,e og.a uoslad :uan3„ :sapteold apo] lruad agl3o ZL aotl:)aS 3JI .L0 bC?-bb J -RC-;�f o auogdalaI •ori auogdalal ( ssaiPPF' ) ( alruru:>>S S,lurwmrjD ) KlIf U,V-10 .�aulouF 3o ssalppF Pur. auirt� ;.•3lrgaq stq uo uoslad autos .iq 10 .01 SaDI.L04 Q_,35 luruurla a.ql-iq pauLis aq lsntu unrp aq.L,. :Sapi.i,old -�•0I6 •jaS ape .L.�.1ci n t lti 3.LI 3.Lt Q :.unfui 10 wappor sigl3o lunoaor uo aprui noe salruipuadsa agl,lsi7 •6 ----------------------- -------------- ------------------------------------------------ •slritdsog pur slouop �sassauiim 3o Sassalppr pur Samr.r�j •g ------ --- ---- ------- --- ---- --- ---- ------p----------------------------------=---------- (•aorwrp to.unfM anuaadsoad.:ur jo iunowr patrwosa aq3 apn(auj) palndtuoa lanouiu pauurla anogr aql sr.b.wog aoj sw3tupsa oAt3 4aruv -paut;rja saoruurp 10 saunful jo luaixa wu a&t!))�Zpagnsal mrcl' noA op saunfui 10 sa'"Rwrp lrgA& '9 ;;:�lnfui so aoruirp aql Uutsnra saa�old�a 1o'slur.uas�s.caai3}o laulstp 10 S1ano�3o saairn aql a1r lrg�, •^y Crockett Auto Body, Inc. Final 1000 Loring Avenue Invoice Crockett,CA 94525-1169 for Repair Order Tel.M (510)787-2742 Fax M (510)787-2465 5050 Shop ID:AH184992 f ********** WRITTEN LIFETIME WARRANTY ********** ! Version: Original Date&Time: 8/27/01 01:50 pm Customer Insurance Claim# Estimator Status Target Date Linda Matthew Open 00100/00 3arner Padgett 00:00 Customer Vehicle Insurance First Name: Linda Color: Blue Co. Name: Customer Pay . Last Name: Garner Year: 2000 Address: Middle Init: Make: VOLKSWAGEN Address: " Co. Name: Model: JETTA City: - - Address: 94 Bonita Plc Prod Date: 03/00 State: Address: Body Style: SEDAN Zip: City: Rodeo License: 4LTW819 Phone#: State:. CA Vin#: 3VWSC29M1YM158015 Fax#: Zip Code: 94572 Paint Code: Claim #: Trim Code: i Home Phone:(510) 799-0983 Mileage In: 118177 Policy#: ! Work Phone: (510) 233-1955 Mileage Out: Loss Date: Fax Number: =Deductible:.$"O.UO�. 3 P.O.#: — --- i Unit#: Adjuster-Name: Comments: Adjuster Phone: ''°' Adjuster Fax: (Referred by:- Farmers Claims -:J Email: VEHICLE OPTIONS: POWER WINDOWS AIR CONDITIONING CRUISE CONTROL POWER DOOR LOCKS HEATED REMOTE CONTROL MIRRORS DAMAGE LINES ID# Payer Operation rDescriptio`n.) AdJ% Bet% Part# Price Labor Unit 001 Cus Additional LaborEREmg)E,TRAFFIC_P_AINT-J ADDNL LABOR OPERATI SM 3.5 002 Cus Additional Labor(:POL"ISH- WAX COMPLETE 1 ADDNL LABOR OPERATI SM 2.0 are Estimators Judgement. SM=Sheet Metal,ME=Mech/Elec,EL=Electrical,FR=Frame,RF=Refinish,SR=Structural,DI=Diagnostic,GL=Glass. r are Taxable line Items. TPM are Taxable Paint Material line Items. PM are non-taxable Paint Material line items. :epair Order-.5050 Page 1 of 3 'tomer) TION RATE ORIGINAL Unit Amount eet Metal @ 58.00/unit 5.5 319.00 Ad-ES TOTAL(including taxable and non-taxable sales) 319.00 scounts 0.00 arkups 0.00 sductible 0.00 Cher Charges 0.00 )pearance Allowance 0.00 :fated Prior Damage 0.00 Atom Line Adjustment @ 0.00% 0.00 )JUSTMENT TOTAL 0.00 :bor 0.00 arts 0.00 iblet 0.00 wing 0.00 orage 0.00 iscellaneous 0.00 %XABLE SALES TOTAL(included in Sales Total) 0.00 ix On Labor(Sheet Metal, @ 0.000% 0.00 ame,Mech/Elect, ;finish ix On arts @ 8.000% 0.00 ix On Sublet @ 0.000% 0.00 ix On Towing @ 0.000% 0.00 ix On Storage @ 0.000% 0.00 ax On Miscellaneous @ 0.000% 0.00 AX TOTAL „ . :. . :: ...: . .. .:•..�, . dd.. ,,..::..... 0.00 etterriient " 0.00 ' ustomer Net Total X319:00_; ATE:Unrelated Prior Damage does not have any impact on net total. VRELATED PRIOR DAMAGE 0.00 OTALS (Summary) ESCRIPTION (�O.RIGINAL-$: ustomerTotal F,31.9:00' . otal I31:9:00-� air Order.5050 Page 2 of 3 AaOO u3woisno - __ - -- - - --- tt p. ( ) _ � a CD M, a I M n.! r� FE 0 W z Ln -' a � A i HE 04 i o ' N t--- t.- .:c "4 — 4+.I W W ; a C3 N IG "~' G O` U V �— Q n fr W tk .`•' w � '� 'fi I ���e � �`� 1,II V�.. y.y .+i y n^'r t.. ,. ,�,� � ,e` �, T _ ti�x,. _ w4i, -r n. � >' � h;�:�,� ..�dY y, �� '`# t:"�'M1� +'.,v P' Y ` � � �8 �� �. �� O �� s» / �. ���.� j �, //J J /�`�' ' �' i �,� +j .� v...,.^{.xy�} ,,,,�;is F=' � ,t� k `��� �{.t_ i r r ,;tjf Fit �. . -'#; Ver;= �.`.,'�:•'•;.•,. .f. C.: ;,t ur.:.'•" z�'t".c;Lt:n';h�:F,i��R :..k;::�i'.',�•+:., .:r.:v r .(t.. no ':>;wn No '.�� - '•F_� �>.:. '.rt� may..,: _ - �'l..�_t.'1;'i.,°Y'.:�. +'.tea' K(��"'�.'.f,'i: r4a:-S: - ��.fL'�% •'f,: '`.:;L:. •'si.r.. �.c. :'?.:. own .. rX'�;�i.,i.]q:.;�:;, k':�;t::"r:;' J'• '.tis _ foil ��..ti.`i%fit:;'•n.':. _ ('�:;:d"•� .-. �:,j: !�f'�r,�.?!r�.:•,. _shy; u;. _ lift f VA yip:•: '03V1SO V INDO SkIOS1AH3dnS 0 40,HVOG HH313 t00Z 9O AQN c� - • t1ti a; Z4 ►, � � I'Q) CLAIM ' BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: $25,000 CLAIMANT: Michael Niemann & Lynn Niemann ATTORNEY: Scott Zimmerman DATE RECEIVED: November 6, 2001 ADDRESS: 812 First St BY DELIVERY TO CLERK ON: November 6, 2001 Brentwood, CA 94513-1120 BY MAIL POSTMARKED: Faxed I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN W/6 SWEET -ler �1 �%� Dated: November 6, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (\).,T6claim 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: (-__�i97? . Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: �) 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: k um]bu) JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: fin/]1L , ) JOHN SWEETEN, CLERK By Deputy 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. 11/06/2001 12:38 9256340781 ZIMMERMAN LAW OFFICE PAGE 02 Law Office of SCOTT K. ziilMME>cuMAN 812 First Street Pl sst office Box 1120 Telephone,(425)634-3571 Brentwood,Cautotoia 94513-112(1 Facsimile:(925)634-0781 E-mil:sWawftacbell.net-web:www.zimmermaalawoffice.coim .__RR RRR•.. VIA FACS MILE and REGULAR U.S. MAIL November 6, 2001 CERTIFIED MAIL RETURN RECEIPT REQUESTED Contra Costa County Board of Supervisors Clerk of the Board of Supervisors NAV 6 2001 CONTRA COSTA COUNTY County Administration Building 651 Pine Street, Room`106 CLERK Bc Martinez, California 94553 Contra Costa County Sheriffs Department 651 Pine Street Martinez, CA 94553 Office of the County Counsel CONTRA COSTA COUNTY County Administration Building P.O. Box 69 Martinez, California 94553 - 0116 Re: Claimants: Michael Niamann, and his minor daughter,Lynn Niemann Claim No: Unknown Date of loss: September 13, 2001. NOTICE OI; CLAIM Pursuant to California Govemmenf Code Section 910 Pursuant to Califomia Government Code Section 910, SCOTT K.ZIMMERMAN of the Law Office of Scott K. Zimmerman, hereby submits a claim on behalf of Michael Niemann, and his minor daughter, Lynn Niemann, against the County of Contra Costa, and the Contra Costa County Sheriff's Departrnant as follows: Law office of Scoff K Zlmma"Hn CASERVER DATA FI E.31BZ\D1910GLAINhW1emANN_MD5.WPD 11/06/2001 12:38 9256340781 ZIMMERMAN LAW OFFICE PAGE 03 November 6.'2U01 Page:2 A. The name and post office box of the claimant: Michael Niemann, and his . minor daughter, Lynn Niemann, cto Law Office of Scott K. Zimmerman, 8112 First Streak P.O. Box 1120, Brentwood, Cafifiomia 98513. B. The name and post office box of the person submitting the claim- SCOTT K. ZIMMERMAN, Esq. of the Law Office of Sccatt K. Zimmerman, 812 First Street, Post Office Box 1120, Brentwood, California 94513: C. On September 13,2001,at approximately 7:30 a.m.,while Claimant,Michael Niemann, was at his home, in his back yard, Claimant was accosted by a number of individuals in street clothes, all of whom Initially failed to identify themselves, all of whom were armed with handguns at the ready, and some of whom instructed Claimant to approach them with his hands raised. Claimant did as instructed, all the while fearing for his fife and wellbeing,as Claimant,being a law abiding citizen, had absolutely no idea why these unidentified, plain clothed armed men were on his private property giving him such instructions. As the armed and unidentified men were in the process of having Claimant get on the ground, one of the men in the back of the group, later identified by Claimant as Contra Costa County Sheriff's Deputy Jeff Baldwin; recognized Claimant from Claimant's long continued residence on Bethel Island,and upon such feaognifm,instructed the remaining unidentified armed men that."he is wrong one"or"ifs not him". and.then instructed the men to"go next door", which they did. As it turned out, the unidentified plains clothed armed men were, it is believed by Claimant,Contra Costa County Sheriffs Deputies,and were attempting to make an arrest of Claimant's neighbors,known to Claimant as Vickie and Bob Rock,with whom their minor son, Brandon, lives. this further believed by Claimant, that the deputies then arrested the individual next door neighbor known to Claimant as"Vickie Rock"on a charge of auto theft, andother charges. Later, Detective Jeff D. Moule, of the Contra Costa County Sheriffs Department, Investigations Division, came to Claimant's home, and explained that there had been a mistake as to the location,of the suspects, and that they had confronted Claimant in error. When Claimant was confronted, his 1.6 year old daughter, Lynn was in their home, and both Claimant and his daughter, also a Claimant herein, were extremely upset and fearful for their well being because of the admitted error by the Sheriffs Deputies. .D. Both Claimant and his daughter.Lynn, a co-Claimant herein, was, is, and in the future shall continue to suffer the long-term effects of the acts or omissions set forth in paragraph "C" preceding, to wit: Claimant and his daughter, co-Claimant herein, sustained a significant fear and emotional distress,and have not felt safe in their residence law Of m of Scof.K.Zfmmennan 0-'*.WW&R DATA FILES%SZ\UW10QLA1"1EMANN.M05.WPd 11/05{2001 12:38 9255340781 ZImmERMAN LAW OFFICE PAGE 04 Ptawember 6,'2001 ami since the date of the incident. This continuing fear and emotional distress is particularly evident in co-Claimant, Cyan.Niemann, a miner who now is fearful on a continuing basis of continuing to reside in her and Claimant's residence of many years. The fluff extent of the damages caused to the Claimants herein has yet to be fully ascertained. E. The jurisdiction of this claim would rest in the Superior Court of Contra Costa County. F. So for as is known at the time of filing this Claim, Claimants have each incurred damages in an unknown amount, but such damages are herein estimated to exceed the sum of$25,000.00 general and special damages for each of the Claimants. November fi, 2009 S f= Y SUBMITTED, . ZIMM ERMAN Atto ey for Clai iants Law office of Scott K.Zimmerman CISERWR DATA FILESISZD%IOClAIM-NIEMANN.MOB.WPo Law Office of SCOTT K. ZIMMERMAN 812 First Street Post Office Box 1120 Telephone:(925)634-3571 Brentwood,California 94513-1120 Facsimile: (925)634-0781 E-mail: skzlaw®pacbell.net-Web: www.zimmermanlawoffice.com VIA FACSIMILE and REGULAR U.S. MAIL November 6, 2001 CLERKNOV ? 2001 B CERTIFIED MAIL SON Rq Cos A V1 ORS RETURN RECEIPT REQUESTED Contra Costa County Board of Supervisors Clerk of the Board of Supervisors CONTRA COSTA COUNTY County Administration Building 651 Pine Street, Room 106 Martinez, California 94553 Contra Costa County Sheriff's Department 651 Pine Street Martinez, CA 94553 Office of the County Counsel CONTRA COSTA COUNTY County Administration Building P.O. Box 69 Martinez, California 94553 - 0116 Re: Claimants: Michael Niemann, and his minor daughter,.Lynn Niemann Claim No: Unknown Date of loss: September 13, 2001. NOTICE OF CLAIM Pursuant to California Government Code Section 910 Pursuant to California Government Code Section 910, SCOTT K.ZIMMERMAN of the Law Office of Scott K. Zimmerman, hereby submits a claim on behalf of Michael Niemann, and his minor daughter, Lynn Niemann, against the County of Contra Costa, and the Contra Costa County Sheriffs Department as follows: Law Office of Scott K.Zimmerman C:\SERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.M05.WPD November 6,2001 Page'2 A. The name.and post office box of the claimant: Michael Niemann, and his minor daughter, Lynn Niemann, c/o Law Office of Scott K. Zimmerman, 812 First Street, P.O. Box 1120, Brentwood, California 94513. B. The name and post office box of the person submitting the claim: SCOTT K. ZIMMERMAN, Esq. of the Law Office of Scott K. Zimmerman, 812 First Street, Post Office Box 1120, Brentwood, California 94513. C. On September 13,2001,at approximately 7:30 a.m.,while Claimant, Michael Niemann, was at his home, in his back yard, Claimant was accosted by a number of individuals in street clothes, all of whom initially failed to identify themselves, all of whom were armed with handguns at the ready, and some of whom instructed Claimant to approach them with his hands raised. Claimant did as instructed, all the while fearing for his life and well being, as Claimant, being a law abiding citizen, had absolutely no idea why these unidentified, plain clothed armed men were on his private property giving him such instructions. As the armed and unidentified men were in the process of having Claimant get on the ground, one of the men in the back of the group, later identified by Claimant as Contra Costa County Sheriff's Deputy Jeff Baldwin, recognized Claimant from Claimant's long continued residence on Bethel Island, and upon such recognition, instructed the remaining unidentified armed men that"he is wrong one"or"its not him", and then instructed the men to "go next door", which they did. As it turned out, the unidentified plains clothed armed men were, it is believed by Claimant, Contra Costa County Sheriff's Deputies, and were attempting to make an arrest of Claimant's neighbors, known to Claimant as Vickie and Bob Rock,with whom their minor son, Brandon, lives. It is further believed by Claimant, that the deputies then arrested the individual next door neighbor known to Claimant as"Vickie Rock"on a charge of auto theft, and other charges. Later, Detective Jeff D. Moule, of the Contra Costa County Sheriffs Department, Investigations Division, came to Claimant's home, and explained that there had been a mistake as to the location of the suspects, and that they had confronted Claimant in error. When Claimant was confronted, his 16 year old daughter, Lynn was in their home, and both Claimant and his daughter, also a Claimant herein, were extremely upset and fearful for their well being because of the admitted error by the Sheriffs Deputies. D. Both Claimant and his daughter Lynn, a co-Claimant herein, was, is, and in the future shall continue to suffer the long-term effects of the acts or omissions set forth in paragraph "C" preceding, to wit: Claimant and his daughter, co-Claimant herein, sustained a significant fear and emotional distress, and have not felt safe in their residence Law Office of Scott K.Zimmerman CASERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.M05.WPD November 6,2001 Page: 3 since the date of the incident. This continuing fear and emotional distress is particularly evident in co-Claimant, Lynn Niemann, a minor who now is fearful on a continuing basis of continuing to reside in her and Claimant's residence of many years. The full extent of the damages caused to the Claimants herein has yet to be fully ascertained. t E. The jurisdiction of this claim would rest in the Superior Court of Contra Costa County. F. So far as is known at the time of filing this Claim, C.laimants have each incurred damages in an unknown amount, but such damages are herein estimated to exceed the sum of$25,000.00 general and special damages for each of the Claimants. November 6., 2001..._.. RESP TF Y SUBMITTED, K. ZIM RMA Attorney for Clai ants Law Office of Scott K.Zimmerman C:\SERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.M05.WPD Law Office of SCOTT K. ZIMMERiVMAN 812 First Street Post Office Box 1120 Telephone:(925)634-3571 Brentwood,California 94513-1120 Facsimile:(925)634-0781 E-mail:skzlaw@pacbell.net-Web:www.zimmermanlaw6ffice.com VIA FACSIMILE and REGULAR U.S. MAIL RECEiVE® November 6, 2001 NOV 7 2001 CLERK BOARD OF SUPERVISORS CERTIFIED MAIL CONTRA COSTA CO. RETURN RECEIPT REQUESTED Contra Costa County Board of Supervisors �. Clerk of the Board of Supervisors CONTRA COSTA COUNTY County Administration Building 651 Pine Street, Room 106 Martinez, California 94553 Contra Costa County Sheriff's Department 651 Pine Street Martinez, CA 94553 Office of the County Counsel CONTRA COSTA COUNTY County Administration Building P.O. Box 69 Martinez, California 94553 - 0116 Re: Claimants: Michael Niemann, and his minor daughter, Lynn Niemann Claim No: Unknown Date of loss: September 13, 2001. NOTICE OF CLAIM Pursuant to California Government Code Section 910 Pursuant to California Government Code Section 910, SCOTT K.ZIMMERMAN of the Law Office of Scott K. Zimmerman, hereby submits a claim on behalf of Michael Niemann, and his minor daughter, Lynn Niemann, against the County of Contra Costa; and the Contra Costa County Sheriffs Department as follows: Law Office of Scott K.Zimmerman C:\SERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.MO5.WPD I November G,2001 Page:2 _ A. The name and post office box of the claimant: Michael Niemann, and his minor daughter, Lynn Niemann, c/o Law Office of Scott K. Zimmerman, 812 First Street, P.O. Box 1120, Brentwood, California 94513. B. The name and post office box of the person submitting the claim: SCOTT K. ZIMMERMAN, Esq. of the Law Office of Scott K. Zimmerman, 812 First Street, Post Office Box 1120, Brentwood, California 94513. C. On September 13,2001, at approximately 7:30 a.m.,while Claimant, Michael Niemann, was at his home, in his back yard, Claimant was accosted by a number of individuals in street clothes, all of whom initially failed to identify themselves, all of whom were armed with handguns at the ready, and some of whom instructed Claimant to approach them with his hands raised. Claimant did as instructed, all the while fearing for his life and well being, as Claimant, being a law abiding citizen, had absolutely no idea why these unidentified, plain clothed armed men were on his private property giving him such instructions. As the armed and unidentified men were in the process of having Claimant get on the ground, one of the men in the back of the group, later identified by Claimant as Contra Costa County Sheriff's Deputy Jeff Baldwin, recognized Claimant from Claimant's long continued residence on Bethel Island,and upon such recognition, instructed the remaining unidentified armed men that"he is wrong one"or"its not him", and then instructed the men to "go next door", which they did. As it turned out, the unidentified plains clothed armed men were, it is believed by Claimant, Contra Costa County Sheriff's Deputies, and were attempting to make an arrest of Claimant's neighbors, known to Claimant as Vickie and Bob Rock,with whom their minor son, Brandon, lives. It is further believed by Claimant, that the deputies then arrested the individual next door neighbor known to Claimant as"Vickie Rock"on a charge of auto theft, and other charges. Later, Detective Jeff D. Moule, of the Contra Costa County Sheriffs Department, Investigations Division, came to Claimant's home, and explained that there had been a mistake as to the location of the suspects, and that they had confronted Claimant in error. When Claimant was confronted, his 16 year old daughter, Lynn was in their home, and both Claimant and his daughter, also a Claimant herein, were extremely upset and fearful for their well being because of the admitted error by the Sheriffs Deputies. D. Both Claimant and his daughter Lynn, a co-Claimant herein, was, is, and in the future shall continue to suffer the long-term effects of the acts or omissions set forth in paragraph "C" preceding, to wit: Claimant and his daughter, co-Claimant herein, sustained a significant fear and emotional distress, and have not felt safe in their residence Law Office of Scott K.Zimmerman C:\SERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.M05.WPD November G,2001 Page: 3, since the date of the incident. This continuing fear and emotional distress is particularly evident in co-Claimant, Lynn Niemann, a minor who now is fearful on a continuing basis of continuing to reside in her and Claimant's residence of many years. The full extent of the damages caused to the Claimants herein has yet to be fully ascertained. E. The jurisdiction of this claim would rest in the Superior Court of Contra Costa County. F. So far as is known at the time of filing this Claim, Claimants have each incurred damages in an unknown amount, but such damages are herein estimated to exceed the sum of$25,000.00 general and special da ges for each of the Claimants. November 6, 2001 \- E-8' CTFULLY SUBMITTED, OAt K. ZI MERMAN Attorney for laimants Law Office of Scott K.Zimmerman CASERVER DATA FILES\SZ\D\910CLAIM-NIEMANN.M05.WPD O nd N �O aH �' cv 7. N m a w, f� I � n t rn n CP �0 4 `CP 1p a. ,„r- oa ilk ol 1�21 701 ON CLAIM C 2g BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown NOV 0 8 2001 CLAIMANT: Gilbert Gomez Jr. COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETS Dated: November 7, 2001 By: Deputy ` J ; / �' ��� l✓ �-/ II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (0-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: L i i/ L11 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: 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: g0no'lU� 9,I JOHN SWEETEN, CLERK, By �, , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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:, JOHN SWEETEN, CLERK By �}�J( Uti V� 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. SIMNO B.MARCHESI DEPUTIES: �^ 1�� PHILLIP S.AI.THOFF COUNTY COUNSEL JANICE L.AMENTA /fit :�`,• F F NORAG.BARLOW SHARON L. ANDERSON / = ~` "\ B.REBECCA BYRNES /�•,'l-r�' k '-"_=_`� ANDREAW.CASSIDY ASSISTANT COUNTY COUNSEL , CONTRA COSTA_COUNTY MONIKAL.COOPER /� /, s. - ?�:'C,k;s.��...�� VICKIE L.DAWES GREGORY C.HARVEY OFFICE''OF THE--C.OUNTY--C'OUNSEL MARKE S.ESTIS ASSISTANT COUNTY COUNSEL i—r _ � LILLIAN T.FUJII II�COUNADMIN,ISTRATION BU1LD�lNGI��I JANE I L.HOLMES R 651rRIIN&STREET�9tli"4FLQO. IjJ �� ra KEVIN T.KERR DENNIS C.GRAVES "/"' f"''•'' '� BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MARTINEZ-CALIFO:R:I '553=1229 EDWARD V.LANE.JR. BEATRICE LIU GAYLE MUGGLI r,\:_ 7Ss11' MARY ANN MASON OFFICE MANAGER �'� � PAUL R.MUMZ •5`7-`3 (nLj;t1� VALERIE J.RANCHE PHONE 925) 335-1800 NOTICE OF'-'-SUFFICIENCY STEVEN P RETTIG ( DAVID F.SCHMIDT FAX (925) 646-1078 AND/OR DIANASSILVER JACQUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELAJ.ZAID TO: Thomas G. McLaughlin 3105 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Gilbert Gomez Jr. 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: [ ] .l. 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. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page 1 SILVANO B. MARCHESI COUNTY COUNSEL Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§641,664) I declare that my business address is the.County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: November ,2001,at Martinez,California. cc: Clerk of the.Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910.910.2.920.4,910.8) Page 2 1 THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 LAW OFFICES OF THOMAS G. McLAUGHLIN 2 3105 LONE TREE WAY, SUITE D ANTIOCH, CA 94509 RECEIVED 3• (925) 754-9900 NOV 7 2001 4 Attorney for Claimant CLERK BOARD OF SUPERVISORS 5 CONTRA COSTA CO. CLAIM OF GILBERT GOMEZ JR. 6 Claimant, CLAIM FOR PERSONAL INJURIES AND WRONGFUT, DEATH DAMAGES 7 (Government Code Section 910) against 8 9 COUNTY OF CONTRA COSTA, Respondent. 10 / 11 You are hereby notified that GILBERT GOMEZ JR., hereinafter described as 12 claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages from the County. of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: 14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle 15 along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella 16 Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County exercised reasonable care and 18 diligence in the construction and maintenance of the roadway. The dangerous conditions 19 included but are not limited to lack of adequate sight distance approaching the intersection and the presence of visibility obstructions along side the roadways. The 20 Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be maintained. Said 21 dangerous condition was not trival and created a substantial risk of injury or harm to 22 people using the roadways. 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to 26 Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of the public employees causing claimant's damages are unknown. At all times herein mentioned, claimant GILBERT GOMEZ JR was the minor son 2 of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 3 The damages sustained by claimant, GILBERT GOMEZ JR, as far as known, as of the date of presentation of this claim are personal injuries, wage loss, special damages, 4 general damages and emotional distress damages as a result of witnessing injuries to other relatives by GILBERT GOMEZ JR., and wrongful death damages for the death of his 5 parents GILBERT GOMEZ SR and DANIELLE GOMEZ. 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 7 of the State of California. 8 All further notices or other communications with regard to this claim should be sent to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, 9 CALIFORNIA 94509 telephone (925) 754-9900. 10 11 Dated: November 5, 2001 THOMAS G. McLAUG IN 12 Attorney for Gilbert Gomez Jr. 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 RECYCLED PAPER 1 CERTIFICATE OF SERVICE 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 I am a citizen of the United States,over the age of 18 years, and not a party to, or interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. 5 McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509.. 7 On November 6, 2001 , I served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. . 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such .14 envelope to be.delivered to the offices of the addressee. . 15 () (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and.a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors. 21 651 Pine Street, Martinez, CA 94553 22 Executed on November 6, 2001 at Antioch, California. 0 C. RUTHIE RILEY E ANS 23 24 25 26 RECYCLED PAPER CLAIM " BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY 4 BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown N9Z22VIII) CLAIMANT: Irene Wright N 0 V U 8 2001 Fredric �,�JLGs COUNTY COUNSEL ATTORNEY: Thaws-Iv�tliin DATE �'�F'November 7, 2001 3 '7193 f�Gii/rD4G( •��� ADDRESS: 3495-1 ne:F Sx..D- BY DELIVERY TO CLERK ON: November 7, 2001 ell, CA -9 ' -� d—6a `?`/5&-5 BY MAIL POSTMARKED:_November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETE k .. Dated: November 7, 2001 By: Deputy / ✓: II. FROM: County Counsel TO: Clerk of the Board of Supervisors ` ( ) This claim complies substantially with Sections 910 and 910.2. ( his 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( 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: �Q,'"V" ) - Q�/�y,� JOHN SWEETEN, CLERK, By (� UU Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: ftA11AW y 01JOHN SWEETEN, CLERK ByDeputy 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. SILVANO.B.MARCHESI DEPUTIES: S,� L PHILLIP S.ALTHOFF COUNTY COUNSEL JANICE L.AMENTA - OF NORAG.BARLOW B.REBECCA BYRNES SHARON L. ANDERSON • ;_� `� '1 \ ANDREA W.CASSIDY ASSISTANT COUNTY COUNSEL �a. MONIKA L.COOPER COWkA COSTq--CO.R"N Y r \...�1 VICKIE L.DAWES GREGORY C.HARVEY OFFICE QF-THE-COON 'CO IUNSEL MARKES.ESTIS ASSISTANT COUNTY COUNSEL .} LILLIANT.FUJII II(:COCJN ADMINISTRAT)rdN�BUILDING�►, JANET L.HOLMES DENNIS C.GRAVES 65y INE STREET��9th F��ORJ) KEVIN L.KERR HOL �� rte• �1�4* . BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MAR Tt.E_Z,-CALI FOR A X455.3-1229 EDWARD V.LANE.JR. -__-1 V� BEATRICE LIU GAYLE MUGGLI MARY ANN MASON OFFICE MANAGER PAUL R.MUNIZ VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF I1 SL7FFICIENCY STEVEN P.RETTIG DAVID F.SCHMIDTHIv11DT FAX (925) 646-1078 AND�OR DIANAJ.SILVER JACQUELINE Y.WOODS PAMELA J.ZAID NON-ACCEPTANCE OF CLAIM TO: Fredrick Webster 3743 Railroad Avenue Pittsburg, California 94565 RE: CLAIM OF: Irene Wright 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: [ ] I. 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. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether-jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page 1 SILVANO B. MARCHESI COUNTY COUNSEL B y: -- Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664) I declare that my business address is the County Counsel's Office.of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,scaled and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: November f ,2001,at Martinez,California. / V cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§§910,910.2.920.4,910.8) Page 2 1 Irene Wright RECEIVED 2 2840 Honeysuckle Circle 3 Antioch, CA 94509 NOV 7 2001 CLERK BOARD OF SUPERVISORS 4 CONTRA COSTA CO. 5 Attorney for Claimant 6 CLAIM OF IRENE WRIGHT, Claimant, CLAIM FOR PERSONAL INJURIES 7 AND WRONGFUL DEATH DAMAGFS (Government Code Section 910) 8 against 9 COUNTY OF CONTRA COSTA 10 Respondent. 11 12 You are hereby notified that IRENE WRIGHT., hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages 13 from the County of Contra Costa, in the amount computed as of the date of presentation of this claim as follows: .14 15 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 16 in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the 17 intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which could not be determined by Gilbert Gomez Sr., but which were known or could have been 18 known by the County of Contra Costa, had the County of Contra Costa exercised 19 reasonable care and diligence in the construction and maintenance of the roadway. The dangerous.conditions included but are not limited to lack of adequate sight distance 20 approaching the intersection and the presence of visibility obstructions along side the roadways. The Respondent, County of Contra Costa also negligently constructed and 21 maintained the roadway such as to create and allow the hazards to exist and be 22 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 23 As a direct and proximate result of the dangerous conditions and actions or failure 24 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the 25 vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 26 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of the public employees causing claimant's damages are unknown. RECYCLED PAPER 1 At all times herein mentioned, claimant IRENE WRIGHT was the mother of 2 DECEDENT GILBERT GOMEZ SR. 3 The damages sustained by claimant, IRENE WRIGHT, as far as known, as of the date of presentation of this claim are wrongful death damages for the death of her son 4 GILBERT GOMEZ SR. 5 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 6 of the State of California. 7 All further notices or other.communications with regard to this claim should be sent to Fredrick Webster, 3743 Railroad Avenue, Pittsburg CA 94565 telephone (925) 439- 8 9181. 9 10 Dated:November 5, 2001 I NE WRIGHT- laimant "J . 11 Fredrick Webster,Attorney 12 ; 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 RECYCLED PAPER 1 CERTIFICATE OF SERVICE 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 1 am a citizen of the United States, over the age of 18 years, and not a party to, or 5 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509. 7 On November 6, 2001 , I served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 14 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 1 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors 21 651 Pine Street, Martinez, CA 94553 22 Executed on November 6, 2001 at Antioch, California. ' RUTHIE RILEY EOVANS 23 24 25 26 NECYCLED . PAPER CLAIM = BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 andRM ease note all "Warnings". AMOUNT: Unknown NOV U 6 2001 EL CLAIMANT: Brandee Gomez CMARTINUCAUR ATTORNEY: Thomas McLaughlin - DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE Dated: November 7, 2001 By: Deputy i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( is 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: �� .. 2 Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). . IV. BOARD ORDER: By unanimous vote of the Supervisors present: 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: '4 q JOHN SWEETEN, CLERK, By ��, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: JOHN SWEETEN, CLERK By i "'- Deputy Clerk w r , 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. SILVANO B.MARCHESI DEPUTIES: PHILL• COUNTY COUNSEL S� L JANIC ALTHOFF ANICEL.AMENTA NORAG.BARLOW SHARON L. ANDERSON -= _ ` ^ B.REBECCA BYRNES °•% 'r � ANDREAW.CASSIDY ASSISTANT COUNTY COUNSEL , -� CONTRA C.OSTA:_:C-O_UNTY MONIKAL.COOPER •I '`t;.r.°�\� .1� VICKIE L.DAWES GREGORY C.HARVEY k MARKES.ESTIS OFFICE OF THE-COUNT Y�COUNSEL ASSISTANT COUNTY COUNSEL -. -- "_-' LILLIANT.FUJII C COU.'. �,P 1,3AA'W6N'BUILDINGI�� JANET L.HOLMES II.� k + DENNIS C.GRAVES 651'PINE STRE�T��9th;EO,OR KEVIN T.KERR tL=� `` ,'11��^*e-" BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MARTI EZ":CALIF :14553 1229 EDWARD V.LANE,JR. BEATRICE LIU GAYLE MUGGLI �•, y'(4` MARY ANN MASON OFFICE MANAGER PAUL R.MUNIZ SrA CnjJ?Z�� VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF INS-FFICIENCY STEVEN P. RETTIG DAVID F.SCHMIDTHMIDT FAX (925) 646-1078 AND/OR DIANA J.SILVER JACOUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELA J.ZAID TO: Thomas G. McLaughlin 3105 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Brandee Gomez 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: [ ] I. The claim fails to state the name and post office address of the claimant. [ ] 2. The claire fails to state the post office address to which the person presenting the claim desires notices to be sent. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [.] 7. Other: Page 1 ' 1 SILVANO B. MARCHESI COUNTY COUNSEL Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013x,2015.5;Evidence Code §§641,664) I declare that my business address is the.County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage folly 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: November_q,2001,at Martinez,California. LZtZC�GQ��- cc: Clerk of the Board of Supervisors(original) Risk Management (NOT ICI:OI;INSUITICIENCY OF CLAIM:GOVT.CODE§y 910,910.2.920.1,910.8) Page 2 THOMAS G. McLAUGHLIN,ESQ., CSB#: 719 1 LAW OFFICES OF THOMAS G. McLAUGHL 2 3105 LONE TREE WAY, SUITE D Noll ANTIOCH, CA 94509 ° 7 3 (925) 754-9900 �FRc80 Ao°Fs 2��� Rq COST pFR�/S 4 Attorney for Claimant °Rs 5 CLAIM OF BRANDEE GOMEZ 6 Claimant, CLAIM FOR PERSONAL INJURIES AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that BRANDEE GOMEZ, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle; Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: .14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 15 in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella 16 Gomez, Brandee Gomez, Gilbert Gomez Jn, and Diana Douglas. The roadways at the intersection of Highway'4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa exercised 18 reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight distance 19 approaching the intersection and the presence of visibility obstructions along side the 20 roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to 26 Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of the public employees causing claimant's damages are unknown. 1 At all times herein mentioned, claimant BRANDEE GOMEZ was the minor 2 daughter of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 3 The damages sustained by claimant, BRANDEE GOMEZ, as far as known, as of the date of presentation of this claim are personal injuries, wage loss, special damages, 4 general damages and emotional distress damages as a result of witnessing injuries to other relatives by BRANDEE, and wrongful death damages for the death of her parents 5 GILBERT GOMEZ SR and DANIELLE GOMEZ. 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 7 of the State of California. 8 All further notices or other communications with regard to this claim should be sent to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D. ANTIOCH, 9 CALIFORNIA 94509 telephone(925) 754-9900. 10 11 Dated: November 5, 2001 . iGG "IA THOMAS G. McLAUGH 1N . 12 Attorney for Brandee Gomez . 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 RECYCLED PAPER 1 CERTIFICATE OF SERVICE 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 I am a citizen of the United States, over the age of 18 years, and not a party to, or 5 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509. 7 On November 6, 2001 , I served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such 14 envelope to be delivered to the offices of the addressee. 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors 21 651 Pine Street, Martinez, CA 94553 n 22 Executed on November 6, 2001 at Antioch, California. RUTHIE RILEY E ANS 23 24 25 26 RECYCUD PAPER _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and POCT-WWManote all "Warnings". AMOUNT: Unknown Nov d 8 2001 CLAIMANT: Marcella Gomez COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET .01`e Dated: November 7, 2001 By: Deputy i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( } This claim complies substantially with Sections 910 and 910.2. ( his 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: �J 1 Dated: By: X14,, ���_. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER:. By unanimous vote of the Supervisors present: ( 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 O MM A y. U� JOHN SWEETEN, CLERK, By f� i�`t ( I Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: L1 1 JOHN SWEETEN, CLERK By t� 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. SILVANC B.MARCHESI DEPUTIES: (BOUNTY COUNSEL 5E j PHILLIP S.ALTHOFF JANICE L.AMENTA NORAG.BARLOW SHARON L. ANDERSON , ,_./ r_ ;,• B.REBECCA BYRNES ANDREAW.CASSIDY ASSISTANT COUNTY COUNSEL CONTRA COSTA'C:OUIVTY MONIEL.DAWCOOPER OFFIC -O�F-THE_C.OUNM'Y 000NSEL MAR EL DAWES GREGORY C.HARVEY _ �- . t�• MARKES.EST IS ASSISTANT COUNTY COUNSEL I —. "� = ��! LILLIANT.FUJII I't^COMfSTY'AD_MINISTRATION•BU I�DtNC��.a �•,'+ JANET L.HOLMES DENNIS C.GRAVES 651, Wt�J�STRE�I� LQOR KEVINT.KERR `'� LI .�P 9M5:- / BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MAfTIIaIEZ,-CALIFOR.1A;94553=1 Z29 EDWARD V.LANE,JR. BEATRICE LIU GAYLE MUGGLI + MARY ANN MASON OFFICE MANAGER �,y PAUL R.MUNIZ CotJlr VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF 1NSL7FFICIENCY STEVEN P.RETTIG DAVID F.SCHMIDT FAX (925) 646-1078 AND�OR DIANAJ.SILVER JACQUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELAJ ZAID TO: Thomas G. McLaughlin 31.05 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Marcella Gomez 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: [ ] L 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. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page I. r SILVANO B. MARCHESI COUNTY COUNSEL By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence.Code§§ 641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. 1 certify under penalty of perjury that the foregoing is true and correct. Dated: November l 2001,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUFFICIENCY OF CLAIM:GOVT.CODE§y 910,910.2.92-0.4,910.8) Page 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown CLAIMANT: Marcella Gomez ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE er l Dated: November 7, 2001 By: Deputy . '��IN I II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: . Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: JOHN SWEETEN, CLERK By 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. i - 1 THOMAS G. McLAUGHLIN,ESQ., CSB#: 71904 LAW OFFICES OF THOMAS G. MCLAUGHLIN ?���®� 2 3105 LONE TREE WAY, SUITE D ANTIOCH, CA 94509 NOv �® 3 (925) 754-9900 cC�RKeO 7,200, 4 Attorney for Claimant o0NrAq oSq cR��so 5 CLAIM OF MARCELLA GOMEZ 6 Claimant, CLAIM FOR PERSHNAI, INJURIES AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) 8 against 9 COUNTY OF CONTRA COSTA, Respondent. 10 11 You are hereby notified that MARCELLA GOMEZ, hereinafter described as 12 claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: .14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 15 in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella 16 Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa exercised 18 reasonable care and diligence in the construction and maintenance of the roadway. The 19 dangerous conditions included but are not limited to lack of adequate sight distance approaching the intersection and the presence of visibility obstructions along side the 20 roadways: The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk.of 22 injury or harm to people using the roadways. 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing iniuries and damages to 26 Gilbert Gomez Jr., Diana Douglas,Marcella Gomez and Brandee Gomez. The names of the public employees causing claimant's damages are unknown. RECYO-W 1 At all times herein mentioned, claimant MARCELLA GOMEZ was the minor 2 daughter of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 3 The damages sustained by claimant, MARCELLA GOMEZ, as far as known, as of the date of presentation of this claim are personal injuries, wage loss, special damages, 4 general damages and emotional distress damages as a result of witnessing injuries to other relatives by MARCELLA GOMEZ, and wrongful death damages for the death of her 5 parents GILBERT GOMEZ SR and DANIELLE GOMEZ. 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 7 of the State of California. 8 All further notices or other communications with regard to this claim should be sent 9 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone (925) 754-9900. 10 11 Dated: November 5, 2001 THOMAS G. McLAUGHLEN t 2 Attorney for Marcella Gomez 13 14 15 . 16 17 18 19 20 21 22 23 24 25 26 RECYCLED PAPER 1 CERTIFICATE OF SERVICE 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 1 am a citizen of the United States, over the age of 18 years, and not a party to,or interested in the within entitled action. I atn an employee of the Law Offices of THOMAS G. 5 McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509. 7 On November 6, 2001 , I served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X ) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such . 14 envelope to be.delivered to the offices of the addressee. 15 () (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 () (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and.a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors 21 651 Pine Street, Martinez, CA 94553 22 Executed on November 6, 2001 at Antioch, California. dc„� RUTHIE RILEY JAIANS 23 24 25 26 AECYCLEU PAPER CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown RMC111MMM) CLAIMANT: Diana Douglas N O V 0 8 2001 COUNTY 7COUNSEL L ATTORNEY: Thomas McLaughlin DATE RECEIVEovember 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET, e Dated: November 7, 2001 By: Deputy ,, II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( �lfhis 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 III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( 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: JOHN SWEETEN, CLERK, By iLJGI VW � Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: U� JOHN SWEETEN, CLERK By l 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. SIIjAN0 0.MARCHESI DEPUTIES: PHILLICOUNTY COUNSEL S __L, JANICP .AME OFF -- JANICE L.AMENTA i NORA G.BARLOW B. ES SHARON L. ANDERSON ANDRE W CAS DY •%l+'� —'-�� ANDREA W.CASSIDY ASSISTANT COUNTY COUNSELti. MONIKA L.COOPER CONTRA C..OSTA:2-OUNTY 1r /, A; —25- 5� .\ VICKIEL.DAWES GREGORY C.HARVEY e• MARKES.ESTIS OFFICE'QF-THE--C:O��U_ 000NSEL ASSISTANT COUNTY COUNSEL et I LILLIAN7.FUJII II^CO.U�1,yADMINISTRATION:BUILD.I.K,i��II JANET L.HOLMES DENNIS C.GRAVES 6S1,vFINESTREEMI�4ih:&t4 41/ KEVIN T.KERR ->-' '` BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MA T11.. CACIFO' rA34553=1229 EDWARD V.LANE,JR. ` _ •V~ BEATRICE LIU GAYLEMUGGLI - �'V�` MARYANNMASON OFFICE MANAGER PAUL R.MUNIZ VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF-1 RS�IIFFICIENCY STEVEN P. RETTIG DAVID F.SCHMIDTHMIDT FAX (925) 646-1078 AND/OR DIANAJ.SILVER JACQUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELAJ.ZAID TO: Thomas G. McLaughlin 3105 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Diana Douglas 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: [ ] I. 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. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page 1 s SILVANO B. MARCIIESI COUNTY COUNSEL By: �28��. Deputy County Counsel .01 CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code §§ 641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: November�,2001,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE 0I7 INSUFFICIENCY OF CLAIM:GOVT.CODE;§§910.910.2.9204,910.8) Page 2 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements,. ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown CLAIMANT: Diana Douglas ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET �v Dated: November 7, 2001 By: Deputy ISI II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel 'III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: JOHN SWEETEN, CLERK By 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. THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 1 LAW OFFICES OF THOMAS G. MCLAUGHLIN TRECEIVED 2 3105 LONE TREE WAY, SUITE D ANTIOCH, CA 94509 N O V 7 2001 3 (925) 754-9900 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 4 Attorney for Claimant 5 CLAIM OF DIANA DOUGLAS 6 Claimant, CLAIM FOR PERSONAL INSURIFS AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that DIANA DOUGLAS, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages 12 from the County of Contra Costa, in the amount computed as of the date of presentation of 13 this claim as follows: .14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 15 . in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez,Marcella 16 Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa exercised 18 reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight distance 19 approaching the intersection and the presence of visibility obstructions along side the 20 roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 he public employees causing claimant's damages are unknown. 1 At all times herein mentioned, claimant DIANA DOUGLAS was the mother of 2 decedent DANIELLE GOMEZ. 3 The damages sustained by claimant, DIANA DOUGLAS, as far as known, as of the date of presentation of this claim are personal injuries, wage loss, special damages, general 4 damages, and emotional distress damages as a result of witnessing injuries to other relatives by DIANA DOUGLAS, and wrongful death damages for the death of her daughter 5 DANIELLE GOMEZ. 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 7 of the State of California. 8 All further notices or other communications with regard to this claim should be sent 9 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone (925) 754-9900. 10 11 Dated: November 5, 2001 THOMAS G. McLAUG IN � 12 Attorney for Diana Douglas 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 RECYCLED PAPEA 1 CERTIFICATE OF SERVICE 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 I am a citizen of the United States, over the age of 18 years, and not a party to, or interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. 5 McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509. 7 On November 6, 2001 , 1 served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X ) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 () (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such . 14 envelope to be delivered to the offices of the addressee. 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors 21 651 Pine Street, Martinez, CA 94553 22 Executed on November 6, 2001 at Antioch, California. RUTHIE RILEY E ANS 23 24 25 26 RECYCLED PAPER CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown Nov 0 8 2001 CLAIMANT: Ray Wayne Douglas COUNTY COUNSEL MARTINEZCALIF: ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. � JOHN SWEF�I' N'1 Dated: November 7, 2001 By: Deputy I1. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (�Zis 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: 1 Dated: �'•�'D By: �� (1Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (X) 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: , _N/y111 y)/1 y,b1. JOHN SWEETEN, CLERK, By r�) , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: o( JOHN SWEETEN, CLERK By 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. SILVANO B.MARCHESI DEPUTIES: COUNTY COUNSEL l� SE �_I U PHILLIP S.ALTHOFF• L.AMENIA NORA ,St.'��.:: _ �•; NORAG.BARLOW SHARON L. ANDERSON _ - B.REBECCA BYRNES r��, _ __�� ANDREAW.CASSIDY AA ASSISTANT COUNTY COUNSEL CONTRA COSTA:COl1'N1 Y MONIKAL COOPER !/ U� s :�+a,•• : .1 VICKIE L.DAWES GREGORY C.HARVEY OFFICE OF-1.1 FIE,CO.UNTI(� I.OUIVSEL MARKES.ESTIS ASSISTANT COUNTY COUNSEL I I LILLIAN T.FUJII A_�C ..,,'DMINISTRATION43U1�J„G•rIl JANET L.HOLMES DENNIS C.GRAVES 65*I?-INESTREET� F BOOR KEVIN T.KERR '-• �...�` "+�[+",.' ',''^.�'�� BERNARD L.KNAPP RTS SENIOR FINANCIAL COUNSEL MAFEZ, CALIF R .A 94,55�3'12Z9 EDWARD V.LANE.JR. BEATRICE LIU GAYLE MUGGLI MARY ANN MASON PAUL R.MUIJIZ OFFICE MANAGER `\ / C �.)�`�_ %' SQA ('njJl`t VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF r1VSTJFFICIENCY STEVEN RETTIG CHMIDT FAX 925 646-1078 DIANADAVID F.SILVER ( ) AND/OR JACQUELINE R JACQUELINE Y.WOODS NON-ACCEPTANCE OF CLAIM PAMELA ZAID TO: Thomas G. McLaughlin 3105 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Ray Wayne Douglas 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: [ ] I. 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. [XX] 3. The claim fails to state the date, place or other-circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public employee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page 1 SILVANO B. MARCHESI COUNTY COUNSEL By: Deputy County County Counsel CERTIFICATE OF SERVICE BY MAIL f (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553; I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true.and correct. Dated: November�,2001,at Martinez,California. cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUITICIE•NCY OF CLAIM:GOVT.CODE§§910.910.2,920.4.910.8) Page 2 CLAIM • BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown CLAIMANT: Ray Wayne Douglas ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE e k Dated: November 7, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: JOHN SWEETEN, CLERK By 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. RECEIVED THOMAS G. McLAUGHLIN,ESQ.,CSB#: 71904 NOV 1 LAW OFFICES OF THOMAS G. McLAUGHLIN 7 2001 2 3105 LONE TREE WAY, SUITE D CLERK BOARD OF SUPERVISORS ANTIOCH, CA 94509 CONTRA COSTA CO. 3 (925) 754-9900 4 Attorney for Claimant 5 CLAIM OF RAY WAYNE DOUGLAS 6 Claimant, CLAIM FOR PERSONAL INJURIES AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that RAY WAYNE DOUGLAS, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: 14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 15 in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the 16 intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa exercised 18 reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight distance 19 approaching the intersection and the presence of visibility obstructions along side the 20 roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 he public employees causing claimant's damages are unknown. 1 At all times herein mentioned, claimant RAY WAYNE DOUGLAS was the 2 husband of DIANA DOUGLAS and the father of decedent DANIELLE GOMEZ. 3 The damages sustained by claimant, RAY WAYNE DOUGLAS, as far as known, as of the date of presentation of this claim are loss of consortium and special damages as to 4 injuries sustained by DIANA DOUGLAS, and wrongful death damages for the death of his 5 daughter DANIELLE GOMEZ. 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court of the State of California. 7 All further notices or other communications with regard to this claim should be sent 8 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, 9 CALIFORNIA 94509 telephone(925) 754-9900. 10 Dated: November 5, 2001 11 TnOMAS G. McLAUGH 12 Attorney for Ray Wayne Douglas 13 .14 15 ' 16 17 18 19 20 21 22 23 24 25 26 NEcrcLO PAPER 1 CERTIFICATE OF SERVICE 2 1, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 I am a citizen of the United States, over the age of 18 years, and not a party to, or 5 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509, 7 On November 6, 2001 , I served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES 9 (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 12 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev.. 5/1/88. 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such 14 envelope to be delivered to the offices of the addressee. 15 ( ) .(By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors. 21 651 Pine Street;Martinez, CA 94553 22 Executed on November 6, 200.1 at Antioch, California. & C L &4LI--�) RUTHIE RILEY E ANS 23 24 25 26 RECYCLED PAPER CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown assmaWTIM) CLAIMANT: Joseph F. Garcia N Q V 0 8 2001 COUNTY COUNSEL MARTIN Z CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 7, 2001 ADDRESS: 3105 Lone Tree Way St D BY DELIVERY TO CLERK ON: November 7, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 6, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEECT / � Dated: November 7 YDeputy 2001 B : � � . II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) This claim complies substantially with Sections 910 and 910.2. (This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return 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: Z By: ✓?7q-a �,� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: II certify that this is a true and correct copy of the Board's Order entered �iln' its minutes for this date. Dated: JOHN SWEETEN, CLERK, By,/� V�Tf�( , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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 C�1/IM�u/I ,6 JOHN SWEETEN, CLERK By �� � 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. SILVANDEPUTIES:O B.MARCHESI PHILLIP S.ALTHOFF S E_1L COUNTY COUNSEL �,` _ , O JANICE L.AMENTA • ,`tjy(�,. ,_•\� NORAG.BARLOW B. ES SHARON L.ANDERSON /-a= - _:_:.. ANDRE WCASCA DY �.,.=r 1 �...._\, ANDREA W.CASSIDY • ASSISTANT COUNTY COUNSEL G' NIRA COSTi4:_�OU �I Y MONIKAL.COOPER OFFICE(11C T1-1=_ -_C.OUN : COUNSEL MARVICKIE S.ESTI S GREGORY C.HARVEY1 MLLIANT ESTIS ASSISTANT COUNTY COUNSEL II I-1" f _ LILLIAN T.FUJI I t^COUNT.I''ADMINISTRATI(jN�BUIL�DING�� JANET L.HOLMES DENNIS C.GRAVES 61�.-I AE STRE•E.T��9th"FLQOR J KEVINT.KERR �� • " .A,-*11 .--IIS"''�'-.• BERNARD L.KNAPP SENIOR FINANCIAL COUNSEL MARTfNE7 CALIFO.RNIA, 45 1229 x-�y ,� EDWARD V.LANE.JR. W.'. v BEATRICE LIU GAYLE MUGGLI l- �.. MARY ANN MASON To U _� ;'%'' PAUL R.MUNIZ OFFICE MANAGER 5�. 7(3i 1`�t`t VALERIE J.RANCHE PHONE (925) 335-1800 NOTICE OF T1 SLUFFICIENCY STEVEN P. D DAVID F.SCHMIDT HMIDT FAX (925) 646-1078D ANI]/OR JACOUELIINEY.WOODS NON-ACCEPTANCE OF CLAIM PAMELA J.ZAID TO: Thomas G. McLaughlin 3105 Lone Tree Way, Suite D Antioch, California 94509 RE: CLAIM OF: Joseph F. Garcia 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: [ ] I. The claim fails to state the name and post office address of the claimant. The claim fails to state the post office address to which the person presenting the claim desires notices to be sent. [XX] 3. The claim fails to state the date, place or other circumstances of the occurrence or transaction which gave rise to the claim asserted. [ ] 4. The claim fails to state the name(s) of the public ernployee(s) causing the injury, damage, or loss, if known. [ ] 5. The claim fails to state whether the amount claimed exceeds ten thousand dollars ($10,000). If the claim totals less than ten thousand dollars ($10,000), the claim fails to state the amount claimed as of the date of- presentation, the estimated amount of any prospective injury, damage or loss so far as known, or the basis of computation of the amount claimed. If the amount claimed exceeds ten thousand dollars ($10,000), the claim fails to state whether jurisdiction over the claim would rest in municipal or superior court. [ ] 6. The claim is not signed by the claimant or by some person on his or her behalf. [ ] 7. Other: Page I SILVANO B. MARCHESI COUNTY COUNSEL By: Deputy County Counsel CERTIFICATE OF SERVICE BY MAIL (C.C.P. §§ 1012, 1013a,2015.5;Evidence Code§§ 641,664) I declare that my business address is the County Counsel's Office of Contra Costa County,651 Pine Street,Martinez,California 94553;I am a citizen of the United States,over 18 years of age,employed in Contra Costa County,and not a party to this action. I served a true copy of this Notice of Insufficiency and/or Non-acceptance of Claim by placing it in an envelope addressed as shown above,sealed and postage fully prepaid thereon,and thereafter was,deposited this day in the U.S.Mail at Martinez,California. I certify under penalty of perjury that the foregoing is true and correct. Dated: November—�,2001,at Martinez,California. j cc: Clerk of the Board of Supervisors(original) Risk Management (NOTICE OF INSUIIICIENCY OI;CLAIM:GOVT.CODr:§§910.9103,920.4.910.8) Page 2 THOMAS G. McLAUGHLIN,ESQ., CSB#: 71904 1 LAW OFFICES OF THOMAS G. McLAUGHLIN REC����® 2 3105 LONE TREE WAY, SUITE D ANTIOCH, CA 94509 3 (925) 754-9900 NOV 7 2001 CLER CONTRAOARD OCOSTA CoVISORS 4 Attorney for Claimant 5 CLAIM OF JOSEPH F. GARCIA 6 Claimant, CLAIM FOR PERSONAL INJURIES AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 9 COUNTY OF CONTRA COSTA, Respondent., 10 11 You are hereby notified that JOSEPH F. GARCIA, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: .14 On or about said date, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek Road. Also 15 in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella 16 Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition which 17 could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa exercised 18 reasonable care and diligence in the construction and maintenance of the roadway. The 19 dangerous conditions included but are not limited to lack of adequate sight distance approaching the intersection and the presence of visibility obstructions along side the 20 roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of 22 injury or harm to people using the roadways. 23 As a direct and proximate result of the dangerous conditions and actions or failure to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries, and damages to 26 Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of the public employees causing claimant's damages are unknown. At all times herein mentioned, claimant JOSEPH F. GARCIA was the father of 1 DECEDENT GILBERT GOMEZ SR. 2 The damages sustained by claimant, JOSEPH F. GARCIA, as far as known, as of 3 the date of presentation of this claim are wrongful death damages for the death of his son GILBERT GOMEZ SR. 4 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 5 of the State of California. 6 All further notices.or other communications with regard to this claim should be sent 7 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA.94509 telephone.(925) 754-9900. 8 9 Dated:November 5, 2001 10 THOMAS G. McLAUGH Attorney for Joseph F. Garcia 11 12 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 1 CERTIFICATE OF SERVICE 2 1, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 3 true and correct. 4 I am a citizen of the United States, over the age of 18 years, and not a party to, or 5 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 6 94509. 7 On November 6, 2001 , 1 served the within: 8 CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH DAMAGES g (GOVERNMENT CODE SECTION 910) 10 on all interested parties in said cause, by delivering a true copy as follows: 11 X B Mail I laced a true co thereof enclosed.in a sealed envelope with postage thereon ( ) ( Y ) P PY P P g 12 fully prepaid. .I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California. 1013a(3) Rev. 5/1/88. : 13 14 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 16 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 17 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 18 following number(s) and a hard copy to follow by mail. 19 Each envelope (if applicable) was addressed as follows: 20 County of Contra Costa- Board of Supervisors 21 651 Pine Street, Martinez, CA 94553 22 Executed on November 6, 2001 at Antioch, California. RUTHIE RILEY E ANS 23 24 25 26 RECYCLED PAPER CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and IRM9111117MR Please note all "Warnings". AMOUNT: $1319.13 N 0 V 15 2001 CLAIMANT: Gwen Willows. COUNTY MARTINEZ CALIFMARTINEZ . ATTORNEY: None DATE RECEIVED:, November 13, 2001 ADDRESS: 3857 Valley Ln BY DELIVERY TO CLERK ON: November 13, 2001 El Sobrante, CA 94803 BY MAIL POSTMARKED: November 9, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE C _ Dated: November 13, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: Co /Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (� This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Datedlu 0 Q;vvl UA L)I JOHN SWEETEN, CLERK B l T Y Deputy Clerk T, Vr l_1ice., WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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: l JOHN SWEETEN, CLERK By ' 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property ore owing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988: must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. ( Govt. Code §911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street. Martinez. CA 945-53. 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. SCC:pcn:it;1.Gi frauduient claims. rcnai CGUI^. S _ 2 at the end of this fc=.. - RE: Claim by ) Reserved for Clerk's Filing Stamp GWEN L. WILLOWS ) ) RECEIVED Auainst the County of Contra Costa NOV 13 2001 or ICLERK BOARD OF SUPERVISORS CONTRA COSTA CO. District) .,(Fill in Name) The undersigned claimant hereby"mak es claim against the County of Contra Costa or the above named District in the sum of$/V 9.i3 and in support of this claim represents as follows: 1. When lid the damage or injury occur? Give exact Date and Hour 1 8:45 ptn,; Friday, August 24, 2001 ---------- ----------------------------------- --------------------------- ------------- 2. Where did the damage or injury occur? (Include Cin•and County 1 On the street '(pavement) near. 3823 Valley Ln. , El Sobrante, Contra Costa Cty. ---- ---------------------- --------------------------------------------- ---------------- 3. How did the damage or injure- occur? (Give full details:use extra paper if required I slipped on the.-loose gravel.at the edge of the road and fell forward onto my face. I- was forced to leave the sidewalk because cars parked on the •sidewalk/road prevented my continuing on the sidewalk. -------------- ----------------------------------------------------------------------- 4. What particular act or omission on the part of county or district officers, sen•ants, or employees caused the injury or damage? Failure. to sweep up/clear loose gravel'frcm the roadway closest to the curbless sidewalk after. -the:se- cond..stage 6f' &-.three-stage repaving operation. Time between stages.; two and three approximately one month.'- (Over) onth.' (Over) aug pur luamuosuduix Bans qloq .+q 10 `( 0004o[S ) scollop pursnogl uai l.uipaaoxa loa jo aug r Sq •uosyd alrls aql ui lnamuosudmi .iq 10 •aug pur mamuosudmi Bans gloq .:q 10 •( poo js ) s-mllop pursnogl auo 'Duipaaaza loa jo aug r ::q `ima auo argl aloin loa}o pouad r 1oj lirf hum) aql ui luainuosudmi Sq laqua algrgsiund si tunu.0 10 °iagonoA •lunoaar `lliq •tumlD lualnpnrl;10 asir3 .:uv �auinua:ji amrs aql .:rd 10 mollu. of pazuoginr °1aalgo 10 plroq loulsip 10 .:Ii? l.uunoa .iur oI 10 °laagjo 10 plroq alrls .:ur of maw.:rd 10;10 aour,,,olir 1oj sluasud -pnrl;ap o1 lualui gjim-oq.i& uoslad .uana„ :sapi%wd apo iruad aql jo Z., aoivaS 3JI10N Y � � � � � � lF � Y � Y Y Y � � K � :f Y Y Y Y % f Y � � Y Y X• Y Y Y X Y Y K Y � lF Y )F � X f � Y � � � is � � Y ori auogdalal •o4 auogdalal .£0816 -.VD . agi.iP.zgoS TS . ( ssalppF) auPZ 1�0TTPn LS ( almrutls s•lurmiriJ ) caiuonv JO ssalppv pur aulrh; ;,•jirgaq siq uo uo$lad autos 10 (-:aulouv) =O.L SaDlloN Qti3s lnruiirl: agl.:q pauLis aq lsn nrl: aq L» :sapi:10lc1 :'016 aac apo' -.coq •gsoo aq go asnPoaq ..sa-4pp ono asaLiq uaan4qaq quaut}uzoddP LIP paTTaouPo I OS gTSTn 0T4o-ejdo:zTLD- £T/6 OS$ gTsTn oTgoP.zdoaTLjD 0£/8 1 01VV, Nall 3.LVU :.:lnfui so ivapiaar siql 3o lunoaar ao aprm noe sa.imipuadxa aq3 isx l 6 ---------------------------------------=--------------------------------------------- TT9V6 KJ 'pUPTVO ' '@AV quourpaTd LZ£V O'Q ' .Q'ud 'NI2iUi gHINKQ 2iOJ VddOUIH0 � '.£ZTS-£ZZ/OTS .sT auoLjd .zaLj :agUP.zgOS Tg 'aLM-I I aG TeA OL8£ .sT -Ssa:zppP .zag •spunom [Zw pagPaTpaui puP paueaTo aqs PUP ' (2�TTiag,0 TOxez)) as.znu P sT oLlm '.zogLibzau P oq guano XTogPTpaunuT I •TPgTdsoLl .zo .zogoop P oq Ob qou PTP os 'aDU'E?-nsUT g4TPaLI ou anPLl I •simidsoq pur siolaop sassauu.+n jo sassa-ippr pur satur.Nj g --- ------ - C`6T£"C$=�ypy-- --- ---- ------- - - -01xy- =a;__;buiza ns"'s'uz�a---- 'OOT$ = q?SZn/OS$ a .sgTsTn oM4:-TogoP.zdo [TLD 88'90- _ '-TLI/SL'£Z$ 6 9Z/8 uo s.znoLj S*V SZ'ZTT$- '-TLV-[V.'OZ$' 0 SZ/8 uo .s.znoLl S'S :SabPm gsoi (-aoeiur.p io,ilnfui anuzadsoad.iu jo iunotur pairuiosa arty apniaul) ,palnduioa ignomr pamif:la anogr aql sr.a ..aolg _ - pauloPggP aas) pagPsuadutoo-qou ure I tjoTLIM zoo '9Z/8 puP SZ�8 uo --N-Tom go sanoq uaq .go ssor •£ sgTsTn oTgb-eido:zzLjo OAq. pa.zTnba.z s-cg4 -'TTA Gq4- Jo ao.aoJ -Oq4 u1039 quaWU TTP To.qno uroxgq a Tarn t�L C pure_ Noau 'Sd. LI 'Nzmq .zanbT dui- TP4aTONS, 'Z szabuT puP surjPd dui oq sasTnzq pure s4rio daap :qno PUP apTsuT Lr4oq 'sdTT .zaM0T 3 .zaddn-Aw oq sgno puP suoTgP.zaoPT .a.zanaS T (aDcunrp Dine sol muur!3- obi tpuud' 'paunrp saoeuirp 10 saunfui to ivaixa nnj anig) ;,palliisal miriz noA op sown f ni 10 sauYmrp lrgtA -9 -------------------------------------------------------------------------------------- 'LIMOLIS�LIT1 ;,unfui 10 anrturp aq;nnlsnr'saagoldma 10`SIIIr.LMS 4S1a' WO PUISip 10.iiun00 j0 samru aq;am lrgb 'S Addendum to claim of Gwen L. Willows: Items 6 and 7: Pain and Suffering As of this date (11/7/01), my upper lip is visibly scarred and my lower lip is still swollen and lumpy; it has been over two months since I fell. 1 feel very self- conscious about my appearance. I also have scars on two of my fingers on my right hand. If you need medical corroboration of this, I shall supply it. I am not normally of a litigious nature. However, because the fall was so shocking to me and I shall most likely have permanent scars on my upper lip, i feel I am rightly due at least the recompense I have asked for. Because the company that was repaving the street clearly failed to sweep up the loose gravel along the edge.of the road, I fell through no fault of my own. (The repaving of the street occurred in three stages; stage two, when loose gravel was left all along the side of the road, remained for at least a month before the "slurry seal"(stage three) was applied and the gravel was eliminated.) � Y (Yenillows Central Library • 2090 Kittredge • Berkeley, CA 94704 • 510/644-6095 • FAX 510/845-7598 Alameda County Linda M U7otyd, CottnCy Librarian C� LIBRARY Albany Castro Valley Centerville Dublin ...Infinite po.+.rrcbcictce.y Extension Services Fremont Main Irvington Newark Niles Sari Lorenzo Union City November 1, 2001 To Whom It May Concern: This letter is to verify that Gwen Willows is employed by the Alameda County Library as a Services-As-Needed Librarian. She was scheduled to work four-and-a-half hours at our San Lorenzo Branch on August 26, 2001. On August 25, 2001, Ms. Willows called the supervisor, Vivian Robinson, and stated that she had fallen the day before and would be unable to work her scheduled hours. Sincerely, ' l Kathleen Strother Manager, Payroll/Personnel ks cc: Personnel File Joan Galvez Administration 2450 Stevenson Boulevard Fremont, CA 94538-2326 510-745-1504 FAX 510-793-2987 www.aclibrary.org County Administrator Contra Risk Management Division Costa 2530 Arnold Drive,Suite 140y, Liability Claims (925)335-1440 Martinez,California 94553 County Fax Number (925)335-1420 se c /• = CONSENT TO RELEASE MEDICAL RECORDS N ? ( � S authorize the County of Contra ('ndividual) Costa to disclose to the bearer, who represents Contra Costa (Requester County Risk Management all medical records necessary for the of Information) following purpose: I hereby consent and request that the bearer be permitted to examine and obtain copies of all my medical records. I hereby acknowledge that I have received a copy of this consent for Release of Medical Records. _ Signature of Patient: w - Ali , a- 1111 Address: J �y re Date: These records are being requested with the permission of the attorney of record who is representing the above patient. Attorney of Record: Address: Date: W 1- C 7 O Tl GC]Clo •'�' i.0 j t7"C3POG 'V ._ •d.I:q) E U G D r-. L � LY: i U) dose u. I � •r-I Y� U� �oees Q) �l P'' -`W v H 0 0 ` 4 rO J M l a L11 1 4-I lL F( Q) N a 0 � +} a � 1 4j o � Ct U U w HW W H COD c� c� o • a� $ $ � o 6 U- O ""$co "$ m t Q 0, —�_ o . 0 C3 d � $- ru m O "° 4 Ln $ ---- 1 OD -4 0 o C `} M W f ♦`\ _ / �, �,`' J) •. I. I r /, • r / .. \ 1 \ ' /, 1 ' �\` C • ( \ •� 1 � � I t. I �_ _ ,..��___-_ w.� -.____ T_�- -_ � __.5_. �I i ti / � �, /�i / i \..` .. / , `1 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 21tem.915.4. Please note all "Warnings". AMOUNT: $350,000D N 0 NOV 15 1001 CLAIMANT: Richard Bebout MARTTCOUNry c F L ATTORNEY: Steven Henderson DATE RECEIVED: November 13, 2001 ADDRESS: 3024 Railroad Ave BY DELIVERY TO CLERK ON: November 13, 2001 Pittsburg, CA 94565 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET Dated: November 13, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (Y This claim complies substantially with Sections 910 and 9.10.2. ( ) 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: Alr Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: C y 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: �Q This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in itsminutesfor this date. Dated: JOHN SWEETEN, CLERK, By �11 'VI��`f��' � , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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�Q JOHN SWEETEN, CLERK By ` ; , JU/L�k 415t� 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. 1 STEVEN H. HENDERSON - SB #88620 2 I JILL STERN-HENDERSON - SB #148172 ,3,h P Attorneys - Abogados z;, 3 ! 3024 Railroad Avenue El�)'A Pittsburg, California 94565 (925) 427-1771 ISORS FAX: (925) 427-4282 CO. 5 � � cl ew_vj 6 Attorneys for Claimant 7 $ CLAIM AGAINST PUBLIC ENTITY i I� 9 RICHARD D. BEBOUT, 10 I Claimant, 11 , 11 VS. 12 CONTRA COSTA COUNTY, DR. MITCHELL 13 APPLEGATE, DR. PAULINE VELEZ, and DOES 14 1 through 10, inclusive, i 15 Defendants. 16 II / i Claimant, RICHARD D. BEBOUT, for causes of action against the Defendants, 17 and each of them, claims as follows: 1 STATEMENT OF FACTS 19 II 1. The name and address of Claimant is as follows: 1410 Yosemite Drive, 20 Antioch, California 94509. 21 I li 2. The address to which Claimant desires notice of this Claim to be 22 directed is to the office of his attorney, Steven H. Henderson, at: 3024 Railroad 23 Avenue, Pittsburg, CA 94565. 24 3. Claimant is ignorant of the true names and capacities of defendants 25 sued herein as DOES 1 through 10, inclusive, and therefore sues these defendants 26 by such fictitious names. Claimant will amend this complaint to allege their true 27 names and capacities when ascertained. Claimant is informed and believes, and 28 1 Claim I i I i 2 thereon alleges, that each of the fictitiously named defendants is negligently 3 responsible in some manner for the occurrences herein alleged, that Claimant's 4 injuries as herein alleged were proximately caused by the negligence of these 5 defendants. 6 4. At all times herein mentioned, defendants, DR. MITCHELL 7 APPLEGATE and DR. PAULINE VELEZ and DOES 1 through 10, were operating as 8 I� the agents, servants and/or employees of each of the remaining defendants, and 9 i were at all times herein mentioned, acting within the purpose and scope of said 10 agency, service and/or employment. 11 5. On or about May 14, 2001, at the County Hospital in Martinez, California, defendant DR.'PAULINE VELEZ, negligently, mistakenly and without 12 f 13 appropriate medical cause, performed surgery on Claimant whereby she removed approximately 1/3 of Claimant's lung. Claimant believes that the surgery was 14 li 15 unnecessary and that defendants, and each of them, committed medical malpractice i by performing the surgery on Claimant on May 14, 2001, which proximately caused 16 the damage to him as hereinafter set forth. 17 6. Defendants, DR. MITCHELL APPLEGATE and DR. PAULINE VELEZ, 18 were health care providers while practicing as physicians and surgeons in the County 19 ' of Contra Costa, California. Defendants, and each of them, undertook employment to 20 provide medical and surgical treatment to Claimant and to provide Claimant with 21 22 proper medical care. 7. Defendants, and each of them, lacked the necessary knowledge and 23 li 24 skill to properly care for Claimant's condition, and were negligent and unskillful in diagnosing and treating that condition. The negligent treatment by defendants, and 25 26 each of them, resulted in the unnecessary removal of approximately 1/3 of the lung of i the Claimant. The injuries sustained by Claimant were proximately caused by the 27 28 2 Claim i 2 negligence of the defendants, and further proximately caused the irreparable and 3 permanent damage to Claimant caused by the loss of approximately 1/3 of his lung. 4 8. As a proximate result of the negligence of defendant, and each of them, 5 Claimant has suffered loss of health, emotional distress, and the potential for 6 additional medical treatment, as well as the loss of earnings and earning capacity. 7 9. At the time of the presentation of this Claim, Claimant claims damages 8 in the amount of: 9 A. Special Damages: $100,000.00 for future medical treatment 10 B. General Damages: $250,000.00 11 10. Claimant additionally claims pre-judgment interest, attorney's fees and 12 costs, and such other and further relief, as the court deems proper. 13 14 Dated: November 13, 2001 1 .�. 5 STEVEN H. HENDERSON 16 Attorney for Claimant 17 18 19 20 21 22 23 24 25 26 27 28 3 Claim I .I 1 PROOF OF PERSONAL SERVICE 2 i I am employed in the County of Contra Costa, California. I am over the 3 4 age of eighteen (18) years and not a party to the within cause. My business I 5 address is: 3024 Railroad Avenue, Pittsburg, CA 94565. 6 On the date shown below, a copy of the attached document(s): I 7 CLAIM AGAINST PUBLIC ENTITY was served on the interested parties in this 8 action by placing a true copy thereof in a sealed envelope, addressed as 9 follows: 10 11 ' Clerk of the Board of Supervisors 651 Pine Street 12 Martinez, CA 94553 13 [ X ] (BY PERSONAL SERVICE) By causing each such envelope to be delivered by hand, as addressed, with instructions that it be personally 14 I served. 15 (BY CERTIFIED MAIL) By placing said envelope, with postage thereon fully 16 ' prepaid for first-class mail, for collection and mailing at my place of business II following ordinary business practice. I am readily familiar with the ordinary 17 I business practice for collection and processing of mail. In the ordinary course 18 of business, mail is deposited with the United States Postal Service on the same day as it is placed for collection. 19 I declare under penalty of perjury under the laws of the United States that 20 21 the foregoing is true and correct. 22 Executed November 13, 2001, at Pittsb alifornia. 23 24 STEVEN H. HENDERSON 25 26 ' 27 28 4 Claim CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and MD 4. Please note all "Warnings". AMOUNT: S10,000 N O V 15 2001 COUNTY COUNSEL CLAIMANT: Roderick Coleman MARTINEZ CALIF. ATTORNEY: None DATE RECEIVED: November 13, 2001 ADDRESS: 901 Court St BY DELIVERY TO CLERK ON: November 13, 2001 Martinez, CA 94509 BY MAIL POSTMARKED: November 10, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE 1 i Dated: November 13, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ()(This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated& A 0,YY1 0 `-I, 01 JOHN SWEETEN, CLERK, By e ,�ts��`��, Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: I.k(� AmP �I , nI JOHN SWEETEN CLERK B � y_ �`�� O/�`-' Deputy Clerk S 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. Claim to: BOARD.OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100'h day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clei k of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street, Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By , Reserved for Clerk's filing stamp RECEIVED Against the County of Contra Costa or ) NOV 1 3 2001 °�• _ District) CLERK BOARD OF SUPERVISORS (Flll,in'.name . � ) CONTRA COSTA CO. The undersigned _laimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$ lo- :and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 7 .7 o/f 2. Where did the damage or injury occur?•(Include city and county) 3. How did the damage or injury occur? (Give full details; use extra paper if required) 4. • What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? �f�G • ��� /5rf 11VIA0 5. What are the names of county or district officers, servants, or employees causing the damage or injury? 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage ) /��U/��� `2el�i`I )9 _8.`Names and addresses of witnesses, doctors, and hospitals. / QI`�eGE�� C� G�fievfC/'�Af �/ � i�,, /V/e./O d4l,"Y. "J. List the you expenditures made on account of this accident or injury. P Y J rY. DATE J TE"E AMOUNT IWAN ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) / ('Claimant's Signature) ♦agnms (Address) ' ) Telephone No. /Va Telephone No. � NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill, account, voucher,or writing, is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000), or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(S 10,000),or by both such imprisonment and fine. fail Ilk 00 1;4 "At co "o CC, 4Q:* ,� � , .,' ` r � � \ .__1.�- J '' 1 '{{�. ,:q� �;rv> :.i // i �� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (P ra aph IV below), given Pursuant to Government Cod 915.4. Please note all " a �® AMOUNT: i;AMVVMn-/g 75 00 NO V 2 0 2001 NOV 212001 COUNTY COUNSEL CLERK BOARD �pERVISORS CLAIMANT: Donald Moitoza MARTINEZ CALIF. CONTRA OF FCOSTA SUCO. ATTORNEY: None DATE RECEIVED: November 15, 2001 ADDRESS: 5693 Olinda Rd BY DELIVERY TO CLERK ON: November 15, 2001 El Sobrante, CA 94803-3539 BY MAIL POSTMARKED: November 12, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET - e Dated: November 19, 2001 By: Deputy 11. i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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: X9,)—,0( By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: N ��1�Ql1 �{ �0 JOHN SWEETEN, CLERK, By t�tj7J( f 014&y- , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: k-)�b% l l LILy JOHN SWEETEN, CLERK By , 1077� 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. Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100"' day after the accrual of the cause of action. Claims relating to causes of action. for death or for injury to person or to personal property ore owing 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 ciaims. Pedal Code Sec: 72 at the eud of this form. RE: Claim by. ) Reserved for Clerk's Filing Stamp RECEIVFn _Against th my of-Coni Cost h U or CLERK BOARD C' 7)R3 CONTRA COSTA CC). District) (Fill in Name) The undersigned claimant herebv makes claim against the County of Contra Costa or the above named District in the sum of S and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) - -=----- --- -- -----�5- -- a-a- ----------------------------------------- - - - ,- 2. Where did he damage or injure" occur.' (Include City and Counn'1 - --- ------ - - -- _ �q __ �--- - -------.- 3. How/dill the damage or injury occur? (``ive full dettails: use extra/paper ifrequired 7/hdQ �cY, /Ja Tl 0�7 O j� O Lr/ /JOIE! e O/1 P OT -71GGL(/I?Pd Q �Sa-��7 : 4n .Li C/GC/!nr �, --- ----- 4. What particular act.or-omissioii- on the part of county or district officers, sen-ants, or employees caused the injury or damage? Cl/f�vr�1i f�� Q r.:�9 c�l�s �vs�e b ��� yaa r,:�•,yc orr�-�r��'"� �Sho�C?�"a A% ---- aag par luauiuosudmi Bons gloq :iq -io `( 000`oTS ) sirilop pursnogl ual Luipaaoxa lou;o aug r Sq `uosud ams aq; ui wamuosudmi .iq io `aug pur wamuosudmi gans gloq .�q .io ( oo0`IS ) sJrllop pursnogl auo ouipaaaxa lou•lo aug r .iq .ma'i auo urq; a nom lou;o pouad r ioj prf .iiunoo aqj ui luamuosudm► .iq iaq;ia algrgsiund si `dui;um io 'iaganon iunoam `iliq •wmla lualnpnri; to aslr3 .iuu `aumuaL 1i avers aq; .ird io molly of pazuoq;nr `laoWo io piroq lou;sip io .iiia .ilunoo :iur o1 Jo;.iaag;o to psroq ams :Cur of luaw,�rd iopo a mumoilr loj s;uaswd `pnr xjap ol;ualui q;i,b oq.++ uosud Cl;;Aa,, :sapiio.id apo lruad agl3o ZL uoilaaS 3JI10N ok auogdalal / -ok auogdalal (ssalppv ,'� i v xaluouv 10 ss;)IppF Pur auirk }lrgaq siq uo uossad awos .Cq ao (:iaulouv) :OZ S3JIJOI QAi3S iurwtula aq1-+q pau:,is aq isnui wrrlo aql,, :sapi.ioad Z•016 -oaS 3p0O -e00 L�:1011 c i Nall aiva :.unfui io ivapioar sigI jo lun000r uo aprm nori-salnlipuadxa aq;ist'I 6 --------- ---------------------------------------------------- ----------------------- •simidsoq pur •sioioop`sassauipA}o Sass;)- ppr pur samrk •g - -- ----------------- ------- ---------------------------------------------------------- �/�.�as.✓,3'il/��y V S ����►� ,-L/O../� a�-r�r�/� L s� P a y.��l/.J d o-'�' /J (•a'zurep io.ianfui a,%wadsoid.iue io mnouic paic`w/Rsa atp apnpul 1 palnndtuoo iunomr/pammlfo aTnogr aq; sr.e mog -----------------��-------------- -------------'------------------------- ' ��✓�i��.b r��;� � �ls�c��v�4 P ua�a�-mar-�..��� a✓a/yi s✓ao�����! ✓���o .+d f.��jam'�K�ss�,S (•aoe�ucp oine .10j saleu[psa oeU y3ei7b 'paunep saoeulrp to saunfui jo 3uaixa ly an!D) Lpallnsaa mmla no+ op saunfui io saLrmrp lrgA& -9 ------------------------ �.i.fnfui ro aarmrp aq;nuisnra saa ioldma io`slar:uas`slaaWo;aulsip to AlunOO 3o samru alp alr jrgA s MELLO'S MOBILE NURSERY 4551 Elmwood Rd EL SOBRANTE, CALIF. 94803 Phone 2231093 Customers Order No. Date J Name Address gZA Phone: a —� SOLD BY C C.O.D. CHARGE ON ACCT. MDSE RETD PAID OUT D E S C R I P T 1 r 1 � I i 1 � I I J I I I I I I I I � 1 l I I All claims and returned goods MUST be accompanied by this bill. TAX BY Received TOTAL /7s 6 V ,� �` .,, ,; :�\ r` . � i `�� I .� 1 `.` �.r', `� `. \� `1 .. . � � ... / .. i ...r � .. \ •. 1 t / ..` ... . / \ ... . �. �; �` �. ��, , . �..�r' ,, � � '., �� `� ... , F v �V ;rr A ' .} Y \ w� O f �V T �a i � V G W � \ s C jai t"i S l• w \ / �,\ \' � / /, ,\ ,\ �� ,\ ,•\ '� � \ ` � ,.� i /� ....� ��� ,' .._ ._ /� � .�� �. --- / � ::� � ..._ ...,. ... .� •- ;' �,� •, .... � �, .:._ ,.. ......, ... ,.�// CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is:your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and IMeollgWTMP 15.4. Please note all "Warnings". AMOUNT: Unknown NOV 2 U 2001 COUNSE CLAIMANT: Roek Construction CMARTINEZ CALIF• ATTORNEY: None DATE RECEIVED: November 16, 2001 ADDRESS: P.O. Box 30038 BY DELIVERY TO CLERK ON: November 16, 2001 Stockton, CA 95213 BY MAIL POSTMARKED: November 15, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Dated: November 19, 2001 By: Deputy- 11. U II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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: LO u�' G lc irn iS h ryJG/ fL10 - e_,Ve4) 3 dc.0 v."`11? 0,17 /o/r a-0� ly"I'infPi /5, .2 oOd. A'y C%girrl5 -J-ha 7 �r'�St a;--i /1/ on 7� 0v2in f /5 a CD Q re vn 7�q2¢l Se C 6710 V. Code s-ecfia? 9 , Z Dated: %(- �"�� By: �rn 61�ulz Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: ��I `certify that this is a true and correct copy of the Board's Order entered )iin�its minutes for this date. Dated:,uk 0QAV1�ZV) �I , D JOHN SWEETEN, CLERK, By (M 4 _"eputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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: t/ ( JOHN SWEETEN, CLERK By 8�64t/io,__ 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. Wr1bSTRU!CT1!0!N Via CERTIFIED MAIL WITH RETURN RECEIPT November 15, 2001 Clerk of the Board of Supervisors of Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 RECEIVED And NO 16 2001 Contra Costa County's Agent: CLERKCONRR O pS PEFt ISORS Barton J. Gilbert Director of General Services Contra Costa County General Services Department 1220 Morello Avenue, Suite 100 Martinez, CA 9453-4711 Re: New Office Building at Delta Fair Blvd. For Employment and Human Services Dept Antioch, CA Gentlemen: Roek Construction is making a claim for an increase in the contract price based on various disruptions caused by the owner during the period of time from receipt of notice to proceed to August 17, 2001. It is our understanding that the claim will be governed by the procedures described in Section 34 of the General Conditions. The parties' participation in the procedure as required by Section 34 should satisfy any obligations the parties might otherwise have to meet and confer in good faith prior to making claims. Lastly; it is our understanding that making a claim under Section 34 tolls the time within which a claim must be provided under the Government Code. However; to ensure that we have fully complied with all statutory deadlines for the submission of claims to the County of Contra Costa, we have provided the Clerk of the Board of Supervisors with a copy of the claim. We assume that the Board of Supervisors will not need to take any action on the claim unless the claim or a portion of the claim remains in dispute after the meet and confer process required by Section 34. LICENSE NO. 171084-B www.RoekConstruction.com email@RoekConstruction.com P.O. BOX 30038• STOCKTON, CA 95213 • 2580 TEEPEE DRIVE•STOCKTON, CA 95205 9 (209) 464-8344• FAX(209) 464-8253 Page 2 Thank you for your consideration of our claim. We look forward to an amicable resolution of this matter. Sincerely, Steve Jasper n Project Manager SJ:tlb Enclosure (18) Cc: Steve Jordan Contra Costa County 1220 Morello Avenue, Suite#1.00 Martinez, CA 94553 Kent Craven Artech Design Group 350 N. Wiget Lane, Suite 4210 Walnut Creek, CA 94596 ES RUCTION November 15, 2001 Clerk of the Board of Supervisors Of Contra Costa County 651 Pine Street, Room 106 Martinez, CA 94553 And Contra Costa County's Agent: Barton J. Gilbert Director of General Services Contra Costa County General Services Department 1220 Morello Avenue. Suite 100 Martinez, CA 94553-4711 SUBJECT: NEW OFFICE BUILDING AT DELTA FAIR BLVD. FOR EMPLOYMENT AND HUMAN SERVICES DEPT. 4549 DELTA FAIR BLVD., ANTIOCH RE: REQUEST FOR EQUITABLE ADJUSTMENT TO THE CONTRACT FOR DISRUPTION OF THE WORK Gentlemen.: Roek Construction has incurred increased costs due to disruption of our work nearly from the beginning of the project. Graphic Network Principal—Gerry Eline, identifies the events causing the disruptions in the following narratives: October 2000 Impact dated May 23, 2001 . November 2000 Impact dated May 23, 2001 December 2000 Impact dated May 23, 2001 January 2001 Impact dated May 23, 2001 February 2001 Impact dated May 30, 2001 March 2001 Impact dated June 0.4, 2001 April & May 2001 Impact dated August 10, 2001 Supplemental April & May Impact dated August 10, 2001 June 2001 Impact dated August 17, 2001 LICENSE NO. 171084-B www.RoekConstruction.com email©RoekConstruction.com P.O. BOX 30038•STOCKTON, CA 95213• 2580 TEEPEE DRIVE•STOCKTON,.CA 95205• (209) 464-8344 • FAX(209) 464-8253 Page 2 November 15, 2001 Clerk of the Board of Supervisors, Contra Costa County The specific events described in the narratives that have disrupted our work are as follows: October RFI's 7,8,9,1.6,17,22,23,2 ,34;37 November RFI's 37a,47,47a Delta 1. Structural Steel Modification December BFI's 47b,58,59,62,63,65,66,67,68 Delta 1 Structural Steel Modification January PCO 7/PG&E Related Issues RFPs 20a,31,47,60;62,6 ,69,73,76,79,80,81,82,83 Delta 1 Structural Steel Modifications PG&E Utility Issues February PCO 7/PG&E Related Issues RFI's 73,76,88,92;98 . Delta 1. Structural Steel Modifications March RFI's 101 Delta.1 Structural Steel Modifications April & May RFI's 102, 1.03, 128 PCO 5,6,10,13,19 Color Selection Supplemental April & May RFI 128 ,Tune PCO 10,17,19,21,27 RFI's 117,1.20;120a,122,128,128a Color Selection Issues The net result is increased jobsite overhead and supervising costs in excess of$12 ,000. These disruptions have also resulted in many jobsite inefficiencies due to weather related issues. For example; the concrete footings and slab alone resulted in material and labor overruns in excess of$20,000. This was due to these activities being rescheduled to a very inclement time period, resulting in substantial dewatering/protection/recovery activity costs as well as concrete material overruns from caved in footings. Roek Construction has used trade stacking techniques and logic revisions to the accepted schedule in order to minimize the disruptions affecting the job. Our scheduling costs related to the disruptions have totaled more than $20,000 to date. Page 3 November 15, 2001 Clerk of the Board of Supervisors, Contra Costa County The increased costs claimed by Roek Construction are associated with events only identified through the June 2001 impact narrative and do not include costs for disruptions not so identified. We reserve the right to modify these costs as more complete information becomes available. Any notices or other communications relating to this claim should be sent to Brian Roek at the address below. Sincerely, iian Roek Secretary-Treasurer BR:tlb Enclosures (15) GRAPHIC NEirwORK PLANNERS CONSTRUCTION CONSULTANTS ROEK CONSTRUCTION MAY 23,2001 ATT:STEVE JASPERSON JOB 0941(2co) PO BOX 30038 PG#1 of 1 STOCKTON,CA. ,95213 RE:NEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT FOR 05/23/01 DELAY ANALYSIS. OF"OCTOBER 2000 IMPACTS" ,OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCHEDULE REVISION #2,/UPDATE #1. Gentlemen; Following is . a .brief narrative for. (4 )Time Impact Analysis (TIA' s)Fragnets covering (4 ) sets of Project Schedule impacts/delay-- issues which occurred during the period October 2000. it should be noted that all Project Schedule activities and their corresponding start and finish dates reflect as-built conditions,regardless of whether or not activities have Job progress/status ( % ' s of work complete) assigned to them. The first impact involves Roek RFT#37 :Central Plant concrete elevations(activity#6113 ) .RFI delays Projectcritical path(and finish date)by (-2 )work days.Impacted Project/Contract completion is 10/03/01. Contract activity directly impacted is #8050 .. Second impact involves Roek PCO#2/RFI#34 :Site soil remedi ation(activity#6111)..PCO/RFI delays Project critical path(and finish date)by (-2 )work days.Impacted Project/Contract comphtion is 10/03/01.. Contract activity directly impacted is #25 . Third impact involves InclementAdverse weather delays (activ- ities#6005/6007/6010/6012) .#6005&6007 delays Project cti,tical path(and finish date)by (-8)work days,#6010&6012 d3-ays Project critical path(and finish date�by- (-9)work days.Impacted Project/Contract completion is 10/11/01 and 10/12/01,respectively.Contract activit;es directly impact- ed are,in increasing order of delay(negative float from +18 t6 -9)#5000/ 15/40/30/25. And finally,fourth impact involves Roek RFI )s#7-9&16-17 :misc- ellaneous structural steel (SUbmittal related) issues (activity#6107 ) ,and RFI 's#22-23&25:miscellaneous structural steel(Suthnittal related) issues (activity#6109) ,Individua,lly and combined,each Mt of RFIs ' delays Pro- ject critical path(and finish date)by (-9 )work days.Impacted Project/ Contract completion is 10/12/01..Contract activity directly impacted is #8085. Sincerely, Gerry (JF'.Eline/Principal 45287 Hesperlan Bivd., Suite 7 • Sten Leandro. CA 94578 Tel:(510)276-8413, Fox:(510)276-8414 GRAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS ROEK CONSTRUCTION MAY 23 ,2001 ATT:STEVE JASPERSON JOB 0941 ( 2co) PO BOX 30038 PG#1 of 1 STOCKTON,CA. , 952.13 RE:NEW EHSD.OFFICE .BUfLDING(ANTIOCH)NARRATIVE REPORT FOR 05/23/01 'DELAY ANALYSIS OF" NOVEMBER 2000IMPACTS",OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCH80ULE REVISION 02/UPDATE #1 . Gentlemen; Following is a brief narrative for. ( 4 )Time Impact Analysis (TIA' s)Fragnets covering ( 4 ) sets of Project Schedule impacts/delay issues which occurred during the period NOVEMBER 200-0 it should be noted that all Project Schedule activities and their corresponding start and finishdates reflect - as-built conditions,regardless of whether or not activities have i-oE cess/status(% 's of work complete) assigned to them. The first impact involves Roek RFI#37a_:Central Plant Elev- ations(activity#6151) ,RFI delays Project critical path(and finish date) by (-6)work days.Impacted Project/Contract completion is 10/09/01 . Contract activity directly impacted is #8050. Second impact involves Inclement/Adverse weather delays(act- ivities#6015/6020/6022/6025) ,Inclement weather activities delays,in increasin order of negative float(from:-9 ,--14&-14 to:-16 work days) the Project critical path(and finish date) ,Itnpacted Project/Contract completion is adjusted from 10/12/01,and 10/19/01 to 10/23/01 ,respec- tively.Contract activities directly impacted are, in increasing order of delay(total/negative float from +22 to -16) #5025/5 3 62 ,respec- tively, Third impact involves Roek PCO#3 :Delta 1 structural steel modifications(activity#6157&6159) .PCO delays project critical path(and finish date)b y (-26)work days.1hipacted Project/Contract completion id. 11/06/01 . Contract activity directly impacted is #8085. And finally,fourth impact involves Roek RFI 's#47&47a:Grade beam rebar/Anchor bolt conflict (activities#6162&6173 ) .RFI 's delay Project critical path(and finish date)by (-26)work days. Impacted Proj- ect/Contract completion is 11/06/01.Contract activities directly im- pacted are, in increasing order of delay(total/negative float from -21 to -26 work days) 48085 and 8050,respectively. Sincerely, Gerry .Eline/Principal 15287}lP,Snerinn Blvd.: Sulle 7 • San Leandro,CA 94578 Tel:(510)276.8413, Fax: (510)276.8414 i GRAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS ROEK CONSTRUCTION MAY 23 , 2001. ATT:STEVE JASPERSON JOB 0941 (2co) PO BOX 30038 PG#1 of 2 . STOCKTON,CA. , 95213 RE NEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT FOR 05/23/01 DELAY ANALYSIS• OF°DECEMBER 2000IMPACTS" , OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCHEDULE REVISION #2/UPDATE U. . Gentlemen; )`allowing is a brief narrative for ( 6)Time Impact Analysis (TIA' s )Fragnets covering ( 6) sets of Project Schedule impacts/delay- issues which occurred during the period DECEMBER 2000 .1t should be noted that all Project Schedule activities and their corresponding start and finish dates reflect as-built Conditions,rega.rdless of whether or not activities have J_0E rogress/status(Vs of work complete) assigned to them. The first impact involves Inclement/Adverse weather delays (activities#603-0/6035/6037 ) ,Inclement weather activities delays, in increasing order of negative float(from:-27 to:-28 work days )the Proj- ect critical path(and finish date) ,Impacted Project/Contract complet- ion is adjusted from 11/07/01 to 11/08/01,respectively.Contract activ- ities directly impacted are, in increasing order of delay(total/nega- tive float from:+11 to:-28 work days`) 45 27/5030/40, respectively. Second impact invdves Roek RFI#60 :Structural steel (sub mit- tal related)issue(activi.ties#6226&6213) .RFI activities delay, in in- creasing order of negative tloat(from:-13 to:-31 work days)the Proj- ect critical path(and finish date) ,Impacted Project/Contract completion is adjusted from 10/18/01 to' ll/13/01,respectively.Contract activities directly impacted are,in increasing order of delay(total/negative float from:-13 to;-31 work days)#8095 and 8085 ,respectively. Third impact involves Roek RFI 's#47b/c&62 :Grade beam reb ar/ anchor bolt./steel base plate conflicts(activities#6205/6207/6215 ) .RFI ' activities combined,delay Project critical path(and finish date)by(-31) work days.Impacted Project/Contract completion is 11/13/01.Contract act- ivities directly impacted are, in increasin order of delay(total/nega- tive float from:-28 to:-31 work. days and 8085,respectively.As a subset to third impact,the following list of near/less critical. ( in terms of total/negative float) impact issues,and their respective activities ' involved(directly).are, in increasing order of delay(total/negative float from:+67 to:-25 work days)as o ows:RFI#40a( activity#6209,with +67 days float) ,RFI#68 (activity#6232,with +53 days tloat) ,RFI#66(ac.tivity#6229, with 0 days float) ,RFI#59 (activity#6210,with -2 days float) ,RFI#58 (act- ivity#6203,with -10 days. flotitp',RFI#67(activity#6235,with -14 days flow, PCO#7 (activities#6218&6223,w ith -16 days float) ,RFI#63 (activity#6219 , with -25 days float) ,and PG&E utility service aggreement procurement(ac- tivity#6221,with -25 days float) ,Impacted Project/Contract completion is (excluding activities with 0 days or greater fl.oat)in inaeasin order o Project delay,&starting with activity#6210, as follows :10 )01 , 10/15/ 01, 1,0/19/01, 10/23/01,&11/05/01. 152,97 lie-,perlan Blvd.. Sulte 7 + Son Levndro..CA 94578 • Tel:(510)276 8413. Fox; (540)27.6-8414 --� P&# t2-- GRAPHIC NETWORK PLANNERS I , CONSTRUCTION CONSULTANTS "DECEMBER 2000 .TMPACTS"CONTIN- MAY 23, 2001 JOB 0941 (2co) PG#2 of 2 Fourth impact involves Roek PCOV .Delta 1 structural steel modifications,and related foundations 'relay-out/staking(activities# 6200&6238 ) .Also involvedrare previously incorporated"NOVEMBER 2000 IMPACT"activities#6157&6159,both of which represent FCO#3, as well. AII (4 )activities combined, delay Project critical path(and finish date) by(-35)work days .Impacted Project/Contract completion is 11/19/01. Contract activities directly impacted(with total/negative float of -35 work days)are #8085&40. Fifth impact involves Roek RFI# nce(canopy)foundat- ions(activity#6234 ) .RFI activity delays pre),5 4critical path(and finish date pby(-41)work days. Impacted Project/Contract completion is 11/27/01.Contract activity directly impacted is(with total/negative float of -41 work days) #55. Sixth and final impact involves" the incorporation • .-Jover- layment)of the"LATE STEEL DELIVERY. INPACT"issue with respect to all other"DECEMBER 2000 IMPACTS"previously incorporated. The resulting delay to the Project ' s critical path(and finish date) is: .(-71)work days.This is a net increase. of -30 .work days(over previously . instal- led"DECEMBER 2000 IMPA�) .Of this -30 work days of additional Proj- ect/Contract delay, ( -5)work days can be attributed to/associate with a -required increase .in 'the Project Architect-Engineer 's time for re- view and approval of Roek's structural steel Fabricator/Erector ' s PCO 3(Delta 1 structural modifications)impacted Shop drawings/Sub mit- tals.The remaining(-25)work days of delay can be attri�biated to the Project structural steel Fabricator ' s/Erector' s Supplier ' s(Mill' s) production. schedule(s)and material availability issues .The impacted Project/Contract completion is 01/14/02 .Contract activities directly impacted(with total/negative float of -71 work days)are #8085/8090/ 8095.Activity#8095 ' s duration is adjusted( increased): y (14)work days, < from (42) to ( 56)work days. Sincerely, Gerry .E].ine/Principal 15287 Hesperion Blvd., Suite 7 • San Leandro. CA 94578 • Tal:(W)276-8x13, Fax: (510)276-8444 GR�WHIC NETWORK PLANNERS CON STnUCTION CONSULTANTS ROEK CONSTRUCTION riAY 23 , 2001 ATT: STEVE JASPERSON JOB 0941 (2co) ' PQ BOX 3.0038 PG#1 of 31 STOCYTON,CA, , 95213 RENEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE. REPORT FOR 05/23/01 DELAY ANALYSIS OF"JANUARY 2001 IMPACTS" ,OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCHEDULE REVISION #2/UPDATE#1 . Gentlemen; Following is a brief narrative for ( 9)Time Impact Analysis (T,W s )Fragnet, covering ( 9) sets of Project Schedule impacts/delay issues which occurred during the period JANUARY2001. It should be noted that all Project Schedule activities and their corresponding start and f _nish dates reflect as-built conditions,regardless. of whether or not activities have Job progress/status( % 's of work complete) assigned to them. The first impact involves previously incorporated"DECEMBER 2000 IMPACT"activities#6218 and .6223 (PC0re aced issues) .Adjusted impact activities combined,delay Project critical path(and finish date) by(-36)work days .This is: a net increase of (-20)work days (Df Project delay)over and beyond that shown u— nor the"MCEMBER 2000 IMPACTS" . Impacted Project/Contract completion(adjusted for January' 01 : Impacts) is 11/20/Ol.C6ntract activity directly impacted(with total/negative float of -36 work days) i.s #5054 . ' Second impact involves Roek RFI 's#20a/80/82/83 :structural steel fabrication related issues (activity#6278 ) .RFI activity delays Project critical path(and finish date)b y (-3.9)work days.Impacted Proj- ect/Contract completion is 11/23/01.Contract activity directly impact- ed(with total/negative float of -39 work days) is #8095. Third impact involves Roek PCO#3 :Delta 1 structural steel modifications(activities#6157/6159/6200/8095)previously incorporated and adjusted in the "NOVEMBER 2000"and"DECEMBER 2000 IMPACTS"analysea. Also involved in this impact are (2 )other issues(sets of RFI ' s) ;the first being BFI' s#47/62 :Grade beam rebar/anchor bolt/steel base plate conflicts(activities#6162/6173/6205/6207/6215) ,and the seeond,RFI#60 : Structural steel(submittal related) issue (activity .#6213 ) .Both of these impact issues were previously incorporated and adjusted under the"NOV- EMBER AND DECEMBER 2000 IMPACTS"analyses .For the "JANUARY 2001 IMPACTS" . analysi.s,only PCO#3 related activity#8095 is adjusted_The activity duration is revised(by 5 working days)from(42)to(47)working days inord- er to accomodate PCO#3 related requirement for additional structural steel fabrication/shop manufacturing labor time.Contract activity#8095 's predecessor 's lag/lead duration is also adjusted(b y .5 working days)from (16)to(21)working days.The effect(s)of these duration adjustments is (are) felt equally by all previously listed impact i.ssues,i .e;PCO#3 ,RFI 's#47/ 62,anU7R_F_1_T60.This last statement may not be entirely accurate and re- quires some further clari.fication,as set forth.Though all the impact issues( 3 total)delay the Project critical path(and finish date)by(-36) working days,except fDr RFI#47/62,which also creates a Project delay of 15287 HPSherlon Blvd.. Suite 7 • San Leandro, CA 94578 • Tei;(510)276-84`13, Fax:(510)276-8414 GRAPHIC NETWORK PLANNERS CONSTRUCTIO.N CONSULTANTS "JANUARY 2001 IMPA TS"CONTIN- MAY 23 , 2001 JOB 0941(2co) PG#2 of 3 (-40)working days,the net danges (increases) in total/negative float tgbf each of (3 ) impact issues are different .RFI#60 ' s negative float has in- creased from(-31 to -36)work days.RFI# 's 47/62 negative float has in- creased from(--31 to -40)work days..And PCO#3 ' s negative float has in- creased from(-35 to 36)work days .impacted Project/Contract completion is adjusted to 11/20/01(for RFI#60);to 11/2:6/01(for RFI# ' s47/62);to 11/20/01(for PCO#3) _Cohtract activities directly impacted by the ad- justment(s)to contract modified activity#8095, axe#$085f809(Y8110-, .all. of which show(-36)work days of negative float.Contract activity#8050 is indirectly impacted fi y *#8095( ..Via RFI447/62 activity#6215) .Negative float shown for #8050 is (-40)work days. Fourth impact involves Roek RFI# ' s73&76 :Electrical rooze 135, and electrical utility routine drawing revi.sions(activity#6256&6265) . RFI activities combined,delay Project critical path(and .finish date) by(-40)work days.Project/Contract completion is 11/26/01.Contract act- ivity directly impacted(with total/negative float of --40 work days) is #5052.As a sivb'set to fourth impact,the .following list of near/less crit- ical(in terms of total/negative float)impact .issues,and their respect- ive activities ' invblved(directly)are,in increasingorder of delay(tot- al/negative float from:+94 to:-16. work da.ys)as fo lowstRFI479'(activity #6275,with +94days float) ,RFI#81(activity#6284 ,with +76 days fl.oati , REE#69 (activity#6250',with +71 days float) ,RFI#68 (activity#6253,with +62 days float) ,RFI# ' s76&73 (activities#6268&6262,with +24 days float each) ,and RFI#72 (activity#6259,with -16 days float ) ,Impacted Project/ Contract completion is(excludinq activities with 0 days or greater float)in increasing order of Project delay,and starting with activity #6259 ,as follows; /23/01.contract activity impacted is#8130. Fifth impact involves PG&E utility service aggreement procure - ment(acti.vity#6221) ,previousl,y. incorporated under the"DBCEMBER 2000 IMPACTS"analysis.The impact activity's' durati.an is adjusted(increased) �bk(21)work days,to (42)work days,for the "JANUARY 2001 IMPACTS"analysis. The adjusted impact activity delays Project critical path(and finish dateb (- )work days.lmpacted Project/Contract completion is 12/06/01. Contract activities directly impactedoboth with total/negative float, of. -46 work days)are #5015&5052. . Sixth impact involves Inclement/Adverse-weather delays(activ- ities#6045/6050/6055/6057) ,Inclement weather activities delayslin in- creasing order of negative float (from:--46 to: -47 work days)the Project r- t' al path(and finish date) .Impacted Project/Contract completion is adjusted from 12/06/41 to 12/07/01,respectively.Contract activiities directly impacted are,in increasing order of delay (total/negative .float from:-27 to:-47 work days) 0/45760/55/65,respectively. Seventh impact invives Roek RFI#65.Building entrance (Canopy) -'foundations(activity#6234) ,previously incorporated under the"OECEM-- BER 2000 IMPACTSOanalysis.The impact activity' s duration is adjusted (increased)by ( 6)work days,to (20)work days,for the"JANUARY 2001 IM- PACTS"analysis.The adjusted impact activity delays Project critical path(and finish date by(-47 )w0rk d.ays .impacted Project/Contract complet- ion is 12/07/01.Contract activity impacted(by-4 7 workdays)is #55. 15287 Hesperion Bivd„ Suite 7 * Seen Leandro. CA 94578 *Tel-(54())2716-8443,Fa : (510)276-8444 SRAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS YCANUARY 2,001 IMPACTS"CONTIN- MAY 23 ,2001 JOB 0941(2co) PG#3 of 3 Eighth impact involves Roek PC0#1/RF1#31 :IMPORT of Site Fill Material(activity#6281) .P'CO/RFI activity delays Project critical path (and finish datopby (-47 )work days.Impacted Project/Contract complet- ion is 12/07/01.Contract activity directly impacted(with total./nega- tive float of -47 work days) is #5005. Nineth and final impact involves the reincorporation(OVER- LAYMENT)of the"LATE STEEL DELIVERY IMPACT"issue with respect to all other'JANUARY 2001 IMPACTS"previously incorporated.The resulting de- lay to the project's critical path(and finish date)is (-76)work days. This is a 'net 'increasp of(-29 )work days (over previously installed "JANUARY 2M IMPACTS'm) .0f this(-29)work days of additional Proj6ct/ Contract delay, (-5)work days can be attributed to associated with a required 'increase in the Project Architect-Engineer ' s time for re- v'i'ew and"approval of Roek' s Structural Steel Fabricator 's/ErectorTs PCb Delta 1 structural steel modifi.cations)impacted shop drawings/ Subbmittals.The .remaining.(-24 )work days of delay can be attributed to . the Project Structural Steel Fabricator' s/Erector ' s Supplier ' s (Mil1 ' s) production schedule(s)and material availability issues.The impacted Project/Contract completion is 01/21/02 .Contract activities directly impacted(with total/negative float of -76 work days )are #8085/8090/ #8095. Activity#8095 ' s duration is adjusted(increased)by .(14 )work days, from (47 ) to ( 61)work days. SinVrq ;RNE/ RINCIPAL 15287 Hesperlan Blvd.. Suite 7 + San Leandro.CA 94578 • Tel:(540)276-8413, Fax:(510) 276-8444 R PHIL NETWORK PLANNERS co STRUCTIO.N _ CONSULTANTS Y ROEK CONSTRUCTION MAY 3 0 , 2 00.1 ATT:STEVE JASPERSON JOB 0941 (2ca) . PO BOX 30038 `' PG#1 of 2.' STOCKTON,CA. , 95713 RENEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT FOR 05/30/01 DELAY ANALYSIS OF'FEBUARY 2001" IMPACTS" ,OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCH$DULE REVISION #2/UPDATE #1. Gentlemen; Following is a brief narrative for ( 8)Time Impact Analysis (TIA's)Fragnets covering ( 8) sets of Project Schedule impacts/delay- issues which occurred during the period rEBUARY 20'11 . It should be noted that all Project Schedule activities and their .corresponding start and finish dates' reflect as-built conditions,regardless of ' whether or not activities have TooFprogress/status(t 's of work complete) assigned to them. The first impact involves previously incorporated"DECEMBER 2000"and"JANUARY 2001 IMPACT"activities 2 and 6223 (PCO#7 related issues) .Adjusted impact activities combined,now, delay Project criti- cal path(and finish date)by(-46)work days.This is a net increase of (-10)work days (of Project delay)over and beyond that shown under the "JANUARY 2001 IMPACTS" . Impacted Project/Contract completion(adjusted for"FEBUARY' 01 IMPACTS" ) is now 12/06/01.Contract activity directly impacted(by -46 work days) is 45054. Second impact involves Roek RFI#88:Structural ' steel dimen- sion(s)/elevation(s) (activity#6300) .RFI activity delays Project crit- ical path(and finish date)by ( -48)work days .Impacted Project/Contract completion is 12/10/01.Contract activity directly impacted(by -48 work days)is #8095. Third impact involves Roek RFI#92 :Curtain wall steel supp- orts(activity#63ll) .RFI activity delays Project critical path(and fin- ish date)by (-50)work days,Impacted Project/Contract completion is 12/12/01.Contract activity directly impacted(by -50 work. days)is#8095. Fourth impact involves Inclement/Adverse weather delays (act- ,ivities#6065/6070/6075) ,Inclement weather activities delay,in increas- ing order of negative float(from:-49 to:-53 work days)th.e Project cr�t- ical path(and finish date): .Impacted Project/Contract completion is ad- justed from 12/11/01 to 12/17/01 ,respecti,vely.Contract activities dir- ectly impacted; in -increasin order of delay(total/negative float from: -40 to :--53 work days)are 07/105/100/2000,respectively. Fifth impact involves Roek RFI#98 :Structural. steel canopy details(activity#6332) _RFI activity delays Project critical path(and finish date)by (-59)work days .Impacted Project/Contract completion is 12/26/01.Contract activity directly impacted(by -59 work days) is#8095. -Sixth impact involves previously incorporated"JANUARY 2001 IMPACT"activities#6256 and b2b5(RFI & related issues) .Adjusted impact activities combined,now delay Project critical path(and finish date)b y(-62).work days.This is a net increase of (-22 )work days (of 45287 Hesperlan Blvd., Sulte 7 - San Leandro. CA 94578 6 Tel:(510)276.8413,Fax: (510)216-8414 SERAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS "FEBUARY 2001 IMPACTS"CONTIN- MAY 30,2001 JOB 0941 (2co) PG42 of 2 Project delay)over andabeyond that shown under the"JANUARY 2001 IM- PACTS" .impacted Project/Contract completion(adjusted for"FEBURRY101 IMPACTS" ) is 12/31/01.Contract activity directly impacted(by --62 work days) is #5052 . Seventh impact involves previously incorporated"DECEMBER 2000" and"JANUARY 2001 IMPACT. ."activity PG&E.site utility service . aggreement procurement issue) .Adjusted impact activity now delays Project critical path(and finish date)b y (-68 )work days.This is a net increase of (-22)work days(of project delay)over and :Ibeyond that s own under the "JANUARY 2001 IMPACTS" .Impacted Project/Contract com- pletion(adjusted for "FEBUARY' 01 IMPACTS" ) is 01/09/02 .Contract act-• ivitios directly impacted(by -68 work days)are 15015 and 5052 . Eighth and final impact involves the reinarporation(overlay- ment)of the "LATE STEEL DELIVERY IMPACT"issue with respect to all other"VEBUARY 2001 IMPACTS"previously incorporated.The resulting de- lay to the Project 's critical path (and finish date)is (-76)work days . This is A 'riet 'increase of (-8 )work days(over and beyond those pre- viously installed "FEBUARY 2001 IMPACTS" ) .Of this.( -8 )work days of additional project/Contract delay, (-5)work days can be attributed to/ associate with a required increase in the Project Architect-Engi- neer 's time for review and approval of Roek' s Structural Steel Fab- ricator ' s/Erector s PCO De to structural steel modifications) im patted Shop drawings/5ubmittals.The remaining(-3 )w ork days of delay can be attributed to the Project Structural Steel FEb ricator 's/Erec- tor ' s Supplier ' s (.Mill' s)production schedule(s)and material availa- bility issues.The impacted Project/Contract completion is 01/21/02 . Contract activities directly impacted(b.y -76 work days) are #8085/ 8090/8095.Activity#8095 's duration is adjusted(increased)by (14 ) work days,from (47 ) to ( 61)work days . Sincerely, Gerry line/Principal 15287 Hesperian Blvd.,Suite 7 • San Leandro, CA 94578 • Tel:(510)276-8413, Fax: (510) 276-8414 GRAPHIC NETWORK PLANNERS CO STRUCTION CONSULTANTS ROEK CONSTRUCTION JUNE 04.,2001 ATT:STEVE JASPERSON JOB 0941 (2co). PQ BOX 30038 PGM of 1 .STOCXTON,CA. , 95213 RE NEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT FOR 06/04/01 DELAY ANALYSIS OF" MARCH 200.1 IMPACTS" ,OCCURRING UNDER THE 04/02/01 CONTRACT PROGRESS SCH9DULE REVISION .#2/UPDATE #1. Gentlemen; Following is a brief narrative For ( 3)Time Impact Analysis (TIA' s )Fragnets covering (3 ) sets of Project Schedule impacts/delay- issues which occurred during the period MARCH 200,1 . it should be noted that all Project Schedble activities, and their corresponding start and frnish dates reflect as-built conditions,regardless of whether or not activities have JooF progress/status (V s of work complete) assigned, to them. • First impact involves Roek RFI#101:HVAC equipment mount- ing issue(s) (activities#6370&6373 ) .RFI activities. combined,delay Project critical path(and finish date)by ( -52)working days.Impacted Project/Contract completion is 12/14/01-Contract activities direct- ly impacted(by -52 work days)are #8350&8355. Second impact involves Inclement/Adverse weather delays (activities#6080&6090) ,Inclement weather activities combined,delay Project critical path(and finish date)by (-68)working days.Impacted Project/Contract completion is 01/09/02 .Contract activities direct- ly -impacted,in increasing order of delay(total/negative float from: +87 to:-68 work days)are #5064/52/5000/5005/5015/50/2020/100/105/45, respectively. Third and final impact involves the .reincorporation(over- layment)of the "LATE STEEL DELIVERY IMPACT"issue with respect to all other"MARCH 2001 IMPACTS"previously incorporated.The resulting delay to the Project's critical path(and finish date)is (-92 )working days . This is a -riet 'incr'ease of (-24)work days (over and beyond those prev- iously installed"M CH 2001 Ir1PACTS" ) .Of this (-24)work days of add- itional Project/Contract delay, (-5)work days can be attributed to ass�ocl4ated with a required inmase in the Project Architect-Engineer 's time for review and approval of Roek's structural Steel Fabricator's/ Erector' s PCO De to I structural .steel modifications) impacted Shop drawings/Submittals.The remaining(-19 )work days of delay can be at- tributed to the Project Structural Steel Fabricator ' s/Erector' s Sup- . plier's (Mill's]production schedule(s)and material availability is- sues.The impacted project/Contract completion is 02/12/02 .Contract activities directly impacted(b y -92 work days)are #8085/8090/8095. Activity's#8095 duration is adjusted(increased)by . (30)work days,from (47 ) to (77 )work days_ Sinc ely,�� Gerry .Eline/Principal 15287 Hesperian 131vd., Suite 7 • Son I.eondro, CA 94578 • tel:(510)276-841.3. Fax: (510) 276-841A rGRAPHIC NETWORK PLANNERS ' CONSTRUCTION CONSULTANTS ROEK CONSTRUCTION AUGUST 10,20Ul ATT:STEVE JASPERSON JOB 0942-CO P.O.BOX 300.38 PG#1 of 2 STOCKTmN,CA. ,95213 RE NEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT FOR 06/01/01 DELAY ANALYSIS OF "APRIL & MAY 2001 IMPACTS" ,OCCURRING UNDER THE 06/01/01 CONTRACT PROGRESS SCHEDULE REVISION#3/UPDATE#2 . Gentlemen; Following is a brief narrative for (9) Time Impact Analysis (TIA' s)Fragnets covering (9) sets of Project Schedule Impacts/Delay issues which occurred during the period: April thru May 2001.It should be noted that all Project Schedule activities and their corresponding start and finis-Fi -dates reflect as-built conditions,regardless of whet- her or .not activit es have Job progress/status ($ 's of work complete) assigned to them. First impact involves Roek RFI#103 :PG&E/PAC.BELL site under- ground electrical/FCOM.lines(activities#6367&6369) ,and PCO#13:addit- ional site undrground electrical/TeleCom.lines(activities#6378&6379) . RFI and PCO activities(#6367, 6378&6379)combined,delay Project critical path(and finish date)by (-69 )working days.Impacted Project/Contract completion is 01/10/02 (this is `-23 work days less ftn previously calc- ulated Impacted Project completion date of 02/12/02,and shown under the "MARCH 2001 2PACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included. Therefore,there is no additional Project delay.Contract activities dir- ectly impacted(by -69. work days)is #5050. Secbnd- impact involves Inclement/Adverse weather delays(activ- ities#6092, 6093, 6095&6096)for month of April ' O1.Inclement weather act- ivities (#6092&6093)combined,delay Project critical path(and finish date) by(-69)working days.Impacted Project/Contract completion is 01/10/02 (this is -23 work days less. than previously calculated. Impacted Proj- ect completion date of 02/12/02,and shown under the"MARCH 2001 IMPACTS" Analysis with"LATE STEEL DELIVERY IMPACT"included) .Therefore , there is no additional Project delay.Contract activities directly impacted(by -69 work days)are#5050&5054. - Third impact involves Roek RFI#102:1Metal roofing substcate,and PCO#12 :Metal roofing substrate issue(activities#6409, 6422&6428) .RFI and PCO activities previously mentioned,when combined,delay Project critical path(and finish date)by(-100)working days.Impacted Project/Contract com- pletion is now adjusted to 02/25/02 .This is a net additional Project de- lay of(-8).working days (over and beyond that amount(=92 -wor.R-days)prev- iously shown under the"MARCH 2001 IMPACTS"Analysis withaLATE STEEL DE- LIVERY IMPACT"inc luded) .Contract activities directly impacted(by -100 work days)is #8190. . Fourth impact involvesreviously incorporated"MARCH-APRIL 2001 IMPACT! activities #6412 anRoek PCO#10:Access control sys- tem related issue) .Adjusted impact activities,when combined;now delay Project critical path(and inish date)by (-68 )work days.Impacted Project/ Contract completion is 01/09/02(this is -24 work days less than prev- iously calculated dIImpacted Project completion date of 502/12/02,,and shgRe spei an Hivd: ui 6Kl Sa LM9,16 WAY (5 �6 l�I . F��c ll J 'Y GRAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS AUGUST 10,2001 "APRIL & MAY 2001 IMPACTS"CONTIN- JOB 0942-CO PG#2 of 2 IMPACT"included)..Therefore,there is no additional Project delay.Con- tract activity directly impacted(by -68 work days)is #8380. Fifth impact involves ereviously incorporated"MARCH-APRIL ; 2001 IMPACT"activity#6328 (Roek PCO :Curved metal ceilings related issue) . Adjusted impact activity delays Project critical path(and finish date) By� work days.Iripacted Project/Contract completion is 11/13/01(this is -61 work days less than previously calculated Impacted Project com- pletion date of 02/12/02,and shown under the"MARCH 2001 IMPACTS"Anal- ysis with"LATE STEEL DELIVERY IMPACT"included) .,Therefore,there is no additional Project delay.Contract activity directly impacted(by -31 work days)is #84.2,5. Sixth impact in,.d.ves Roek' .PCO#19:Central Plant underground HVAC refrigeration piping(activities#(6420 , 6436,&642.4) .PCO impact act- ivities delay,in increasing order of negative float(from:0 to:-7 work days)the Project crltica path(and firrish date) ,Impacted Project/Con- tract completion is 10/10/01(this is -85 work days less than previous- ly calculated Impacted Project completion date of 02/12/02,and shown under the"MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT" included) .Therefore, there is no additional Project delay.Contract activity directly impacted(by -7 work days) is #8360 . Seventh impact involves Roek RFI#128:Curtain wall/Window wall "story-drift"issue(activity#6430) .RFI impact activity delays Project critical path(and finish date)by (-107.) work days.Impacted Project/Con- tract completion is now adjusted to 03/06/02 .This is a ' net additional Project delay of(15)working days (over and beyond that amount(-92 work days)previously shown under the"NiARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT."included) .Contract activities directly impacted , in increasin order of delay(total/negative float from:-106 to:-107 work days)are #8257&8270,respectively. Eigth impact involves Roek PCO#6:Central Plant structural modi- fications(.activities#6355,existing,and#6425,new) .PCO impact activi- ties,when combined,delay Project critical path(and finish date)by(-11) work days.Impacted Project/Contract completion is 10/16/01(this is -8.1 work days less than previously calculated Impacted Project completion date of 02/12./02,and shown under the"MARCH 2001 IMPACT S"Analysis with "LATE STEEL DELIVERY IMPACT"included) ..Therefore,there is no additional Project delay.Contract activity directly impacted(by -11 work days)is #8062. Ninth and final impact involves previously incorporated"NIAP.CH- APRIL 2001 IMPACT."activity#6.403, and new activity 6470 (Project finish/ color schedule approval0issue by Owne�Architect) .Adjusted(and new)im- pact activities,when combined,now delay' Project critical path(and fin- ish date)by(-26)wotk days.Impacted Project/Contract completion is 11/06/01(this is -66 work days less thanpreviously calculated Impacted Project completion date of ,02/12/02,and shown under the"MARCH 2001 IM- PACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Therefore; there is no additional Project delay.Contract . activity directly impact- eiv$"yLfft��% 4Lj�lndro, CA 94x78 Tel:(510)276-8413, Fax: (510) 276-8414 Sincerely, GERRY -,.EL IRINCIPAL f GRAPHIC NETWORK PLANNERS ROEK CONSTRUCTION CONSTRUCTION CONSULTANTS AUGUST 10,2001 ATT:STEVE JASPERSON JOB 0942-CO P.O.BOX 30038 PG# 1 of 1 STOCKTON,CA. , 95213 RE:NEW EHSD.OFFICE BUILDING(ANTIOCH)NARRATIVE REPORT(SUPPLEMENTAL) FOR 06/01/01 DELAY ANALYSIS OF "APRIL &- MAY 2001 I14PACTS",OCCURRING UNDER THE 06/01/'01 CONTRACT PROGRESS SCHEDULE REVISION#3/UPDATE#2 . Gentlemen-; This narrative report(supplemental)attachment is provided to incorporate the Project Impact/Delay(additional)which occurred as a direct result of the application of Job progress (current status of Project as of 06/01/01,per Schedule Update#2) .With current Job prog= rest applied,Roek RFI#128 :Curtain/Window wall:"story-drift"issue(act- ivity46430)impacts/delays Project critical path(and finish date)by(-111) working days.This is a net additional Project delay of(-19)working days (over and beyond that amount(- work days)previously shown under the "MARCH 2001. IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) . This is also, a net increase of(.-4 )work days(of Project delay)over and beyond that amount -1l woi days)previously calculated and shown un- der the"APRIL & MAY 2001 I14PACTS"Analysis without current .Job prog- ress applied to impact activity#6430.Reference GNP narrative ' s"Seventh impact" .Impacted Project/Contract completion is now adjusted to 03/12/02 , (versus . 03/06/02 date previously shown) . Sincerel , GERRY P. LINE/PRINCIPAL 15287 Hesperlan Blvd., Suite 7 • San Leandro,CA 94578 •.Tel:(610)276-8413, Fax: (510)276-8414 jOR PHIL NETWORK PLANNERS T CO STRUCTtON CONSULTANTS. ;'ROEK CONSTRUCTION AUGUST 17.,2001 �ATT:STEVE .JASPERSON JOS 0943-CO - PO BOX 30038 PG#1 of 2 STOCKTON,CA. , 95213 RE NEW EHSD.OFFICE BU$LDING(ANTIOCH)NARRATIVE REPORT FOR 07/ 02/01 DELAY ANALYSIS OF" JUNE 2001 IMPACTS" ,OCCURRING UNDER THE 07/ 02/01 CONTRACT PROGRESS SCH$DULE REVISION # 4/UPDATE #3. Gentlemen; Following is a brief narrative for ( 8)Time Impact Analysis (TIA's)Fragnets covering ( 8) sets of Project Schedule impacts/delay, issues which occurred during the period JUNE 2001. It should be noted that all Project Schedule activities and their corresponding start and finish dates1 reflect as-built conditions,regardless of whether or not activities have Job progress/status($ ' s of work complete) assigned to them. First impact involves previously incorporated "MARCH-APRIL 2001 IMPACT"activity#6415(-Roek PCO :Access control system) ,and "APRIL- MAY -2001 APRILMAY 2001 IMPACT"activity#6424 (Roek PCO#19 :Central Plant underground HVAC refrigeration piping) Adjusted impact activity#6415,and#6424 now delays Project critical pat and finish date)by(-89)work days and(-14) work days,respectively. Impacted Project/Contract completion is 02/07/02 , and 10/19/01,respectively(this is -3 work days and -78 work days,re- spectively,less than previously calculated Impacted Project completion date of 02/12/02 ,and shown under the "MARCH 2001 IMPACTS"Analysis with "LATE STEEL .DELIVERY IMPACT"included) .Therefore,there .is no additional Project delay.Contract activities directly impactedWy -89 and -14 work days,respectively)are#8380 and#83.6'0,respectively. Second impact involves Roek PCOJ18 :Modified Steel column base threaded bolts/rods (activities#6502 , 6506,and 6510) .PCO impact act - ivit'ies,when combined,delay Project critical path(and finish date)by (-99)work days .Impacted Project/Contract completion is now adjusted to 02/22/02 .This is a net additional Project delay of(-7 )working days(.over and beyond that amount(- 2 wort ays)previously shown under the "MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Contract activities directly impacted,in increasing order of delay(total/nega- tive float from:-52 to:-99 work ays)are 8100,270, 262,and#260,respec- tively. Third impact involves Roek RFI#117 and PCO#21 :Metal framing deflection issue and modifications (activities#6552,6504 ,and 6508 ) .RFI and PCO impact activities previously listed,when combined,delay Proj- ect critical path(and finish date) in order of increasing total/negative float,from:-72 to:-103 work days.Impacted Project Contract completion- is now adjusted from 01/15/02 to 02/28/02,respectively(this ranges from -20 work days less to -11 work days more than that amount(-92 work days) . and impacted Project cor#etion date of_U2/12/02,both previously calcu- lated and shown under the "MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Contract activities directly impacted ,in in- creasing onbr of delay(total/negative float from:-72 to:-103 work days) 15287 Hesperian Blvd..Suite 7 • San teandroXA.94578 • Tel:(510).276-8413. Fax:(510)276-8414 GRAPHIC NETWORK PLANNERS CONSTRUCTION CONSULTANTS AUGUST 17,2001 "JUNE 2001 IMPACTS"CONTIN- JOB 0943-CO PG# 2 of2 are #8285,310,8257,8270,and 1000,respectively. Fourth impact involves Roek RFI#120 (&A) and PCO#17:Add metal deck slab reinforcing(activities#651'4, 6516', 6518, 6524 ,and 6527 ) .RFI and PCO impact activities previously listed,when combined,delay Project/ Contract critical path(and finish dateXby(-99)work days.Impacted Proj- ect/Contract completion is now adjusted to 02/22/02.This is a net add- itional Project delay' of(-7 )working days(over and beyond that amount T--3-2work days)previously shown under the "MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Contract activities directly impacted,in increasing order of delay(total/negative float from:-84 to:-99 work Tays7are #2701and 260,respectively. Fifth impact involves Roek RFI#122 and PCO#19:HVAC ductwork transitions(activities#6525,6533, 6554 ,6562,and6564 ) .P.FI and PCO impact activities previously listed,when combined,delay Project critical path (and finish date)by(-103)work days.::Impacted Project/Contract complet- ion is now adjusted to 02/28/02.This is a net additional Project delay of(-11)work days(over and beyond that amount7-3T wort ays)previously shown under the"MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Contract activities directly impacted,in increasing of'der of delay(total/negative float from:-23 to:-103 work ays are #8360 and 320,respectively. Sixth impact involves -previously incorporated"APRIL-MAY 2001 IMPACT"activity#6470,and new impact activity#6529 (Project finish/color schedule issue and clarification by Architect) ,Impact activities,when combined,delay Project critical path(and finish date)by(-36)work days. Impacted Project/Contract completion is 11/20/01(this is =56 work days less than previously calculated Impacted Project completion date of 02/12/02,and shown under the"MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Therefore,there is no additional Prbject delay.Contract activity directly impacted(by -36 work days).is #8435. Smenth impact involves impact activities#6531 and 6560.(Toilet accessories additional cost issue) , Impact activities.,when combined,de- lay Project critical path(and finish date)by(-36)work days.impacted Project/Contract completion is 11/20/01(this is -56 work days less .than previously calculated Impacted Project completion date of 02/12/02 ,and shown under the"MARCH 2001 IMPACTS"Analysis with"LATE STEEL DELIVERY IMPACT"included) .Therefore,there is no additional Project delay.Contract activity directly impacted(by -36 work days).is #8520. Eigth and final impact involves Roek RFI#128 (&A) :Aluminum Curt- ain/Window wall"story-drift"issue(activities#6535 and 6537) .RFI impact activities,when combined,delay Project critical path(and finish date) by(.-117)working days.Impacted Project/Contract completion is now adjust- ed to 03/2.0/02.This is a net additional Project delay of(-25)work days (over and beyond that- amount(- worn days)previously shown under the "MARCH 2001 IMPACTS"Analysis:with"LATE STEEL DELIVERY IMPACT"included) . Contract activities directly impacted,in increasing order of delay(total/ . negative fl f om:-116 to:-117 work days)are and 8270 ,respectively. S�FZEMF?e rian � �5 'L/ 1 A 1578 • Tet:(5 40)276-8413. Fax: (510) 276-8444 y r Ln OEr ocr ti � o� r o rrnn 7y z b rn Z o fn y rd y z xn o Dy � m y OR N (n n H H cn x MW --1 cn axa m _zooms %D M n w DW C D �yo o cUl00 a N, r W O H d F, w Z � 000 0 0 rn l O q O C-�Isl U 1 1 a� 0 O 0 1 � 1 t o � o ' o ' o / �r x`00110*10 ool CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA c4qwvNTY BOARD ACTION, Ts-,4 Claim Against the County, Or District Governed by the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. . ) notice of the action taken on your claim.by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 1neKLC55o� 915.4. Please note all "Warnings". AMOUNT: $10,000 N O U Z O 2001 CLAIMANT: Timothy Dukes COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: James Rogers DATE RECEIVED: November 19, 2001 ADDRESS: 1941 Jackson St BY DELIVERY TO CLERK ON: November 19, 2001 _ Oakland, CA 94612 BY MAIL POSTMARKED: November 16, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE r Dated: November 19, 2001 By: Deputy ' II. FROM: County Counsel TO: Clerk of the Board of Supervisor ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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: ;20— yl By: Ll � Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ()C) This Claim is rejected in full. ( ) Other: I certify that ,,this , is a true and correct copy of the Board's Order entered MVWQ4,AQ_--' in its minutes for this date. Dated: QJg1 U 1 Y , n( JOHN SWEETEN, CLERK, By %t , Deputy Clerk _ WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully irepaid as certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. dated: LQ O�Q,1AA L`1 aUt JOHN SWEETEN, CLERK By ",&Olvl_ 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 JAMES M. ROGERS JAMES M. ROGERS JUDITH W. MAARSHRSH 1941 Jackson Street Tel. (510)444-.4464 Oakland, California 94612 Fax (510)444-4.460 VIA CERTIFIED MAIL RECEIVED =ARDFS [CLERKBOOUPERVISORS CLAIM.AGAINST PUBLIC ENTITY CONTRA COSTA CO. Name of Public Entity: Contra Costa County Name and Address of Claimant: Timothy Dukes 1941 Jackson Street Oakland, CA. 94612 Send Notices To: Attorney James M. Rogers, Attn: John Bell, Attorney 1941 Jackson Street, Oakland, CA 94612, (510)444-4464 x323. Place and Date of Occurrence: Homeless Shelter at Brookside Drive,Richmond, CA. May 22 2001 Circumstances of Occurrence: The drainage system at the shelter"backed up" and flooded-the floor with water which caused Mr. Dukes to sly and fall. . Description of Damage and Loss: Serious personal injury, medical and other associated and incidental expenses, lost wages. Total Amount Claimed: In excess of$10,000,jurisdiction in Limited Court. Breakdown of Amount Claimed: General and special damages. Dated: 11 16/01 Signed: _ Z= John T. Bell LAW OFFICES OF JAMES M. ROGERS Attorney for Claimant LAW OFFICES JAMES M. ROGERS JAMES M. ROGERS 1941 IaCICSOn Street JUDITH W. MARSH Tel. (510)444-4464 Oakland, California 94612 RECEIVED NOV 1 9 2001 CLERK BOARD OF SUPERVISORS CLAIM AGAINST PUBLIC ENTITY CONTRA COSTA CO. Name of Public Entity: Contra Costa County Name and Address of Claimant: Timothy Dukes 1.941 Jackson Street Oakland, CA. 94612 Send Notices To: Attorney James M. Rogers, Attn: John Bell,Attorney` 1941 Jackson Street, Oakland, CA 94612, (510)444-4464 x323. Place and Date of Occurrence: Homeless Shelter at Brookside Drive,Richmond, CA:May 22 :... .. . 2001 Circumstances of Occurrence: The drainage system at the shelter."backed up"and flooded the floor with water which caused Mr. Dukes to slip and fall. Description of Damage and Loss: Serious personal injury,medical and other associated and incidental expenses, lost wages. Total Amount Claimed: In excess of$10,000,jurisdiction in.Limited Court. Breakdown of Amount Claimed: General and special damages. Dated: 11/16/01 Signed: 1 John T. Bell LAW OFFICES OF JAMES M. ROGERS Attorney for Claimant '.C•f.t :1-i' -t' .....E �J. �!. l l.: ,.\:t?f� .1l Jr �:• ,1s .I�. 1St.. .. 1�. . V/ .• . rh•.���. � tr 1r' 1 r •.. t:.• _�.. i r J 'i i. ':1 :���11 i5 ''t •r� iii ..._!+`�,. .,•_ 'J . . .. ,.. .. _.. . .._..._.-..._. ..._.'__..__is ... ..._.. ..__......- _. ....._.._..._. ,_.. .. -..... ' - is 'i:�.;:r: is°.. .i':.1' - '1::• '`r. /�r:.! ... �\ ... .,. ,. �t:\,. l 0�9 d o. NNCD N� N D Y Q 0 0 r t f � G 'r r �' --...:_ i '�� .� 0 C7 a m o Pu 33 D -- m a o m Fri v � 70 • CD .n am CD o` • o I C .C,1 F24 i - � y ai.E4. a. ..-aIj CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and RIEC311W 915.4. Please note all "Warnings". TIM AMOUNT: Unknown N Q V 2 0 2001 CLAIMANT: Gilbert Gomez Jr COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 16, 2001 ADDRESS: 3105 Lone Tree Way#D BY DELIVERY TO CLERK ON: November 1.6, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 _ I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEEN, e k, Dated: November 19, 2001 By: Deputy_TV 1 ` r�- 11. FROM: County Counsel TO: Clerk of the Board of Supervisors ( OIfhis 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). �7ine'/v ililGOC.GBY1 D Dated: By: ��� Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (X) 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:\W CkwVI LCA y 1) I — JOHN SWEETEN, CLERK, By a- Alhj o'&V( , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen. of the United States, over age 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, addressedp to the claimant as shown above. Dated: q , I JOHN SWEETEN, CLERK B VIS y �l _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. THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 [ER 1 LAW OFFICES OF THOMAS G. McLAUGHLIN 2 3105 LONE TREE WAY, SUITE D 1 ANTIOCH, CA 94509 3 (925) 754-9900 SORS 4 Attorney for Claimant 5 CLAIM OF GILBERT GOMEZ JR. "AMENDED" 6 Claimant, CLAIM FOR PERSONAL IN.HJRIFS AND WRONGFUL DEATH DAMAt;�S 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA, 9 Respondent. 10 11 You are hereby notified that GILBERT GOMEZ JR., hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: .14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his rnotor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek: 15 Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County exercised reasonable 18 care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight distance approaching the 19 intersection and the presence of visibility obstructions along side the roadways. The 20 Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be maintained. Said 21 dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek. Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. MCI REVOLM e.�o At all times herein mentioned, claimant GILBERT GOMEZ JR was the minor son 1 of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 2 The damages sustained by.claimant, GILBERT GOMEZ JR, as far as known, as of 3 the date of presentation of this claim are personal injuries, wage loss, special damages, general damages and emotional distress damages as a result of witnessing injuries to other 4 relatives by GILBERT GOMEZ JR., and wrongful death damages for the death of his parents GILBERT GOMEZ SR and DANIELLE GOMEZ. 5 6 Jurisdiction of the claim.rests with the unlimited jurisdiction of the Superior Court of the State of California. 7 All further notices or other communications with regard to this claim should be sent 8 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone(925) 754-9900. 9 10 Dated:November 13 2001 `'�-- 11 THOMAS G. McLAUGIfILIN Attorney for Gilbert Gomez Jr. 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 nEcraFo CERTIFICATE OF SERVICE 1 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 2 true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13, 2001, I served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 12 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. .14 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 21 Executed on November 13, 2001 at Antioch, California. 22 RUTHIE RILEY EVA JS 23 24 25 26 necraEo A CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given C�I�II� Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown N O V 2 0 2001 COUNTY COUNSEL CLAIMANT: Irene Wright MARTINEZ CALIF. ATTORNEY: DATE RECEIVED: November 16, 2001 •Fi-�c���. e(os-(� ADDRESS: 3 BY DELIVERY TO CLERK ON: November 16, 2001 -7 Lf 3 �� rer��,/�V'e—BY MAIL POSTMARKED: November 13, 2001 Aitsburl,CC45105 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET r 4A �'1�! Dated: November 19, 2001 By: Deputy �- II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( his claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are 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). /!?GIGOy a. (;,)/OV-7 me (1.7rl/t �, ate/ Dated: �l��—d By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: �) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: IJOHN SWEETEN, CLERK, By _� Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: UJOHN SWEETEN, CLERK By Deputy Clerk t 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. Irene Wright RECEIVED 1 2840 Honeysuckle Circle 2 Antioch, CA 94509 NOV 16 2001 CLERK BOARD OF SUPERVISORS 3 CONTRA COSTA Co. 4 Attorney for Claimant 5 CLAIM OF IRENE WRIGHT, 11AMENDED11 6 Claimant, CLAIM FOR PERSONAL IN.HTRIES AND WRONGFUL HEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that IRENE WRIGHT, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages 12 from the County of Contra Costa, in the amount computed as of the date of presentation of 13 this claim as follows: 14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek 15 Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight 19 distance approaching the intersection and the presence of visibility obstructions along 20 side the roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek: Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. e.�o S I At all times herein mentioned, claimant IRENE WRIGHT was the mother of 1 DECEDENT GILBERT GOMEZ SR. 2 The damages sustained by claimant, IRENE WRIGHT, as far as known, as of the 3 date of presentation of this claim are wrongful death damages for the death of her son GILBERT GOMEZ SR. 4 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 5 of the State of California. 6 All further notices or other communications with regard to this claim should be sent 7 to Fredrick Webster, 3743 Railroad Avenue, Pittsburg CA 94565 telephone (925) 439- 9181. 8 9 Dated: November 13,2001 ✓ (/l 10 IRENE WRIGHT- Clai t Fredrick Webster, Attorney 11 12 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 necrc�o CERTIFICATE OF SERVICE 1 1, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 2 true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13, 2001, I served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County 12 of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. 14 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 15 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 () (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 n 21 Executed on November 13, 2001 at Antioch, California. 22 RUTHIE RILEY#VANS 23 24 25 26 RECnP LAW OFFICES OF THOMAS G. McLAUGHLIN 3105 Lone Tree Way,Suite D 1120 Second Street, Suite 101 Antioch,California 94509 Reply to Antioch Brentwood California 94513 Telephone(925)754-9900 Telephone(925)516-4717 Fax(925)756-6604 Fax(925)756-6604 November 13, 2001 County of Contra Costa Board of Supervisors 651 Pine Street Martinez, CA 94553 Re: Claim of Gomez Family against State of California Department of Transportation To Whom It May Concern: Enclosed herewith please find the original and one copy each of claims against the State of California Department of Transportation. Please file each original claim and return the endorsed copy to my office. Very truly yours, t�-� THOMAS G. McLAUGHL TGM:rre Enclosure V i r CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph.IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown NOV 2 0 2UU1 CLAIMANT: Brandee Gomez MARTIN MARTINEZZOALIFCALIFL . ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 16, 2001 ADDRESS: 3105 Lone Tree Way#D BY DELIVERY TO CLERK ON: November 16, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET Dated: �11®rvi Dated: November 19, 2001 By: Deputy i II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( its 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). (L4-'O ther: !,z�i rrlQ tt/ D���� / �����Gl�.c� © CL t>r An /fir Q� L✓� �y-�� Dated: �/r alb" By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its �minutes for this date. Dated: (I PLI(VI , �� JOHN SWEETEN, CLERK, By I�,J1 ;� ����`1{ t�'�l ��L- , Deputy Clerk --�,� WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with.this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have 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, addrressssend, t2o/1the claimant as shown above. Dated::�l�ll� -I r JOHN SWEETEN, CLERK By �,�'Lf VUV�J Deputy Clerk v 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. THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 RECEIVED 1 LAW OFFICES OF THOMAS G. McLAUGHLIN 2 3105 LONE TREE WAY, SUITE D Nov 16 2001 ANTIOCH, CA 94509 3 (925) 754-9900 CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. 4 Attorney for Claimant 5 CLAIM OF BRANDEE GOMEZ. "AMEND D" 6 Claimant, CLAIM FOR PF,RSONAI. IN.TIJR[ES AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that BRANDEE GOMEZ, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: .14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek 15 Road. Also in this vehicle.being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable.care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate: sight 19 distance approaching the intersection and the presence of visibility obstructions along 20 side the roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. At all times herein mentioned, claimant BRANDEE GOMEZ was the minor 1 daughter of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 2 The damages sustained by claimant, BRANDEE GOMEZ, as far as known, as of 3 the date of presentation of this claim are personal injuries, wage loss, special damages, general damages and emotional distress damages as a result of witnessing injuries to other 4 relatives by BRANDEE, and wrongful death damages for the death of her parents GILBERT GOMEZ SR and DANIELLE GOMEZ. 5 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court of the State of California. 7 All further notices or other communications with regard to this claim should be sent 8 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone(925) 754-9900. 9 10 Dated: November 13, 2001 11 THOMAS G. McLAUGH Attorney for Brandee Gomez 12 13 a 14 15 16 17 18 19 20 21 22 23 24 25 26 RECVCM '"FA e' CERTIFICATE OF SERVICE 1 I, RUTHIE RILEY.EVANS, declare under penalty of perjury that the following facts are 2 true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13, 2001, I served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X ) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 12 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. .14 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 15 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 () (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 _ County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 21 \ Executed on November 13, 2001 at Antioch, California. 22 RUTHIE RILEY tVANS 23 l 24 25 26 PIcYCM i - . ,� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and R7.(r1311V[EM) 915.4. Please note all "Warnings". AMOUNT: Unknown NOV 2 0 2001 CLAIMANT: Marcella Gomez CORTIN COUNSEL MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin .: DATE RECEIVED: November 16, 2001 ADDRESS: 3.105 Lone Tree Way#D BY DELIVERY TO CLERK ON: November l6, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE " 1 r , Dated: _ November 19, 2001 By: Deputy � i M/ 6 II. FROM: County Counsel TO: Clerk of the Board of Supervisor (-Tiis 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). ( �, her: 1'I�i C( CJ�/eel O�'I Dated: �� �� �� By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator (2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: �) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. l' Dated,L,o Q/Y4l W3,-p - I L JOHN SWEETEN, CLERK, By � Vti �- rf � , Deputy Clerk WARNING (Gov. code section 913) Subject to certairi exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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 q,01 ,01 JOHN SWEETEN, CLERK Byj�� U�' �/� 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. THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 RECD ..._.- 1 LAW OFFICES OF THOMAS G. McLAUGHLIN NOV 1 6 3105 LONE TREE WAY, SUITED 2001 2 ANTIOCH, CA 94509 CLERK BOARD OF SUPERVISORS (925) 754-9900 CONTRA COSTA Co. 3 4 Attorney for Claimant 5 CLAIM OF MARCELLA GOMEZ "AMF,NDFD" Claimant, CLAIM FOR PERSONAL iNHJRIFS 6 AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA, 9 Respondent. 10 11 You are hereby notified that MARCELLA GOMEZ, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of presentation of this claim as follows: 13 14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek 15 Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez., Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 1 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight 19 distance approaching the intersection and the presence of visibility obstructions along side the roadways. The Respondent, County of Contra Costa also negligently constructed 20 and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. At all times herein mentioned, claimant MARCELLA GOMEZ was the minor 1 daughter of decedents GILBERT GOMEZ SR and DANIELLE GOMEZ. 2 The damages sustained by claimant, MARCELLA GOMEZ, as far as known, as of 3 the date of presentation of this claim are personal injuries, wage loss, special damages, general damages and emotional distress damages as a result of witnessing injuries to other 4 relatives by MARCELLA GOMEZ, and wrongful death damages for the death of her parents GILBERT GOMEZ SR and DANIELLE GOMEZ. 5 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court of the State of California. 7 All further notices or other communications with regard to this claim should be sent 8 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone(925) 754-9900. 9 10 / Dated:November 13, 2001 0� .-Mc !� 11 THOMAS G. McLAUG LIN Attorney for Marcella Gomez 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 aEcra.Eo 1. CERTIFICATE OF SERVICE 1 2 1, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13, 2001, 1 served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X ) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County 12 of Contra Costa, State of California 1013a(3) Rev. 5/1/88. , 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. .14 15 () (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 () (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 , 21 Executed on November 13, 2001 at Antioch, California. 1 c e G 22 RUTHIE RILEY EVANS 23 24 25 26 _ ONCLAIIVI C a8 BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown N O V 2 U ?illi COUNTY COUNSEL CLAIMANT: Diana Douglas MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 16, 2001 ADDRESS: 3105 Lone Tree Way#D BY DELIVERY TO CLERK ON: November 16, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET r Dated: November 19, 2001 _ By: Deputy _ UY lt II. FROM: County Counsel TO: Clerk of the Board of Supervisors (O,Tfits 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: 0 Dated: �� By: L_�7Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (X) 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. 1 n� ( Dated: @�/VV1k�f11 , �� JOHN SWEETEN, CLERK, By �U� , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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: ��' �r 01 JOHN SWEETEN, CLERK By (( �� 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. THOMAS G. McLAUGHLIN,ESQ., CSB#: 71904 1 LAW OFFICES OF THOMAS G. McLAUGHLIN �CE� D 2 3105 LONE TREE WAY, SUITE D ANTIOCH, CA 94509 NOV 16 2001 -3 (925) 754-9900 CLERK BOARD OF SUPERVISORS 4 Attorney for Claimant CONTRA cosTA co. 5 CLAIM OF DIANA DOUGLAS "AMENDED" 6 Claimant, C'I.AIM FOR PERSONAL IN.HJRIF:fi AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that DIANA DOUGLAS, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims damages 12 from the County of Contra Costa, in the amount computed as of the date of presentation of 13 this claim as follows: 14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creel: 15 Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Goraez, Marcella Gomez; Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight 19 distance approaching the intersection and the presence of visibility obstructions along 20 side the roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or -failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek: Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. RECYCLED At all times herein mentioned, claimant DIANA DOUGLAS was the mother of 1 decedent DANIELLE GOMEZ. 2 The damages sustained by claimant, DIANA DOUGLAS, as far as known, as of the 3 date of presentation of this claim are personal injuries, wage loss, special damages, general damages, and emotional distress damages as a result of witnessing injuries to other relatives 4 by DIANA DOUGLAS, and wrongful death damages for the death of her daughter DANIELLE GOMEZ. 5 6 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court of the State of California. 7 All further notices or other communications with regard to this claim should be sent 8 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone(925) 754-9900. 9 10 . Dated:November 13, 2001 11 THOMAS G. McLAUGHL Attorney for Diana Douglas 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 nEcrct,EO CERTIFICATE OF SERVICE 1 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 2 true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. e 6 On November 13, 2001, 1 served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 12 13 ( ) (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. .14 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 15 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission.to the 17 following number(s) and a hard copy to.follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 21 Executed on November 13, 2001 at Antioch, California. tiU- 22 RUTHIE RILEY tVANS 23 24 25 26 pE�YC1.ED 1Alec _ CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dee 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown NOV 2 0 2001 CLAIMANT: Ray Wayne Douglas COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 16, 2001 ADDRESS: 3105 Lone Tree Way#D BY DELIVERY TO CLERK.ON: November 16, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET"t ; -- Dated: November 19, 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors (t)-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 tim.ely 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 presenta late claim Section 911.3). (Other: 617e 1V D/? IV /�IJLI U/' D/7 Dated: �� ;0- 9/ By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (X) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order e�n�terre,d in its minutes for this date. z Dated: 0 /yo�Zj4 q . 0 I JOHN SWEETEN, CLERK, By_' 1,'VU �j I �l/b'L- , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have 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. �e(� 11�N1 �� JOHN SWEETEN, CLERK By )/ �;�� Oa4A- Dated: 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. ••ti THOMAS G. McLAUGHLIN, ESQ., CSB#: 71904 1 LAW OFFICES OF THOMAS G. McLAUGHLIN 2 3105 LONE TREE WAY, SUITE D RECEIVED ANTIOCH, CA 94509 3 (925) 754-9900 NOV 16 2001 4 Attorney for Claimant CLERK BOARD OF SUPERVISORS Y CONTRA COSTA CO. 5 CLAIM OF RAY WAYNE DOUGLAS "AMENDED" 6 Claimant, CLAIM FOR PERSONAL IN.111RIF.S AND WRONGFUL DEATH DAMAGES 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA 9 Respondent. 10 11 You are hereby notified that RAY WAYNE DOUGLAS, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: 14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek 15 Road. Also in this vehicle being operated by Gilbert Gomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 16 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight 19 distance approaching the intersection and the presence of visibility obstructions along 20 side the roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 o act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 ailed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 he public employees causing claimant's damages are unknown. At all times herein mentioned, claimant RAY WAYNE DOUGLAS was the 1 husband of DIANA DOUGLAS and the father of decedent DANIELLE GOMEZ. 2 The damages sustained by claimant, RAY WAYNE DOUGLAS, as far as known, 3 as of the date of presentation of this claim are loss of consortium and special damages as to injuries sustained by DIANA DOUGLAS, and wrongful death damages for the death of his 4 daughter DANIELLE GOMEZ. 5 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 6 of the State of California. 7 All further notices or other communications with regard to this claim should be sent to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, 8 CALIFORNIA 94509 telephone(925) 754-9900. 9 10 Dated:November 13, 2001 THOMAS G. McLAU L 11 Attorney for Ray Wayne Douglas 12 13 .14 15 16 17 18 19 20 21 22 23 24 25 26 CERTIFICATE OF SERVICE 1 2 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13, 2001, I served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X ) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon. 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County 12 of Contra Costa, State of California 1013a(3) Rev. 5/1/88. 13 ( ) (By Hand) I placed a true copy thereof.enclosed in a sealed envelope. I caused such envelope to be delivered to.the offices of the addressee. .14 15 ( ) (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 () (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa-Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 21 Executed on November 13, 2001 at Antioch, California. - 22 RUTHIE RILEY EVANS 23 24 25 26 nEcrc�c CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Dec 4, 2001 Claim Against the County, or District Governed by ) the Board of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to ) The copy of this document mailed to you is your California Government Codes. ) notice of the action taken on your claim by the Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and 915.4. Please note all "Warnings". AMOUNT: Unknown NOV 2 0 2001 COUNTY COUNSEL CLAIMANT: Joseph F. Garcia MARTINEZ CALIF. ATTORNEY: Thomas McLaughlin DATE RECEIVED: November 16, 2001 ADDRESS: 3105 Lone Tree Way#D BY DELIVERY TO CLERK ON: November 16, 2001 Antioch, CA 94509 BY MAIL POSTMARKED: November 13, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETPjlejk�b, IDated: November 19, 2001 By: Deputy ` It. FROM: County Counsel TO: Clerk of the Board of Supervisors ` Q-'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). �J ( Other: 7 rn-2 ��/ D�r/� l /yl C4d�` 6 O o't Oe- Dated: ✓Dated: By: ��9�k�- Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant (Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( 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:UN&QA y M JOHN SWEETEN, CLERK, By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6) months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 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. 1i�_ ^ � Dated: e �nl 1 1 y, JOHN SWEETEN, CLERK By % 'l�v't ( 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. THOMAS G. McLAUGHLIN, ESQ.,CSB#: 71904 REGETtv 1 LAW OFFICES OF THOMAS G. McLAUGHLIN 3105 LONE TREE WAY, SUITE D N0V 1 6 2001 2 ANTIOCH, CA 94509 3 (925) 754-9900 CLERK13O CONRR°o TAP 4 Attorney for Claimant 5 CLAIM OF JOSEPH F. GARCIA 'AMENDED' 6 Claimant, CLAIM FOR PERSONAL IN.HJRIFS AND WRONGFUL DEATH DAMAC.FS 7 (Government Code Section 910) against 8 COUNTY OF CONTRA COSTA, 9 Respondent. 10 11 You are hereby notified that JOSEPH F. GARCIA, hereinafter described as claimant, whose address is 2840 Honeysuckle Circle, Antioch, California 94509 claims 12 damages from the County of Contra Costa, in the amount computed as of the date of 13 presentation of this claim as follows: 14 On or about May 6, 2001, Decedent Gilbert Gomez Sr., was operating his motor vehicle along and up said Highway 4, approaching its intersection with Marsh Creek 15 Road. Also in this vehicle.being operated by GilbertGomez Sr., were Danielle Gomez, Marcella Gomez, Brandee Gomez, Gilbert Gomez Jr., and Diana Douglas. The roadways 6 at the intersection of Highway 4 and Marsh Creek Road were in a dangerous condition 17 which could not be determined by Gilbert Gomez Sr., but which were known or could have been known by the County of Contra Costa, had the County of Contra Costa 18 exercised reasonable care and diligence in the construction and maintenance of the roadway. The dangerous conditions included but are not limited to lack of adequate sight 19 distance approaching the intersection and the presence of visibility obstructions along 20 side the roadways. The Respondent, County of Contra Costa also negligently constructed and maintained the roadway such as to create and allow the hazards to exist and be 21 maintained. Said dangerous condition was not trival and created a substantial risk of injury or harm to people using the roadways. 22 As a direct and proximate result of the dangerous conditions and actions or failure 23 to act, of the respondent, Justin Nave, who was driving his vehicle on Marsh Creek Road 24 failed to notice and stop at the intersection of Highway 4 and Marsh Creek Road for the vehicle being operated by Gilbert Gomez Sr., and collided with the vehicle causing the 25 death of Gilbert Gomez Sr., and Danielle Gomez, and causing injuries and damages to Gilbert Gomez Jr., Diana Douglas, Marcella Gomez and Brandee Gomez. The names of 26 the public employees causing claimant's damages are unknown. At all times herein mentioned, claimant JOSEPH F. GARCIA was the father of 1 DECEDENT GILBERT GOMEZ SR. 2 The damages sustained by claimant, JOSEPH F. GARCIA, as far as known, as of 3 the date of presentation of this claim are wrongful death damages for the death of his son GILBERT GOMEZ SR. 4 Jurisdiction of the claim rests with the unlimited jurisdiction of the Superior Court 5 of the State of California. 6 All further notices or other communications with regard to this claim should be sent 7 to THOMAS G. McLAUGHLIN, 3105 LONE TREE WAY, SUITE D, ANTIOCH, CALIFORNIA 94509 telephone(925) 754-9900. 8 9 Dated: November 13, 2001 10 THOMAS G. McLAU6 LIN Attorney for Joseph F. Garcia 11 12 13 14 15 16 17 18 .19 20 21 22 23 24 25 26 CERTIFICATE OF SERVICE 1 I, RUTHIE RILEY EVANS, declare under penalty of perjury that the following facts are 2 true and correct. 3 I am a citizen of the United States, over the age of 18 years, and not a party to, or 4 interested in the within entitled action. I am an employee of the Law Offices of THOMAS G. McLAUGHLIN, and my business address is 3105 Lone Tree Way, Suite D, Antioch, California 5 94509. 6 On November 13,2001, I served the within: 7 AMENDED CLAIM FOR PERSONAL INJURIES AND WRONGFU DEATH 8 DAMAGES (GOVERNMENT CODE SECTION 910) 9 on all interested parties in said cause, by delivering a true copy as follows: 10 (X) (By Mail) I placed a true copy thereof enclosed in a sealed envelope with postage thereon. 11 fully prepaid. I deposited said envelope in the United States Mail in the City of Antioch, County of Contra Costa, State of California 1013a(3) Rev. 5%1/88. 12 13 () (By Hand) I placed a true copy thereof enclosed in a sealed envelope. I caused such envelope to be delivered to the offices of the addressee. .14 () (By Federal Express) I sent a true copy thereof enclosed in a sealed envelope to be 15 delivered to Federal Express for overnight courier service to the office(s) of the addressee(s). 16 ( ) (By Facsimile) I sent a true copy thereof via telephone facsimile transmission to the 17 following number(s) and a hard copy to follow by mail. 18 Each envelope (if applicable) was addressed as follows: 19 County of Contra Costa- Board of Supervisors 20 651 Pine Street, Martinez, CA 94553 21 , Executed on November 13, 2001 at Antioch, California. 22 RUTHIE RILEY E ANS 23 24 25 26 Facrcm APPLICATION TO FILE LATE CLAIM f, BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY, CALIFORNIA BOARD ACTION Dec 4, 2001 Application to File Late Claim ) NOTICE TO APPLICANT Against the County, Routing ) The copy of this document mailed to you is your Endorsements, and Board Action. ) notice of the action taken on your application by (All Section References are to ) the Board of Supervisors (Paragraph III, below), California Government Code.) � C �1I�l�Ten pursuant to Government Code Sections 911.8 and .4. Please note the "WARNING" below. N O V 15 2001 Claimant: Andre's Williams COUNTY COUNSEL Attorney: None MARTINEZ CALIF. Address: High Desert State Prison Fac C Bid 8 Cell 126 P.O. 3030 Susanville, CA 96127 Amount: $2512.87 By delivery to Clerk on November 13. 2001 Date Received: November 13, 2001 By mail, postmarked on November 8, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late DATED: November 13, 2001 JOHN SWEETEN, Clerk, ByCl n // I uty Clerk II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim (Section 911.6). (0---�The Board should deny this Application to File Late Claim (Section 911.6). DATED: 11-11-el SILVANO MARCHESI, County Counsel, By ''� �/ aVVC---Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted (Section 911.6). (�►� This Application to File Late Claim is denied (Section 911.6) 1 certify that this is a true and correct copy of the Board's Or r enteed in its minutes for this date. DATE: (� /IM1,aQ/1 JOHNSWEETEN, Clerk, By �/� �/��/� Deputy Clerk WARNING (Gov. Code §911.8) If you wish to file a court action on this matter, you must first petition the appropriate court for an order relieving you from the provisions of Government Code Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be filed with the court within six (6) months fsrom the date your application for leave to present a late claim was denied. You may seek the advise of any attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. IV. FROM: Clerk of the Board TO: (1) County Counsel (2) County Administrator Attached are copies of the above Application. We notified the applicant of the Board's action on this Application by mailing a copy of this document, and a memo thereof has been filed and endorsed on the Board's copy of this Claim in accordance with Section 29703. DATED: WWI�(.LQ/l �, ()�JOHNSWEETEN, Clerk, By� 1 1 V��L'l`11 Deputy Clerk V. FROM: (1) County Counsel (2) County Administrator TO: Clerk of the Board of Supervisors Received copies of this Application and Board Order. DATED: County Counsel, By County Administrator, By APPLICATION TO FILE LATE CLAIM 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. r ' ----- .. __._ �_c2, _�c x__3030_-------------- - —-- -•------- _ ---RECEIVE11- NOV 1- 3 2001 CLERK BOARD OF Sl_`� — --- CONTRA C(-.%-.. -- ---- —aY1�fES�GyY.tCvl—_ lA_;�1I;:gYtt�- -- ----•— ----- --- --d�C`�-rO_�)- '�c��.__I('ltv�i.J�_ ��E�Er(� �Q�!E.C1cuYo- — -- -- C —STC Y_1C.15--- 'S--rQCI LtL?S�=n4_ C� l_FQVi_- _t�—f� S_Q•vc _ct_1Cf _.0 �CtiVt��_..1 G ! 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Tc� __ ._.. __ Jam. _ _ _ _ _ r :i'f.1TE OF CALIFORNIA � DEPARTMENT OF CORRECTIONS RULES VIOLATION REPORT—PART C Page 2 of 2 CDC NUMBER INMATE'S NAME LOG NUMBER INSTITUTIONTODAY'S DATE; K35000 WILLIAMS FD-01-05-0041 HDSP July 27, 2001 ❑41PPI.ENIFNIA1: 0 CONTiNUAT1ON OF ❑ 115 C:IRCUNISTANCES 0 11EARING ❑ I.E.REPORT ❑0.1.11F:R: participating or attempting to-participate as .an active member of such a group. If f1lis offense involves one group attacking another group, this charge applies to the victims of attack if those victims refused to comply with orders or, by their actions, promoted continued violence. The circumstances of the violation were read to WILLIAMS. He acknowledged understanding the charge filed against him. WILLIAMS pled NOT. GUILTY to that charge and stated, "I was attacked by Broadway and McDowell, I had to defend myself." FINDINGS- All INDINGSAll evidence was considered during this hearing. The preponderance of that evidence as described Here in supports a finding of NOT GUILTY of the charge, Participation in a Riot a Division D offense, which:is in violation of CCR Section 3005 (c). The preponderance of that evidence as described here includes the contents of the disciplinary report. In which Officer J. Petersen stated, "On Wednesday, May 30, 2001, at approximately 1435 hours, while performing my duties as D-1 Floor Officer #2, 1 was covering the yard from the yard from D-1 Control Booth, during yard release. I observed (3) three inmates later identified as WILLIAMS K35000 D4-2021J and Inmate McDOWELL E52400 D4-203L and Inmate BROADWAY K36798 D3-120U involved in an altercation in front of D-4, next to the metal tables. I observed all three inmates repeatedly strike each other with closed fists to the head and upper torso area. I utilized my public address system and ordered the three combatants to "get down" three times which was met with negative results. The altercation continued in spite of my verbal warning, which necessitated me to use my state issued 37MM Launcher serial # LS-2579. I fired one 265 CN round ten feet in front of the combatants. The inmates continued to fight after the 265 Skat shell discharged. Again I used my public address system and ordered the three combatants to get down three times which was metwith negative results. The altercation continued inspite of my verbal warnings, which necessitated me to fire a second 265 Skat shell. And the attached CDC-7219 report included in CDC-837 log #HDF'-FDO-01-05- 0250, compiled by medical staff which indicates the injuries to WILLIAMS were consistent with the actions described in this Rules Violation Report. Based on the evidence presented, WILLIAMS was the victim of this assault, and acted in self-defense. DISPOSITION: WILLIAMS and BROADWAY K36798 and McDOWELL E52400 are to be considered enemies. Their respective CDC-812's shall be up-dated appropriately. Charges dissmissed. ADVISEMENT OF RIGHTS OF APPEAL: Inmate WILLIAMS was advised that he would receive a copy of this completed report upon final review and audit by the Chief Disciplinary Officer. He was also advised that he may appeal any portion of the hearing or the findings of the SHO. He was further advised that he must attach the final copy of the 115 to the appeal and submit it for second level review and action. SIGNATURE OF WRITER DATE SIGNED R. Plainer, Correct onal Lieutenant July 27, 2001 ;2k,COPY OF CDC-115 GIVEN TO INMATE GIVEN BY STAFF SIGNA'1URE: DATE SIGNED TIME SIGNED Y/3 f r��a CDC-115-C F Qo0j� September 24, 2001x�r State of California Victim Compensation and Government Claims Board Government Claims Branch P.O. Box 3035 Sacramento, CA 95812-3035 (800)-955-0045 ATSS (916)-323-3564 Andres Lamon Williams K35000 P O Box 3030 Susanville, CA 96127 RE: Claim G518933 for Andres Lamon Williams, K35000 Tort claim for No Jurisdiction,Not a State Agency Dear M. Williams: The Victim Compensation and Government Claims Board (Board ) received your claim on September- 13, 2001. eptember•13, 2001. We have reviewed your claim and determined that the Board has no jurisdiction to consider the claim for the following reason(s): The entity that you allege caused the damages or injuries is not a State Government Agency. The State of California has no jurisdiction over Contra Costa County Sheriff. The Board will take no further action on your claim. If you have questions about this matter, Blease mention letter reference 97 and claim number G518933 when you call or write your claim technician/analyst at (800)-955-0045. Sincerely, Government Claims Branch Victim Compensation and Government Claims Board cc: SBOC Staff Ltr 97 No Jurisdiction OFFICE OF THE SHERIFF CONTRA COSTA COUNTY WARREN E.RUFF,SHERIFF-CORONER FORENSIC SERVICES DIVISION PROPERTY SERVICES 401 ESCOBAR STREET,MARTINEZ,CALIFORNIA 94553 (925)646-2453 FAX(925)646-1611 September 14, 2001 Andre Williams/K-3500 High Desert State Prison Facility C Bld 1 #227 P.O. Box 3030 Susanville,CA 96127-3030 Re: CCCSO Case# 99-16124 Dear Mr. Williams, Enclosed is a claim form that must be filled out and sent to the Clerk of the Board of Supervisors (address highlighted in yellow). I am returning your forms to you so that they may accompany your claim form. If you have further question or inquiries you may contact our office at the address listed above. Sincerely, Specialist A. Commiskey Property Services Supervising Attorneys Pubkc Defender k.,ontra Costa Suzanne J.Chapot 800 Ferry Street Martinez Martinez, California 94553-1626H.Kenneth Doth6e 925-335-8000 County Martinez »r:e. Jack Funk <'�' ;- •. ,•' Martinez David C. Coleman a ,: �, Public Defender Michael J.Kotin Richmond Susan A. H6t6h& ". Richmond OCT. 27,2000 ' MS. DOROTIJY WILLIAMS �Y 1900 COMMERCE WAY, APT. E OAKLAND, CA. 94606 DEAR IVIS. WILLIAMS, ENCLOSED PLEASE FIND AN ORDER TO THE CONTRA COSTA SHERIFF'S DEPTI' ALLOWING V-)U TO OBTAIN ANDRE'S PROPERTY. YOU WILL NEED TO TAKE TiiiS�?r ORDER A q) 1DF.,NTI.FICA.HON FOR YOURSELF TO THE SHERIFF'S PROPERTY OFFICE; , '401 ESCOBAR STREET, MARTE EZ, DURING NORMAL BUSINESS HOURS. THEY WILL;": TREN RELEASE HIS PROPERTY TO YOU. I FAXED T:IEM. A COP" 09F THIS ORDER ONS,: . TODAY'S DATE. Very trul ours l t _ DAN CLARK DEPUTY PUBLIC DEFENDER ;•r�..':''Y. i y' tti•' " • n; ii I I Li � I 1 lJ _ _ b I� 7 Ii i 8 IN THE SUPERIOR COURT OF THE STATE OF CALIFORNIA IN AND FOR THE COUNTY OF CONTRA COSTA r. !:"1'HE PEOPLE, Ul~ 'FHE STAI E OFC 3 N.- L1t OK1 '1, i N o. 5-6 0003 7-5 10 11 v ORDER FOR RETURN OFV. V?? ; PROPERTY `� ' ,I 12 ANDRES LAMONT WILLIAMS, .k 13 yrr .F< — Defendant. 14 I l TO: WARREN E. RUPF, SHERIFF/CORONER OF CON-FRA COSTA.COUNTY, APD, ALUs f� ,1]S EFi TIES: d.16 F. IS Hf.-REB Y ORDERED that the following property to wit: THREE NECKLACES; ;.: 11 YELLOW METAL, ONE WITH CHAINS BROKEN. ONE PENDANT, YELLOW METAL. �a ONE WATCH "FOSSIL". ONE RING, YELLOW METAL,`V/WHITE STONE. TWO SILVEF, 19 -)p HALF DOLLARS, ONE DATED 1944 AND ONE DATED 1949. ONE PAIR PAN S "GAP y ;.. BEIGE. ONE SIiIRT "GAP" PLAID, BROWN AND WHITE. ONE PAIR "NEW YORK SHOE"--, 2 S'. 11 CO.", "L,UTZ", SIZE 11, obtained from the defendant in the above-captioned case, by officers of ` d the CONTRA COSTA St IERIFF'S DEPT., case number-99-16124, be returned to THE ?4 Y' 25 1 DEFENDANT'S MOTHER, DOROTHY WILLIAMS, forthwith, uponpresentation of this.order.-- -6 Dated: 8 i! JOHN C. MiNNEY Documen[13,K• r� r;: Tay`_— Cin _ Case File — =Fr• Process for print✓ O*her }:.v Cr-�-: _ Suspect.— Description uspect — _ Description of property 1 „-I z" �� I o. '\i C,T I— S I��..L�1rL`L1L����`? ' SalU.$ T n. [:4_�_.taa,�V'�r__�� y -; 1' Il✓... A.l.�)_t l..I/3TC._ ____ — , LT F X11 ` —Name of Owner Phone — ,ti Address _�w tx Officer /�&_, r-0 Dep!.9L :�• Date_'-1 �-" ;4 Claimed by Owner. JDate tl`fIOT GY7 tl F RERvORD CONTRA COSTA COUNTY a SHERIFF'S OFFICE CL-t 30 FORENSSC SERVICES DIVISION-PROPERTY SERVICES SECTION :Iv LL NA man` M oO o o� 10 -a ID cao� E . i z vU ��- O c �Ecqa Ln � Z l 1„ ' � `r l� a a �z v l A71 occ -� I i LL l4 I? 3;r,t lag_ Bin f Case rife P i j"6ss for prints __ Other :. rirra i� �. � � - Suspect C iLk- At,k., ra C -—. ci property13 ':� �. ` r j r 3 `-�I r_—,�.•—.,D t.::G'�nom., ' _...__._- • ':<« Name of Owner 'y T�Y — Phone_ — j'y+ ; '` Add ess Offscer�_�'` Dept. rr-,.gip Date L� .w. GaBmed by Owner Date PROPERTY RECORD - -�? CONTRA COSTA COUNTY - SHERIFF'S OFFICE ) �5.'• '�• ..,,�i. K...-730 FORENSIC SERVICES DlYl5lON-PROPERTY SERVICES SECTION *l t} LO, ? c j, < n. O d w+ W m iso b • Q` r a a> 00 (L Ln Q o a: v) o 01 n + I z p LL E 'Claim to: . BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY i INSTRUCTIONS TO CLAII�2,4NT 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's 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 A ) Against the County of Contra Costa or ) District) (Fill in name) ) The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named district in the sum of$'z512, S. 7 and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) t �. D Un?cQ /10 /2 340 a 2. Where.did the damage or injury occur? (Include city and county) L�4/ �',f Cobar S,f- ��Q (`�ifJ2•'e:Z, — �.o����, C�.s=1-� CoUnt y1 3. How did the damage or injury occur? (Give full details; use extra paper if required) (};1 y Pe:CS -pr " r 046, > $,en ck6 ev a -ravdy < A44-on"r 4�5ke f6r can cr(G-r- <1<,r` rr,� Qecs�n�i Pio b.0 tsiz efc cc X 6vuQ -qAa::Y); . �Coeu Aor6 [z-n+M,�. esonc: 1 ( a( ' �S soi�� G . 4061) Jtlitnk v: Q MAr evSffn.;gK� Pfo�• Q, a m� Q'E?fS�1�� Qr'6(7:er1 is:cam, 5�1'. �rer�Av-e)N , As Yov coy sw fia� `A, "Ace:' p cfer W,vv, . 4. ,What;particular act or omission on the part of county or district officers, servants, or employees caused the injuryor damage? �.c�ur�4�{ e MQ 1 oA{e55 Sol. rny' n a 0 1,01- Z.G - D 3 yel (pur v,r Wag ct.,u e:-i•i!o.rl e - eC��� }', C- 1" S. What are the names of county or district officers, servants, or employees causing the damage or injury? (0.LA r�c��. C�efe�� o 41 Q:.hecv> 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or e. dams ' g ) -�2�re��1 P'���'�Q5 �oar �•i -e-c. 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TIME AMOUNT ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf." SEND NOTICES TO: (Attorney Name and Address of Attorney ) (Claimant's Signature) yi-35000 / P,o. 030 (Address) s�s�nv Ilex ,LA 961 z'7 - 3g3za ) Telephone No. )Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defraud,presents for allowance or the payment to any state board or officer,or to any county,city,or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account, voucher,or writing,is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand(S 1,000),or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars($10,000),or by both such imprisonment and fine. cv J <�16 } tY� .. b O M