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HomeMy WebLinkAboutMINUTES - 01082002 - C3 CLAII4I BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan $. 2002 C, an 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: $15,000 CLAIMANT: Joseph Johnson ATTORNEY: DATE RECEIVED: December 4, 2001 ADDRESS: 220 California St#838 BY DELIVERY TO CLERK.ON: December 4 2001 Rodeo, CA 94572 BY MAIL POSTMARKED: November 30 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: December 4 2001 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors C> is claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.8). ( ) Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). ( ) Other: Dated: 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: (�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 its minutes for this date. Dateda 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:`j` v u' `� ��� � �` #. JOHN SWEETEN, CLERK By � t� ' ,>' Deputy Clerk �, t .laim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAIIVIA.NT 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 presenters not later than.the 100th day alter 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,either by mail or in person.. 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 filets 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 Joseph Johnson \ prr i c J Against the County of Contra Costa or DEC 0 The Housing Authority of Contra Costa District ' Gill in name) u..._..._. *. . w The undersigned claimant hereby makes claim against the County of Contra Costa or the above-named District in the sum of$ !�2 and in support of this claim represents as follows: 11 1. When did the damage or injury occur? (Give exact date and hour) 22c> 2. Where did the damage or injury occur? (Include city and county) . ice %r - -r",... ,eke„ �" Ia6. C,-,f15c C�,i +.00 fXA\ `s �i- a t 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? clmform 5. What are the names of county o district offers, servants or eAlployees causing the damage or injury? 6. What damage or injuries do you claim resulted.? (Give full extent of injuries or damages claimed.. Attached two estimates for auto damage.) 7. How vas the amount claimed above computed? (Include the egimated amount of any f, prospective injury or damage.) A o , V , A 8. Names and addresses of witnesses, doctors and hospita1s. y E r' 9. hist the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT �.� 't'Y-`•iit `,- � iAe'rc:. �y lr`s',<.�� �,-.�...4 � t-'s�'3.,.. f �kf�" L,.,�.`� ,�'C. .y.t.yy yy y,y yy y.y yy yY.yy yy y.Eyy yy yy..LL ma�yy,,yy yy.W{.y/rrdd.. WW yy yyyy yy-.i..LL yy..,by yy..`4L'�yy yy..LL'.`yy yyy}yyn..yy ySa,,..ff..yy SaL..yys'�,yy,�ii..yy�:;WW�yy'WW yy �yy�y.L yyyd,y.4 y,yy�yL�•„9, .-x`1-'�. . TT TTTTTTTTTT TTT TTTTTT�TT��T4"TTTTTTTT T'F�T�T MKT TT T"F`T"T 9"�TFTTTT"F�T°1`•PT TT'1"TTT�� "}� 1fy'3 F � Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf." Name and Address of Attorney kl� f 9-4x4 C- (Claimaht'sSignature) (Address) Telephone No. Telephone No. k Y NOTICE Section 72 of the Penal Cede provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000)or by both such imprisonment and fine." CIMfor m CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 8,2002 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 a�:5 nF Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and D E C 1 01 915.4. Please note all "Warnings". Nsv CO:_;'c; AMOUNT: Unknown vF t ;zAL CLAIMANT: Cynthia Lang & Samantha Lang Wolfe ATTORNEY: Stan Casper DATE RECEIVED: December 6, 2001 ADDRESS: 2121 N. California Blvd#1020 BY DELIVERY TO CLERK ON: December 6, 2001 Walnut Creek, CA 94596 BY MAIL POSTMARKED: December 4_2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET-g' Dated: December 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. CDated, ' t 5 r' �' r` < )„6��JOHN SWEETEN, CLERK, By E, E � `; Deputy Clerk WARIv'ING (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 prepai4 certified copy of this Board Order and Notice to Claimant addressed to the claimant as shown above. Dated: s JOHN SWEETEN, CLERK By Deputy Clerk KE 4 Stan Casper(State Bar No. 56705) DEC 0 6 2001 Casper, Meadows & Schwartz 2121 N. California Blvd., Suite 1020 131 EPxBOAR] Ur�v{ Walnut Creek, CA 94596 '' CO, Tel: (925) 947-1147 Fax: (925) 947-1131 Attorneys for Claimants, CYNTHIA LANG and SAMANTHA LANG WOLFE, by and through her Guardian Ad Litem, Dylia Klatt CLAIM AGAINST THE COUNTY OF CONTRA COSTA TO : Board of Supervisors County of Contra Costa 651 Pine Street, Room 106 Martinez, California 94553 CLAIMANT'S NAME CYNTHIA LANG (mother of Decedent, Harlan "Chris" Lang, D.O.B. 06/09/61; D.O.D. 06/08/01) SAMANTHA LANG WOLFE (daughter of Decedent, Harlan "Chris" Lang, D.O.B. 06/09/61; D.O.D. 06/08/01)by and through her Guardian Ad Litem Dylia Klatt CLAIMANT'S ADDRESS CYNTHIA LANG 709 Citrus Avenue Concord, CA 94518-2308 SAMANTHA LANG WOLFE 132 Penbroke Drive Penfield,NY 14526 CLAIMANT'S TELEPHONE : CYNTHIA LANG (925) 827-2052 SAMANTHA LANG WOLF (716) 377-0039 Page 1 AMOUNT OF CLAIM : In an amount exceeding the jurisdiction of the Superior Court ADDRESS TO WHICH NOTICES ARE TO BE SENT Stan Casper, Esq. Casper, Meadows & Schwartz 2121 N. California Blvd., Suite 1020 Walnut Creek, CA 94596 DATE OF OCCURRENCE : June 7, 2001 PLACE OF OCCURRENCE Contra Costa Regional Medical Center Contra Costa County, Martinez, California HOW DID CLAIM ARISE: On or about June 7, 2001, Claimants' son and father(Decedent) Harlan "Chris" Lang (D.O.B. 06/09/61) was brought to the Contra Costa Regional Medical Center, Mental Health Services, on two separate occasions. "Chris" Lang was released on both occasions without proper assessment, diagnosis, or treatment, the second time occurring no more than approximately one and one-half hours after he had been previously released. On the second occasion, "Chris" Lang was medically cleared to the County Jail in Martinez. The staff at the medical center was well acquainted with "Chris" Lang's history of mental illness, including,but not limited to,bipolar disease, drug abuse, and severe obstructive sleep apnea, which required a CPAP (Continuous Positive Airway Pressure) device at all times if he was to avoid life-threatening complications. Decedent "Chris" Lang was found dead in the Martinez Detention Facility Intake Area, (Room 9) approximately 12 hours later, on June 8, 2001. The County of Contra Costa and the other defendants to be named in such action negligently failed to exercise the proper degree of knowledge and skill in examining, assessing, diagnosing, treating and caring for Decedent. Said defendants further negligently failed to carry out a determination not to confine "Chris" Lang for mental illness or addiction; defendants further failed to comply with §5152 of the Welfare and Institutions Code and they breached their duty to hire and retain only those persons possessing the necessary skills to provide appropriate and competent treatment and evaluation of patients. The injuries sustained by Claimants, as of the date of presentation of this claim, consist of the loss of future earnings, love, comfort, society, and companionship of their son and father, Harlan "Chris" Lang. Page 2 NAME OF COUNTY EMPLOYEES INVOLVED: County employees who were negligent include, but are not limited to: Robyn Draper, Ph.D., J. Guton, R.N., Dr. Mark Stinson, Dr. David B. Reedy. ITEMIZATION OF CLAIM: Jurisdiction over the claim would rest in the Superior Court. Loss of Earning Capacity: Undetermined at this time. General Damages, including loss of love, comfort, and society: Undetermined at this time. Dated: December 4, 2001 STAN PER ,E Attorneys for Claim Page 3 1 PROOF OF SERVICE (C.C.P. §§1013, 2015.5) 2 3 I am a citizen of the United States and am employed in the County of Contra Costa, State of 4 California. 1 am over eighteen (18) years of age and not a party to the above-entitled action. 5 My business address is 2121 North California Blvd., Suite 1020, Walnut Creek, CA 94596. 6 On the date below, I served the following documents: 7 8 CLAIM AGAINST THE 9 COUNTY OF CONTRA COSTA 10 11 12 by Certified Mail—Return Receipt Requested at the following address: 13 14 Clerk, Board of Supervisors County of Contra Costa 15 651 Pine Street, Room 106 16 Martinez, CA 94553 17 18 19 I declare under penalty of perjury under the laws of the State of California that the foregoing is 20 true and correct and that I am readily familiar with this firm's practice for collection and 21 processing of documents for mailing with the U.S. Postal Service. 22 23 Dated: December 4. 2001 f �° 24 Nadine Ross 25 26 27 28 CASPER,MEADOWS &SCHWARTZ 2121 N.California Blvd., Suite 1020 Walnut Creek,CA 94596 TEL:(925)947-1147 FAX(925)947-1131 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: .Ian 8, 2002 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 0 915.4. Please note all "Warnings". AMOUNT: Unknown "`'UNM` CLAIMANT: Cynthis Lang& Samantha Lang Wolfe ATTORNEY: Stan Casper DATE RECEIVED: December 10. 2001 ADDRESS: 435 Walnut Blvd BY DELIVERY TO CLERK.ON: December 10, 2001 Brentwood, CA 94513 BY MAIL POSTMARKED: December 6. 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOAN SWEET ,. kf #i ~i r'f ✓r i S✓ Dated: December 10,_2001 By: Deputy 1I. 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: �'_ —It ell1 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. ' j JOHN SWEETEN CLERK B � ;?` d Dated. ' ,U > Y :. ,deputy Clerk i 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 Claima"dressed to the claimant as shown above. Dated. >0", JOHNT SWEETEN, CLERK.B yu t Deputy Clerk. 4i� Stan Casper(State Bar No. 56705) Casper, Meadows & Schwartz a 2121 N. California Blvd., Suite 1020f Walnut Creek, CA 94596 «_:r ' ff Tel: (925) 947-1147DEC 21...,,fs Fax: (925) 947-1131 s Attorneys for Claimants, 4 f CYNTHIA LANG and SAMANTHA LANG WOLFE, by and through her Guardian Ad Litem, Dylia Klatt CLAIM AGAINST THE COUNTY OF CONTRA COSTA TO Board of Supervisors County of Contra Costa 651 Pine Street, Room 106 Martinez, California 94553 CLAIMANT'S NAME CYNTHIA LANG (mother of Decedent, Harlan "Chris" Lang, D.O.B. 06/09/61; D.O.D. 06/08/01) SAMANTHA LANG WOLFE (daughter of Decedent, Harlan "Chris" Lang, D.O.B. 06/09/61; D.O.D. 06/08/01) by and through her Guardian Ad Litem Dylia Klatt CLAIMANT'S ADDRESS CYNTHIA LANG 709 Citrus Avenue Concord, CA 94518-2308 SAMANTHA LANG WOLFE 132 Penbroke Drive Penfield,NY 14526 CLAIMANT'S TELEPHONE CYNTHIA LANG (925) 827-2052 SAMANTHA LANG WOLF (716) 377-0039 Page 1 AMOUNT OF CLAIM In an amount exceeding the jurisdiction of the Superior Court ADDRESS TO WHICH NOTICES ARE TO BE SENT : Stan Casper, Esq. Casper, Meadows & Schwartz 2121 N. California Blvd., Suite 1020 Walnut Creek, CA 94596 DATE OF OCCURRENCE : June 7-8, 2001 PLACE OF OCCURRENCE Contra Costa County Jail Contra Costa County, Martinez, California HOW DID CLAIM ARISE: On or about June 7, 2001, Claimants' son and father(Decedent) Harlan "Chris" Lang (D.©.B. 06/09/61) was brought to the Martinez Detention Facility, where he was placed in the Intake Area (Room 9), along with numerous other inmates. The staff at the Martinez Detention Facility was well acquainted with "Chris" Lang's history of mental illness, including, but not limited to, bipolar disease, drug abuse, and severe obstructive sleep apnea, which required a CPAP (Continuous Positive Airway Pressure) device at all times if he was to avoid life-threatening complications. Further, Decedent's sleep apnea was well known to the jail staff to cause annoyance, disturbance and unrest amongst other inmates because of the loud snorting and snoring noises which "Chris" Lang made while sleeping without his CPAP device. Decedent "Chris" Lang was found dead in the Martinez Detention Facility Intake Area, (Room 9) on June 8, 2001 at approximately 4:00 a.m. The claims asserted herein include, but are not limited to: 1. The failure of the County, through its employees, to provide reasonable medical care to "Chris" Lang, whose condition required such care; 2. "Chris" Lang was so negligently and carelessly confined, assigned, treated, classified, managed, controlled, supervised, and cared for so as to proximately result in the injuries described above; 3. "Chris" Lang was treated by health care providers who were the agents, servants, and employees of Contra Costa County, and who negligently and carelessly treated, diagnosed, examined, classified, assigned, confined, and otherwise cared for"Chris" Lang so as to proximately cause the injuries as Page 2 set forth above; 4. At all times relevant, the County of Contra Costa failed to provide adequate or sufficient equipment, personnel, or facilities, required by State law and as further required by the regulations of the State Department of Health Services, Social Services, Developmental Services or mental health, describing minimum standards for equipment, personnel or facilities proximately resulting in the injuries set forth above; 5. The detention facility was carelessly, negligently, and effectively designed, constructed, owned, operated, repaired, controlled, inspected, supervised, installed, used, and maintained by the County of Contra Costa as to render it unsafe, defective and dangerous, proximately resulting in the injuries to Claimants' Decedent. The injuries sustained by Claimants as of the date of the presentation of this claim consist of the loss of future earnings, love, comfort, society, and companionship of their son and father, Harlan "Chris" Lang. NAME OF COUNTY EMPLOYEES INVOLVED: The identity of such employees are not known at this time. ITEMIZATION OF CLAIM: Jurisdiction over the claim would rest in the Superior Court. Loss of Earning Capacity: Undetermined at this time. General Damages, including loss of love, comfort, and society: Undetermined at this time. Dated: December 4 2001 TAN CASPER Attorneys for Clai ants Page 3 1 PROOF OF SERVICE (C.C.P. §§1013, 2015.5) 2 3 1 am a citizen of the United States and am employed in the County of Contra Costa, State of 4 California. I am over eighteen (18) years of age and not a party to the above-entitled action. 5 My business address is 2121 North California Blvd., Suite 1020, Walnut Creek, CA 94596. 6 On the date below, I served the following documents: 7 8 CLAIM AGAINST THE 9 COUNTY OF CONTRA COSTA 10 11 12 by Certified Mail—Return Receipt Requested at the following address: 13 14 Clerk, Board of Supervisors County of Contra Costa 15 651 Pine Street, Room 106 Martinez, CA 94553 16 17 18 19 1 declare under penalty of perjury under the laws of the State of California that the foregoing is 20 true and correct and that I am readily familiar with this firm's practice for collection and 21 processing of documents for mailing with the U.S. Postal Service. 22 !� 23 Dated: December 4 2001 ( Nadine Ross 24 25 26 27 28 CASPER,MEADOWS S SCHWARTZ 2121 N.California Blvd., Suite 1020 Walnut Greek,CA 94596 TEL:(925)947-1147 FAX(925)947-1131 CLAIM ` BOARD OF SUPERVISORS OF CONTRA COSTA COUNT'' BOARD ACTION: Jan S,2002 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: $3212.84 1.,-;, u •nnJ;L_s'Y�;o;; SE_. CLAIMANT: Tommy Pulos ATTORNEY: DATE RECEIVED: December 6, 2001 ADDRESS: 435 Walnut Blvd BY DELIVERY TO CLERK ON: December 6 2001 Brentwood, CA 94513 BY MAIL POSTMARKED: December 5, 2001 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET�F � C Dated: December 7 2001 By: Deputy 11. 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: 717 �{ Dated: la t` '#� By: ' �. -_ .`' Deputy County Counsel 1I1. 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 Ord'er•,entered in its minutes for this date. 17 f f Dated:' ` ` :.` . ;_ JOHN' SWEETEN, CLERK, By Deputy Clerk r 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 v; f.` JOHN SWEETEN, CLERK By /� , ` ,'' f r y Deputy Clerk 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 1010th 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 fled with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553, either by mail or in person. 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 Tommy Pulos Against the County of Contra Costa LEA ES or The Housing Authority of Contra Costa (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$32 i, OV i and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) ,x°41* [ &'17 RRAH-A/ CA 5�1 2. Where did the damage or injury occur? (Include city and county) , 3. How did the damage dr injury occur?(Give full det is; use extra paper if required) 4. What particul actZ r omission on the part of county or district officers, servants or employees caused the injury or damage? clmform 5. What are the names of county or district officers, servants or employees causing the damage or injury? D a t-fb m Y t,et f,, (Agt&& 01c 7) �trA tx� r q cfe.,fc.,�. �.} 6. What damage or injuriesdo you claim resulted? (Give full extent of injuries or damages claimed. Attached two estimates for auto damage.) 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) 8. Names and addresses of witnesses,doctors and.hospitals. 9. List the expenditures you made on account of this accident or injury: DATE ITEM AMOUNT Gov. Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOTICE TO: (Attorney) or by some person on his behalf:" Name and Address of Attorney 0--�--l�X".aiiiiatit's--gig'natureJ (Address) Telephone No. Telephone No. ; y` `!` NOTICE Section 72 of the Penal Code provides: "Every person who, with intent to defraud,presents for allowance or for payment to any state board or officer, or to any county, city or district board or officer, authorized to allow or pay the same if genuine, any false or fraudulent claim, bill, account, voucher, or writing, is punishable either by imprisonment in the county jail for a period of not more than one year, by a fine of not exceeding one thousand($1,000), or by both such imprisonment and fine, or by imprisonment in the state prison, by a fine of not exceeding ten thousand dollars ($10,000)or by both such imprisonment and fine." cimform 1112712001 at 02:21 PM Job Number: 17163 CASEY'S AUTO BODY License *:AB057216 Quality is our Number 1 Concern 4515 O'Hara Brentwood, CA 94513 (925)634-2211 Fax: (925)634-7257 PRELIMINARY ESTIMATE Written by: DOUG STATLER # Adjuster: Insured: TOMMY PULOS Claim # Owner: TOMMY PULOS Policy # Address: 435 WALNUT BLVD Deductible: BRENTWOOD, CA 94513 Date of Loss: Day: (925)634-7135 Type of Loss: Point of Impact: 13. Rollover Inspect CASEY'S AUTO BODY Business: (925)634-2211 Location: 4515 O'Hara Brentwood, CA 94513 Insurance Company: Days to Repair 1955 MAID RX7 6S 1.2L-R 2D Int: VIN: JM1FB3319F0860062 Lic: Prod Date: Odometer: Rear Defogger Intermittent Wipers Tinted Glass Body Side Moldings Power Brakes Power Antenna Power Mirrors Bucket Seats Recline/Lounge Seats Styled Steel Wheels ------------------------------------------------------------------------------- NO• OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT ------------------------------------------------------------------------------- 1 ROOF 2 Repl Roof panel wlsun roof 1 311-50 15.5 4.0 3 Repl Outer panel 1 247.00 Incl• 1.5 4 Overlap Major Adj. Panel -0.4 5 Repl Weatherstrip 1 34.85 Incl 6 Repl Latch rotary 1 88-05 Incl. 7 QUARTER PANEL 1 11/2712001 at 02:21 PM Job Number: 17163 PRELIMINARY ESTIMATE 1985 MAID RX7 GS 1»2L-R 2D Int: NO. OP. DESCRIPTION QTY EXT. PRICE LABOR PAINT 8* Rpr LT Quarter panel 2.8 9 Overlap Major Adj. Panel -0.4 10 Repl LT Reveal molding rear corner 1 18.60 Incl. 11 Repl LT Reveal molding front 1 37.10 Incl. 12* Rpr RT Quarter panel a_-a 2.8 13 Overlap Major Adj. Panel -0.4 14# Cover Car 1 5.00 T 0.3 15# COLOR TINT 1 0.5 Subtotals ==> 742.10 25.3 9.9 Parts 737.10 Body Labor 25.3 hrs @ * 60.001hr 1518.00 Paint Labor 9.9 hrs c3 * 60.00lhr 594.00 Paint Supplies 9.9 hrs B * 28.00/hr 277.20 Sublet/Misc. 5.00 ---------------------------------------------- SUBTOTAL $ 3131.30 Sales Tax 1019.30 B 8.0000% 81-54 GRAND TOTAL # 3212.84 ADJUSTMENTS: Deductible 0.00 ---------------------------------------------------- CUSTOMER PAY 0.00 INSURANCE PAY 3212.84 2 11/27/2001 at 02:21 PM Job Number: 17163 PRELIMINARY ESTIMATE 1985 MAZD RX7 GS 1.2L-R 2D Int: This is just an estimate of repairs, if on futher inspection, additional parts or repairs are needed, you will be contacted for authorization. We are not responsible for loss or damage from fire, theft accidents or causes beyond our control to your vehicle. Storage charges will occur 48 hours after customer is not ified that vehicle is completed. Casey's Auto Body guarantees all repairs performed on your vehicle including parts, workmanship and refinishing for a period of not less than one year from the time of completion of repairs. Defects in craftmanship or refinishing are warranteed for as long as you own your vehicle. Failure to present an Insurance estimate at time of repairs may result in additional costs to you. Estimate based on MOTOR CRASH ESTIMATING GUIDE. Unless otherwise noted all items are derived from the Guide AOH5401 Database Date 511996 and the parts selected are OEM-parts manufactured by the vehicles Original Equipment Manufacturer. Asterisk (*) or Double Asterisk (**) indicates that the parts and/or labor information provided by MOTOR may have been modified or may have come from an alternate data source. Non-Original Equipment Manufacturer aftermarket parts are described as AM or Qual Repl Parts, Used parts are described as LKQ, Qual Recy Parts, RCY, or USED. Reconditioned parts are described as Recon. Recored parts are described as Recore• NAGS Part Numbers and Prices are provided from National Auto Glass Specifications, Inc. Pound sign (#) items indicate manual entries. Pathways - A product of CCC Information Services Inc. 3 Date, 11/27/01 03.22 PM Estimate ID. 7534 Estimate Version: 0 Preliminary 'profile 1D. BAB [60127] BRED 4535 O'HARA AVENUE BRENTWOOD, CA 94513 (925) 634-5366 Fox. (925)634-2533 Darrge Assessed By: MATT PIPER Deductible,. fi'WNOWN Darer TOMMY PULOS Address< 435, WALNUT BLVD BRENTWOOD, CA 94513 Telephone. Home Phone- (925) 634--7135 Mitchell Service: 915161 1985 Mczda RX7 6.5 Vehicle Production Date: 3/84 Burly Style: 2D Cpe Drive Train: 1.2L 4 Cyl 5M VIN; J`MIF83319F0860062 License- 4,`R8102 CA Mileage: 162,814 0E3 /Af T-, 0 Seat Code, None Color-. RED Options., AIR CONDITIONING, POWER STEERING, POWER BRAKES, TILT STEERING WHEEL ELECTRIC DEFOGGER, 5 SPEED MANUAL TRANSMISSION, PREMIUM SOUND SYS. MANUAL SUNROOF, TRIP COUNTER, POWER ANTENNA, 2-00OR HATCHBACK Line Entry Labor Lire Item Part Type/ Do€lars Labor CE Item Numbers Type Operation�..�._ Description _� Part Number Amount units Unit 510780 CLS REMOVE/REPLACE W/SHIELD GLASS PW30462BTN 375,40 2.C,* 3.Cr 2 513190 REF REFINISH L FRT DOOR OUTSIDE ; 2.3 2.3 3 515950 ODY REM-OVE/REPLACE ROOF PANEL 1482-74-030 311.50 19.0 19.i`T 4 AUTO REF REFINISH ROOF PANEL C 2.2 2.6 5 515740 BOY REMOVE/REPLACE SUNROOF SLIbIN6 PANEL "Qual Rely€ Parte" 500.00'" 1.0 1.C5 6 AUTO REF REFINISH SUN ROOF PANEL C 1.5 1.5 7 16070 REF REFINISH R QUARTER PANEL CU'TSIDI C 2.0 2.4 3 516250 BDA' REPAIR L QUARTER MUTER PANEL Existing 5.0*#15,5 9 AUTO REF REFINISH L QUARTER PANEL C'UTSIDE C 2,0 2.4 10 AUTO REF ADWL OPR CLEAR COAT 2.5* 11 AUTO ADWL C05T PAINT/MATERIALS 337,50" r * Tudgement Item # a Labor Mote Applies C - Included in Clear Coat Cole ESTIMATE RECALL NUMBER: 11/27/01 15:12:11 7534 UltruMate is a Trademark of Mitchell International Mitchell Data version N V v1_-A Copyright(C) 1994 - 2001 Mitchell Inter€tatioml Page 1 of 2 U€truMote Version: 4.7.007 All Rights Reser4ed Dote: 11/27/01 03;22 PM Estimate ID: 7534 Estimate Version, 0 Preliminary Profile T.D. BAB 160127) Add'l Labor Sublet 1. Lab�or Subtotals Units Mate. Amount Amount Totals II, Part Replacement Summary Aunt Body 25.0 60.00 0.00 0.00 1,500.00 Taxable Parts 11,186,90 Refinish 12.5 60.30 0.00 0.00 750.00 Sales Tax 8-000% 94.95 Mass 2,0 60.00 0.00 0.00 120,00 Total Repioce►ment Parts Amount 1,281.85 Non-Taxable Labor 2,370,(30 Labor Summary 39.5 2.370.00 III, Additional Costs Amount TV. Adjustments Amount Taxable Costs 337.50 Customer Responsibility 0,00 Sales Tax 8.00078 27,00 Tptal Additional ``osis 364,50 T. Total Labor: 2,370.00 II, Total Replacement Darts: 1,281.85 T . Total Additional Cost.- 364.50 &rocs Total. 4,016.35 IV. Total Adjustments, 0.00 Net Total: 4,016.35 This is apreiiminga estimate. Additional chanaes to the estimate may be cqq!red for the actual repair. ESTIMATE RECALL NUMBER: 11/27/01 15.12:11 7'.x-.34 UltraMate is a Trademark of Mitchell Inter-national Mitchell Doto Vers!OW NOV--P1_A Copyright(C) 1994 w 2001 Mitchell International Page 2 Of 2 Ultramate Version: 4.7.0€37 All Rights Reserved del X ::X.X. a f; �Ff�JF i �F + xviflg FY FF �S F US F 4r a i Oji Sri%. ,/SEEN"/ g� �g s f �; f A /4 .. ............ ... .. � /'�-spa &' - �• a/. : It — -------------- ------.,. ... ............................... _.. A, ,a - s a ------------------- joft f, / .. f . ..........:::::: Alma. ................ ........... . ........... .................. ................ ...... ew � .Xx }}}} f} f '9 r ry f C �Eyq u S. ef I Ex Se US, r y}f/5Y}/i f F� 7 f rig / i4o E }}} F" 7 t'r t } CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 8 2002 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 j 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: Gary Leard ATTORNEY: DATE RECEIVED: December 3. 2001 ADDRESS: P.O. Box 410 BY DELIVERY TO CLERK ON: December 3. 2001 Greenville, CA 95947 BY MAIL POSTMARKED: I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE eliqs Dated: December 4 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: r� Dated: " 6 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 Orderc4ntered in its minutes for this date. ,�� ,�. � y -Deputy Clerk Dated ;^<u � " . _ JOHN SWEETEN CLERK B f s WARNING (Gov. code secti`o'n 9 i ) 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 : . JOHN SWEETEN, CLERK By ` e ;` . t -r %" Deputy Clerk f 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. 72 at the end of this form. RE: Claim by. ) Reserved for Clerk's Filing Stamp } —s- ', v ) RECEIVE Against the County of Contra Costa [_IEC 0 3 2001 or CLERK BOARD Or SUPERVISORS District} CONTRA COSTA CO. (Fill in Name) The undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sum of S and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact Date and Hour) 2. Where grid the damage or i4ury occur? (Include city and County) '------- ---- ` ------ �_�-, __ -'- ------------------------ 3. How did the damage or injury occur? (Give full details;use extra paper if required) p4 A �Vvl� 4. W-_ -'nr as#�r"nom a art---otto � taYrt-s, or or damt�4ge c A (Over) INDIAN VALLEY HOSPITAL DISTRICT CLINIC'ENCOUNTER FORM fUTURE1APPQMMEt' REFERRAL I7AT4 TIME MEDICAL RECORD# i ACCOUNT N R!N �ASSIII�Y OSE DATE: PA"IENTS NAME(Last.First,Midd e) PHONE NUMBER SEX AGE S- HDATE ;> ; ... .. TIME: ADDRESS(N4m+aw,Street,Orty,State,ZIP Coda) DR: CLINICS tV3 E L`CJCE - PHYS aA#N NAME :•;: DATE: RETi7RN 440INTME3 T(Comptated by?hysiclan) L`$$F ORE NEXT V,'S1T I TIME: REAR O REFER TO REFER 70 _ DRi PATIENT IS YEARS OF AGE.PATIENT IS NOT EMPLOYED.PATIENT'S SPOUSE IS NOT EMPLOYED,PATIENT IS NOT COVERED BY WORKER'S ; COMPENSATION,THE BLACK LUNG PROGRAM,ORA LARGE GROUP HEALTH PLAN.THIS VISIT IS NOT THE RESULT OF ANY KIND OF ACCIDENT. NO OTHER INDIVIDUAL IS RESPONSIBLE FOR THE PATIENT'$MEDICAL BILLS.#CERTIFY THAT ALL OF THE ABOVE STATEMENTS ARE TRU€. ; WITNESS TO S!GNATJRE --- (TATE SIGNATURE OF PATIENT OR PATIENTS REPRESENTATIVE RELAi iONSH!P i It ESTRADIAi 9255`1 '; AUDIOGRAJIM 99ZC1 NP'RIM FOCUSED PRC$LEM 215236 TEST LIST;=FP£J,NE 92100 TONOMETRY _ . 10601 HOT PACKS _ 99202 Fl! 226;5 V!TAMNI812 TYNtPAfIOM"r Ry 97328 ULTRASt?I R3 9923 EIV DETAILED 000Wl ALLERGY 4 - ri 204 "ENICOAT /V 17DFAATE-- 001032 N TIA_CPSP _ /-HIGH. 11002 EKG 59425 #,#:TIAL 08 9921# EP Elul M;`1#VAt 93225 HOLTER MOM 08 59426 ANTEPARTUM 9922 1 EP E/^J FOCUSED PROBLEM 93015 STRESS CXT - - 59430POSTPARTUM -- 99213 EEp E/IV EXPAN- ED PROBLEM 57452 _1 COLOSCOPY - - 99214 EP E/M C-,AILED 57454 W18#OPSY Y, - - 992`35 EP€/IV'.COMPREHENSIVE 45378 ^L A PY -_ 90635 NO CHARCE 453&3 WITH?:; Y %241 GUNS>vLT FOCUSED 45385 WITH POLYP 95242 CONSULT-EXP PROBLEM - ___ 43235 F f7 _.,... 93243 CG'4SI;LT-M0D COMPLEX 43239 V1 ! P Y - 112 3 EX SIMP LES 99245 Q014SLILT-HIGH COMP!EX 43247- REM FOR BODY 11400 EX IN RA NEVI - 98900 FAMILY CONSUff 9251' :A' ARYN _ 11401 EX.G 1.0 vM - 97260 CMT, - 4533) S3 11402 EX 1.9 2.0 45331T SY 11423 £X LES 229£13 1 PEE, 45333 WIT 1000 #&D ABSCESS 22902 I T - 10-08G I&D CYST 229#e 652(5 BURN DEBRIDE B-FED 2 - 22917 HEP B-AD L- 65220 17340 CRYOTHERAPY 51032 MMR 65222 -1� IT P 11765 INGROWN,OE 5103G j ppv _ 30801, NASAUGMERY 111180 PUNCH BIOPSY 99999 00M FEE 51014 FlP0 69210 99070 STERILE TRAY 789.010 ABL'OM,NALPAIN 372.300 CGWUNCTWIS 692.9 ECZEMA - 242.90 HYPIRTHYROOISM SEGMENTAL OYSFUNCTIONS: ORTIi11P£WCiDES. 303.900 C3 ICL#SM -- 564.0 CDNST#?kT#ON _ 782.3 EMMA _ 244.9 #iYPOT#V90 019M, 034.0 STEP THROAT - 924111 CON`TLS ONI,KNEE 477.9 ALI ERGIC RHINITIS 496 COPD 784.7 EPISTAXIS _- 272.3 HYPERDCLESTEROLEMA 295,90 S„KZOPHREN#A - 717.8 NTL.ORIvCiMNT,KIfE : 427.31 ATRIAL PIMILATION1 _ 414.00 CAD -- 491.8 EMPHYSEMA 272.4 HYPERLIPIDEMIA - 702.19 SESORRNEIC KERATOSIS- 836,2 MEMa WS TEAR 42732 rl RIA#FLLrl TER 786.2 COUGH _ 780.7 FATIG&LiE 684 #VPETGO _ 706.3 SEBORR#1EiC 626'o A#V#;:NCRR#-€A 438 GVA 780.6 FEVER 464.0 IARY-WIT#S 78£1.39 SEIZURE DISORDER � PAIN: 285.9 ANEMIA 733.99 C0STCCHONDR:T#S 729.3 E#BRGSIT#S 722.93 LU AR DISC DISEASE _ 461.9 S NUSMS _LL 724:8 BACK 413.9 ANGINA 380.4 CERWENWPACTION _ 535,50 GASTRITIS 785.6 LY#vPHADENOPAfHY -- 780.2 SvNCuPE -- 724.2 BACK,LOIN 300.00 ANXIETY _ 715.90 DJD,SITE UNSPEC 530.11 GERD 728.85 MUSCLE SPASMS - 785.0 TACHYCARO;A _ 719.47 A# (LE,FOOT 427.9 A8^nHYTHMiA _ 276.5 D£HYDRATIflIV 578.9 G>$L*eL 424.0 MVP _ 725.90 TENDONITIS _ 715.42 EE8f3Jd 493.90 ASTHMA _ 311 DEPRESSION 365.9 G;AUCOMA 729.1 MYOSITIS 451.9 THROMBOP41LEBITIS -- 719.44 rAKa 800 BPH _ 692.9 DERMATITIS 274.9 GOUT 787.02 NAUSEA __ 112.0 TNRUSH 719.45 HiF 466.0 BRO VCH#TIS,ACO i E __ 250.01 DIABETES,INSU!#N 477.9 HAY FEVER 715.90 OSTEIDA.RTHRMS _ 435.9 T#A _ 719.45 KNEE 4911,q BRONCrIMS,CHRONIC' _ 250.00 DIABETES,NO'd 784.0 hEADAC1'E OT TIS _ 463 TONSIL#TIS _ 729,5 "LEG 727.3 BURSMS 558.9 DLARR#?EA _ 307.81 TeNSION 380.10 EXTERNA ^429'.1 TRI"aERP31NTS _ 719:41 S#iOiLCER - 571.5 CIRRHOSIS,!iVER755.09 DYSPEEA 345:93 MIGRAINE 382.9 MEDIA _ #55.5 JRf 723.1 NECK 682.5 CELLLUTIS,SITE J#MPEC 599-7 H"MATUR;A 381.4 SEROUS _ 399.0 UTi 722.4 CERVICAL DISC DISEASE~.-_ EXAMS: ' 455.6 HEMORHo01 YS 278.00 OBESITY -- 708.9 DRT#CARIA 786.50 CHEST PAIN V20.2 CH#LD ` 054:5 HERPES S;MFL D( _ 533.90 Pb0 _ 6#0:10 VACIN#T1S -- 786.52 CHEST WALL PAN V70.5 DMV,EMP ` 053.9 "ZOSTER _ 462 PHARYNGITIS _ 780.4 VERTIGO -- 428.0 CHF _ VT).3 OTHER 729.10 HNP 614.5 P#D _ 787.03 VOMITING -- 575.1 CI O#ECYSTIT#S V72.3 PEEV;0 401.9 iYPERTEWDN _ 486 P�JEUMO#v!A _ 078.10 WART 558.9 COLITIS 729.2 RADICUUT#S _ 783.1 WEIGHT GAIN 783.2 WEIGHT LOSS AE"ENDING P YSIC'AN SIGNATURE DATE PATIENT S!GNATLPRE PATE Date: W 7X0106:28 PM Estimate 8i: 5283 Es nate Vandow 0 Preliminary Pm ft V. C8AA-GM BILL NELSON CHEVROLET,Inc. 3233 Auto Plaza Richmond,CA 94N6-1994 (610}222-2070 Fax, (610)22341M Tax 10: 94-1699426 BAR 0: AB007001 EPA#: CA9819975811 Damage Assessed By: Chrls Haghund Deductible: UNKNOWN Insured: GARY LEARD Address: 3641 STEWARTON RICHMOND,CA 94803 Telephone: Horns Phone: (SiO)3234687 Mitchell Service- 910491 Description: 1984 Chevrolet Corveft Body Style: 20 Cps Drive Train: 6.71.Inj 9 Cyl YIN: 1G1AY0782ES129658 Mli+ige: 120,293 OEMIALT: A Such Code: 094806 Calan; RED Una Entry Labor Una lbern Part Type/ Dollar Labor Rom Number Typo Operet on l ri Part Number Amount Units 1 011940 MCH ALIGN FOUR WHEEL .M _ 3,6 2 018820 GLS REMOVEIR134LACE WlSHIELD GLASS DWO0951G ON 463.30 4.0 # 3 419900 BOY REMOVEIREPLACE UPR WISHIELD REVEAL MOULDING 14149033 GM/PART 82.00 INC # 4 019914 BOY REMOVEIREPLACE R W/SHIEU)REVEAL MOULDING 14049032 GM PART 58.75 INC # 5 419920 BOY REMOVEIREPLACE L W1SHIELD REVEAL MOULDING 14049034 G[M!PART 56.75 INC # 6 021700 MCH REPAIR NOT PANEL CLUSTER -M Sublet 75OW 2.500 7 900500 MCH* REMOVEIREPLACE COR. **Quaff Repi Part $7.75* 1.0* 8 900500 MCH* REMOVEAtEPLACE HM IGNITION SYS **Qual Repi Part 75.00* 0.0* 9 904500 MCH* REMOVEIREPLACE SPARK PLUGS **Qual itapl Part 16.00* 2,0* 10 900500 MCH* ADWL LABOR OP DIAGNOSTIC TIME Existing 2,0* 11 000069 BDY REMOVEIINSSTALL L FRT DOOR TRIM PANEL INC 42 0215930 BOY REMr'VEiREP GCE L FRT DOOR POWER GLASS REGULATOR 22063225 GM PART 295.40 2.3 # 13 033880 MCH REMOVEIREPLACE FUEL.SYSTEM DUEL PUMP -M 25168719 GM PART 70M 1.15 # *-Judgement Itm #-LAbm Note Appi(ee ESTIMATE RECALL NU0151Ek 817/0117:28:15 5M UltmMate Is a Trademark of Mitchell International Mitchell Data Version: AUti 01 A Copyright(C)1994-2000 Mitchan International 1 of 2 Ulbr Maate Version: 4.7.007 ,l p4gft Reserved Data: V 7131 05:26 PM Estimate Ilk $262 { Estimate verslon: 0 Pr+ailminmy Prow ID. CSM43M A,dd`l Labor Sublet Labor Subtotals Units Raba Amount Amount Totals U. Part Replac wnent Summary Amount soft 2.3 54.00 0.00 0.00 12420 Taxable Parts 1,173.82 Glares 4.0 54" 0.00' 0.00. 216.00 Parts AdjrmtmeMs 56.18- MecMnlcei 12.8 85.00 0.00 750.00 1158$.09 Salsa Tax +8.000% 88.41 Non-` exabie Labor 1,909.20 Total R PIWARnOnt Parts Amount 1,207.05 Labor Summary 18.9 1,808.20 tli. Additional Costs Amount IV. Adjustments Amount Total Adenat Costs 0.00 Customer Responsibility 0.00 L Total Labor- 1".20 It. Total Replacement Parts: 1,207.05 M. Total Additional Costa: 400 Oro"Tri 3,118.25 IV. Total Adjustments- 0.00 Net Total: $,116.25 THIS ESTIMATE HAS BEEN PREPARED BALD ON THE USE OF C}ASH PARTS SUPPLIED BY A StRiRM OTHER THAN THE MAY+T WALT=R OF YOUR MOTOR Vi$HICLZ. ANY MRRARTICS APPLIChMX TO 'THESE REPLACRMENT PARTS ARE PROVIDED BY THE MUMPAC'TURER OR DISTRIBUTOR Or THE PARTS, RATTIER THAN BY THE ORIGYNAL MAWFACTURER OF YOUR VEHICLE. This is a tsMilminartr estimate. haingas to theu1El r 0 0 actua f re 01r. SPZCZAL PARTS NOTE:ALL CRASH FARTS ON THIS BSTZMATE ARE "NZW" PARTS (CRiK) SSS OTHHRWISH SPRCIFXZD. PARTS D88CR188D AS R2Dr RWCORZD, OR RZKNNUFACTURZD ARE" ZITHZR "ARCONDIT'IONRD" PARTS OR "RMUILT" PARTS. CRKSH 'PARTS DHSC RIBHD AS QUAL RRPL PART" ARM MW Obi A2TZF44hR=T PARTS. Company Cade: DropOff Data: W7101 Repair Dabn: Promise Dabs: 817101 Start Data: 017101 ESTWATE RECALL MiMBER: 81710117:28:15 5262 UftraNkft is a Tndwwt of Mitchell hit rrudkmai Mitchell Darts Version- l 01-A CoWrW t(G)1904.2901E Mit.W1 international Ps" 2 of 2 UltraUste version: 4.7.007 All fthba Reserved �� CJ��--' o(�'� � ,�.1 Ir�<; �f `✓4_!.� f d l _ r� .. .,� 6 d � � (.�� � -�^y���F ^.. <- .70r._ -6 IPA CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 8, 2002 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: Wendall Bashaw :. ATTORNEY: Jay Moisant DATE RECEIVED: December 3, 2001 ADDRESS: 150 N. Wiget Ln#206 BY DELIVERY TO CLERK ON: December 3, 2001 Walnut Creek, CA 94598 BY MAIL POSTMARKED: November 30 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET Dated: December 4 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: R� By: '' ,'' .& -r�-m-� 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). ]V. 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 k#/r ; , ;�:%ss:.. JOHN SWEETEN y CLERK B J '} r`�: ; , s y ; , Deputy Clerk y 0i 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 theglaimant as shown above. Dated. j f, A iiovv,4, `. ` �� JOHN SWEETEN, CLERK By >#� ; � '� f fel ? }�' ✓� De ut Clerk P Y a! 4g C•aim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLAMANT �. 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, 198'7, trust be presented not later than the 100"' day after tate accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or browing 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. Corse §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.Mardnez. CA 94553. C- If CIaim is against a district aoverned by the Board of Supervisors. rather than the Count•, the name of the District should be filled in. D. I the claim is against more than one public entity. separate claims must be filed against each public entity. Fraud. Seepenalt`•for fraudulent claims. Penal Code Sec. 7: at the end of this form. R-E: Claim by ) Reserved for Clerk's Filing Stamp LALf�.r'lia f �y�J } R E "IVSD Against the County of Contra Costa LDEC 21001 or CLERK BOARD OF SUPER+,':SCIRS District (Fill in Name) :"rye undersigned claimant hereby makes claim against the County of Contra Costa or the above named District in the sura of S and in support of this claim represents as follows: r ,,),4w' iS t'j {lit . When did the damage or injur}•'oecur? (Give exact Date and flour) Z. Where did the damage or injure occur. (Include City and County.) n Ul- Evr1L�� i✓t�ve, (n �fh�'��{,�� ����;;� �� �'br�ft'y, �'US�a ------------------------------------------------------------------------------------- w 4 Vit, f u,a tt _. r How- did the damage or injury {occur? !Give full details:use extra paper if required) slc�cf 1i�c {t t'U iz 3 rcbiF. 06iAk. e 0 fn.'efd �t i tt} vt j _ 1 ti t s.,:en __-__-------------------------------------------------------------------------------- :_ What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? �j d.t iC'r u `� °` �r u�•^t ;£�uLttVO,Lt' rG?; c roof (jaf-ti4�t� V J { Over) -auU pur Iuauruostldtut gars ==oq .ic .10 00040IS} urttop pursnog2 u2i AD luipaazxa jou 3o auU r :q °Uosud a2rls ;)q2 at Iuauruosudm! .iq ro -autj :)UT ivauruosudiat Bans tpoq .iq 20 '( 0()()-IS ) s milop pursnogl auo autpaa3xa lou jo aug r :sq °2trah auo urge a tottz :Du 10 pat2ad r .roj tref .ixuno3 aq2 ut Iuawuosudurt .iq 2agpta atgrgstund st `21111u.b 20 -2aganon -2unoaar -iitq •utmp e:.atnprn:.rj 20 as;r3.iur -auinual".Tt aures aq2 .iud 20 .aolry o2 pazuotpnr °ia3Wo ro pitoq iaulstp so uia `.ti2uno:) :iur 2 20 :aat�}o 20 p2rOq alE1S .iur of ltraurnrd 20j so aaUE.�+ot�r 2of s2IIasa2d-pnr2;ap d1 lIIaltrt g2r.a•oq.'A uossad,ClaA3,, esapLio.sd apo' tEuad aq2}o ZL uop:;as aDiio .Y. Y Y Y Y .yG SF SF Y• Y 1F Y X .K �f d� Y Z %f X Y. i� aC Jb aC X �f 7C X X � � K iC iC 3& Y. K aC a4 X �C X 1F AQ � X. X. Y M 3E 6 Z X Y 0r� auogdata auogdaza j v fv� ( a2nlrcrDtc S. ur.tutrt ) p,, fei 4 iatuoli'jo ssasppv pur aurr „ tregaq stg uo uas2ad auros .iq so ( aruouv) :oj- saDuo!� a.,�as IUEturcya aq2.iq paints aq Isntu turrta aql,, :sapt.io2d 4'016 -oas apeD ..too k :.isn f ut 20 ivappoe srg2 jo iugnoaar uo`�apEru}noC sa xm!puadsa axp Isr I 6 ----------------" P .1 iSyti3 "6 .i13a 31;x% ay2?+r �1C)T4v 3 1f�3L E7 �`f 3 / _'_ __ _ d3;� a�t� •strltdsoq pur uolaop •sassauxt.x 3o sassaappr pur satire S � .s, �a IOCfZsJ}jJ1� 2} 7V� n�?yi :JS�3va2^t r �y7air s�'� :j .a' IJ7n?}rJ3 1 `'1 kxf} j # a:csuep so,unfuc anu�adsoad.iur.�o nxnouir patsmosa ayi apn�auF� ;,palndtIIt7a Iuntltitr paurtEta ant)gE agI SE.ti .wog .. --------..________________ e___.._ _.,______-o__o®__m-_o__________ iV")jJ f d 'its (-Aeump ams �;�ssrsass oda eziV 'P� saaautsp to sauntutla tuavn tPK a�t9 i Lp22jnsar tarela noA op saunfur 20 saaarurep IEgAl 'q ___.._____________.._.. -______aWe-_.__o _ ®_____________ w'-l2,41,p0 �1.FnfIIr 20 anEIIIrp aq2 a�IIISnra SaaAOtdIIra 20`SIuE.uas'S2ant�0 X,L12Srp 2t3.iltIrto�,�o Sau2EII ark a.tE IEq� '� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 82002 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 1ft,3=aV11b 915.4. Please note all "Warnings". AMOUNT: Unknown DEC 12 2001 COUNTY COUNSEL CLAIMANT: Ronald Babino MARTINEZ CALIF. ATTORNEY: DATE RECEIVED: December 11, 2001 ADDRESS: 1172 Saranap Ave#39B BY DELIVERY TO CLERK ON: December 11, 2001 Walnut Creek, CA 94595 BY MAIL POSTMARKED: December 10, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. � JOHN SWEET f Dated.: December 12 2001 By: Deputy � ' S # II. FROM: County Counsel TO: Clerk of the Board of Supervisors 6—Khis claim complies substantially with Sections 914 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: V) 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 , ;ti. . ca '; t '. hOHN SWEETEN, CLERK, By° d `` , Deputy Clerk WARNING (Gov. code section 913) J Subject to certain exceptions, you have only sit (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, ddressed to the claimant as shown above. Dated. € # €, i JOHN SWEETEN, CLERK By Deputy Clerk f Y 11/21/01 18:24 P. 001 Claim to: BOARD OF SUPER'V'ISORS OF CONTRA COSTA COUNTY I1S'I&U-CTIONS TO CL–A—IMLNJ A. Claims relating to causes of action for death or for injury to person or to personal property or growing craps and which accrue on or before December 31, 1987, must be presented not later than the 10&day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or mer January 1, 2988, 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 ofthe cause of action. (Gov't Cade 911.1) 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 thars one public er►tity, separate claims must be filed again:! each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. ####tkk+kkkN###*tk+B* R**#ttfilrs##tYM+k#iw*#+K*+1*###tMrls^+t##+t#t!c###1t;#Mt+l##isit,�i##khi+YMtiiRic#Mfs#+M44## RE: Claim By Reserved for Clerk's filing stamp tea } Against the County of Centra Costa or ) £ .U' 1 2001 District) (Fill in name) ) to The undersigned claimant hereby snakes claire against the County of"Contra Costa or the above-named district in the sum of 5 and in support of this claire represents as follows �tl� 0, X 1. When did the damage or injury occur7(Give exact date and hour) 2. Where did the damage or injury occur?(Include cit and county) ,� �`©Y' t i V1 �t r 3. Flow slid the damage or injury occur?(Give full details; use extra paper if required) v+r -4• cosi-M S +-,+�s i,, ►. : ,��.tl # w:tk fb 1�v ma1;cio3.t; v } i g3�1`91� gSi4 fry" `3 r"t Ccx3 tC'C tx iM ttl+"�52 vw� \3D C,�AaA%4 YYV- * G"Sza�-' je) -� )i . �,t� .+-�'�A11 j co n�-rok Cos P. 002 11121102 18;24 atr3 Pue tvauntnstxdtut Batts t oq{q xo`(t3Q4'0i3)sxeyop it+ ►o +#8utpowx2 tou jo otnj a kq'uosud awn at{i ut taautuosudmi kq jo`aug pue tu"nosudutt tans gioq xq xo'{tom`T S)pmaotD ouo furl,-aaox2 lou to arty:a sq'mg auo am aloux lou jo pound tt xoi pef�Wnw up us tuau:uospdwl I*q xagita aigegs!tmd st`9utiuna xo"xaprto;e itmo a iT!q`ur€ o tttaittpp 3o ash;rats'atrmua� acnes aqt tad xo nto ¢of pa�xuogm 'aaot, oto pieaq la�mcp xo 194p`�uxum SUR o f xo'xaow xo pnoq att'is�us o3 ivautAsd atp xo a*utttaop xoj s#ttasojd'pn+gap of ituitq qlfft'ogAi rxMad,txang :sapt apoO FWd UP p xL UO" 3OLLON **t###tl�xii## i*+k�li�*'I�+k�itY*iltiik�R+ti*t*!#+i!##irii#it##tR*#3/t#*+�#t#iil#�!i##�fti+�r*i{ttlrtlti#*rlt�Y#*#*rtr�+1�1R � - •otqauogdaja, 'otqauogdata,L { (ssai per) (2iniuu8cs s,iueWTVID) i s ( (Quioiiyjo ssaippy pus atustq u � ,;Ilegaq sig uo uos tad otuos Xq xo iuewia(o aqi Aq pou8is aq isms wteio aql.,,sap!noxd r`p I6 _oaS OPO:) 'AOO { *irW�sM�M#*+k*##�k�i�M�M*ltir*#*i*+y�*i*#*#i1�*ir�M###fki##**#i#�dct�►'RYt##�it�e*Its#�t*Mi#F*#*MiR*dtir#Yfr#*+�t*a}#i VI Rva- kinfut as iuoptoov sigi jo iunowr uo apew nox saxnitpuadxz oq1 ist-I '6 TF s;eicdsoq pug 'slopop 'sossatlip+ p sassa.rppe pug sawim •8 sv kinfut antinadsold Xue jo iunowe paiewtisa aqi apnlotq) Lpaindwoo anogt pawtala iunowe ag;st'm mOH ,4 VVCo 7a � �Sswe� nine xo sa utt c,nni P 3 ttoeuy 'pawtuio saaeump xo satinrut3o ivaixa Its antcJ}Lpaijnsa.t WTVJCo nOA Op saun(ut ao assutgp IRVA '9 ,71kb0"N i+ ')nxOQ4 q Lil t ,{lA tM6 ( fn,,ttt.tri aziewep aqi Wulsneo sa24ctldtua A `siuvvas sj;):)qjo jzujstpIT WOO jo satut u 2qi are i qtA ''i u - - IA �ti.3 J d� ° Ga'Aatuep 10 ki frit aqi pasns:3 soaX wa so `sxue�tixas `smwo pt ISIp 10 �4uno-o jc� t~sed aqi uta uta sstuzo xa xat; to tr :ix d ieg CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 8. 2002 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". rt .4 AMOUNT: Unknown T' Y CLAIMANT: Kristen L Rose ATTORNEY: DATE RECEIVED Dfetr lk3r� ,• ADDRESS: 162 2n6 St BY DELIVERY TO CLERK.ON: December 13 2001 Rodeo, CA 94572 BY MAIL POSTMARKED: December 12, 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETS . lc , • ,� Dated: December 14 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: r ' Dated: '" By: 'y h-.,. 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:' . j},u - JOHN SWEETEN CLERK By .{r eputy Clerk •J. WARNING{Gov. code section 913} Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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 Claimantaddressed to the claimant as shown above. Dated: CLERK By_tV �, ' Deputy Clerk Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO CLALWANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2. ) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 146, 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 C Against the County of Contra Costa 13 j 200 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 and in support of this claim represents as follows: 1. When did the damage or injury occur" (Give exact Date and Hour) �. _ 2. Where dict the dam ge or injury occur' (Include City and County) - . ���,..# ��.� ¢g'` £` --------------------- --- ---��------__- 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? � t ,. (Over) anU pue ivawuoS�aduz{Bans gloq �q a0 `( 000`0TS ) sarilop puesnogl ual yurpaaaxa lou jo auTj a .sq luosud aims aql ui mamuosudmi aq ao `au;j pine luamuosudmi Bans gloq �q ao `( 00011S ; urliop pursnogi auo outpaaaxa lou jo ;)ug r Sq .jm C auo uugl ajow IOU jo pouad a ao3 1crf ,4uno3 aql ut ivauiuosudmi q xagM atgegstund si 1ouclu,,A as°xaganoh lunoaar `ll!q Itumla lualnpnuij.zo asTrj sur °auinualb;{auzes aql.ird ao aonr of pazuotpar °aaziWo ao p moq laulsip ao :Cu:) :4unoo :iue of ao 1.123u;o 10 paraq alms :wr of luamtird aoj ro aaue.t&aj,*e ioj sluasaid 1pnux;ap of lualui gl!Ai-oqm uo";z d eLaA3, :sapiiwd apo:);mad aql}o ZL uog3as JDLL0 -tiI 117 :A •ok auogda{aZ •oK auogdalaL (ssaapp�} 1-30 (aan�suots s,lurtucr.ID ) ;Oulouv 3o ssaappv put oxuv -jfuiqaq siq uo uouad autos.iq ao (Sauaouv`, :oL s3�I.L0� tl s 1uruan~ia aq}.�q paufis aq Imam uuirlo aqj,,, :sap►.i,oad Z•016 •aac aPt :s0 Cf -_.I'e4 .'?, s r ' W 41C?3e� Nall x,G"dQ :.unfut so luapr3ap sigl;0 lunoaae ua apuut noe sasr#tpuadxa aql asap •s - ------------------------------------------------------------------------------------ -sjm!dsoq pine s zoiaop•sassaul!,h%10 sassaappe Pur sautrk •8 ------------- ---------- ---- ---------------------------------------------------------- ( a rsutap jo.ijntxrc an}laadsojd.sue}o mnorue paizwnsa axp apn{auF) pznndwo,3 iunomr pau trl:) an0g8 aql SL,a .tea$ - ------------------------------------------------------------------------------------- (-a$sump o;n's jos miturnsa o,Nj 1prud 'paurre{a saaeulsp ao saL ntur jo xua=xa mg an(D) Lpallnsaa turelz non, op saunfm 30 sairmrp lrq& -3 ---------------------------------------------- - ` � --- Q,. ---- ----------------- �" r �tunfui 30 aortavp aql 2uisnvo saaAo[dw do'S jmjjas°sla3Wo 1:) ustp ao:�iunaa jo saureu aql air iml.A& •9 t.n�Wtt.____ L 8 mac" (.J1 ` c ��Lf bLf 5b4 0b 10 � ., /04 V t v a lL r, QUAN.1 CLASS I DESCRIPTION PRICE ANiOUNi k f � r n ro + OATS. AUTHO�+17AT10SUB 10 RF C F �— TOTAL I M, %' r !+ REFERENCE NO... REO EPT. _1 O r5 TAX ( �" � !— r FOLIOJCHECK N0, SERVER CLERK �' { P PUURCHASER SIGN HERE, SALES SLIP • ,'1` 11th )��tf IMPO� APIT:RETAIN THIS COPY FOR YOUR RECORDS nowt pas me pt of goods andlor"twice*In the , amount of the Total shown hereon and somas to perform the ' s obligations set forth In the Gardhoidees agreement with the Issuer, -7 PINOLE RODEO AUTO WRECKERS f a: t PHONE(510)758-4722 �. t 700 PARKER AGUE RODEO,CALIFORNIA 9 572 3 TERMS:Net 111 Prox No discount_A Sm'ce Charge of 1?2%per month(18%per ann ZI f {minimum Service Charge- 5Q'w;!#be charged on aE pas>due accounts Should legal services be necessar -o collect sums due hereunder,the Eyyer sha!1 pay reasonable fees and costs. ENOTE,We esek e the right to rep:ace parts purchased before making cash refund.No re.`un V"or exchanges made afte,48 hcrz fpm date ar purchase.Ni merchandise accepted for refund subject to 20%halls ng.charge Liability 1�mYied+A amaun;,cf p nonose. Customer's Order Na. Ship Via 20 Address MDSE.SOLD 'MDSE RET'D RECD.ON M.i CIL PAID OUT CASH CHA13GE WASH CREDIT ACCT.NOT : { f 3 i' c: { } E ... a TAXTOTAL ` t ,r F; <: All c€a€f�hs and r Ctrrted goods MUST be accofmpan€ed y tAIS blit— .......... is€€-- I . : Salesman v.. Receive 3y €t: JACKFORMS FNLHM64m`6 ,}•, .: (EEC: G: C: -- ..� __ _ _ _ x x f r: t a �: a a t t �' }}� 3 �: { k: 3: e: �: ;: G: k �: is �_ �: f: s: " P��;. -1 I I I.,�:;,..�1.-I.....1.11=-..,.-Z---".-�-,-,,---.,.:-m,-�-,-��� -7.e:--:,�,--�;---1:1;-l ; - 1.1.I---I I�I�I�11,11-- 71 �', :1� � ' F % .. ... 2'% ...I'll1. .. .. . - -? r rr� ss k std" # g :5 h L ph t :: 1111 111-11 I % £ ., .� _ _ 7 J[ t �;. r yy r 2 s .. r. k , .. 11 -, ; n11111-1 , - -I'll .. 11: ...,I -11-1;. ,.. tFni...; if ✓... S..{%#3, tI I 11 I 'll 11 -.1-11111 a 5 - .F..{> .., .•a..^% '5.,. .4 ... ., ?$,. f,..to k.l,o £ '��- ';,.i.a#�, . {J k � k'�,,,�'���' , { ? N,--k'As q:�.v"{,.Ykwx. .#': 0 3{s'�{ I'll -:�..�>s1.7C: r [ t� :.f{3..k': U.s: ...kki f. .. ..: .i....?x.?. -t�%x a'�'.L' ..'k'%jyr �%,.+%3,ti 1: p �,- ", ", '' , , � � -,-- p "", �;��Z�,z;i,,�:, , -1111-1 11 ",,.,,v3,",�,�'l-,., I I �� �,� ,,,,.,�, ff "' ,""',,,"-,,-,, I I a; , , -:I 11.:-x. dh 3.e sr�z 8d11 11 Ige nv# and 6r approvat cit any 1n�ease En"ttie odginai estimated price. ti, DOT #ERAt�s:(NE T t{itts PR{1X.y i'A�Due::Q 3ARCE S oiomp.:€o �a" F wlc k f "C.F 4 6%3 Lii ,, T 3A TN l IQ#Uhl#A11- LAfi1C1 kYi[ Fi# 'Alk At11Qt3i�# f+k �ih tai � ;tF At�3A . 919. 919. 11 9 INS nVM LE11 GAL AMON To9.11919. 9 11. MME 1.C lECT##?�#'O9.19.919.19 9.9 FTH�AAdZ:UNt�� TtSi INfi�4t 19 ,-.9 ' . L�'3 F T#. BUYS#AGREE 'TQ{W AL1 N ESMW t, 9919WM AND A 99 00 .9 9-999191991.1919-1111-9 S $. 3e. , cs1.t `Y :# £ {�s', 11, � sf .# . . , . £ s .tt� ;? i# x: t{ a r 91 �€ 19 �� t� ,�fi9. ti r . . 9.� m9.9 . ... . y ... CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan S, 2002 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. Pleasp,r t*L,,." Ia t i ngs". rz AMOUNT: Greater than $25,000 CLAIMANT: Frank McGuire ATTORNEY: Eduardo Gonzalez DATE RECEIVED: l ecerriber i .2001 ADDRESS: P.O. Box 27402 BY DELIVERY TO CLERK ON: December 18 2401 Oakland, CA 94642 BY MAIL POSTMARKED: 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE%I'� e Dated: December,18, 2001 By: Deputy ` 11. 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 914 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 914.8). { } Claim is not timely filed. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim (Section 911.3). { } Other: Dated: r. ' By: .f�F '' = y . ...... 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: N- 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 ' ' ;,r s ^, JOHN SWEETEN, CLERK, By k ' ` rr r wj ""---DeputyClerk ;i 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:,. < °;} s ",.' 1 U i", JOHN SWEETEN, CLERK B d f t € # r ;,,... . y y ,�47't° Deputy Clerk ELDUARDO A. GONZALEZ H Attorney At Law PO BOX 27402 OAKLAND,CA 94602 DEC 1 8 2,001 TELEPHONE. (510)639-7733 December 18,2001 Via hand delivery t Contra Costa County City of Martinez Clerk of the Board of Supervisors Attn: Clerk 661 Pine Street 525 Henrietta Street Martinez CA Martinez CA Re: FRANK JAY McGUiRE Gov't.Cade sect 910 et seq.Claims against: Contra Costa County and City of Martinez (injury date: July 19,2001) Dear Sir or Madam Clerk: This notice constitutes a NOTICE OF CLAIM AGAINST PUBLIC ENTITY(pursuant to Calif. Government Code section.910 et seq.)of claimant 1''12ANK JAY McGUIRE against Contra CostaCounty and the City of Martinez. The address for Claimant McGuire is in care of her attorney: Eduardo A. Gonzalez,Attorney at Law,PO Box 27402,Oakland, CA 94602,telephone number(5111)8)9-7733; such address is for purposes of this claim. On July 19,2001,at 48,61 Pacheco Blvd Martinez,CA,claimant McGuire sustained severe personal injuries,civil rights violations and severe emotional distress,resultant present and future medical expenses,impaired earning capacity as a direct result of the negligence andlor negligent supervision of Contra Costa Sheriff and Martinez Police Dept. personnel. Said injuries resulted from the negligence of such unknown employee(s)and/or the negligent supervision, training,control and wrongful acts of said unknown Contra Costa Sheriff and Martinez Police Dept. employee(s). At all times relevant herein,Contra Costa County and Martinez Police Dept. failed to properly supervise,train or control the unknown employees)which created a reasonably foreseeable risk of the injuries sustained by claimant McGuire. To date,claimant has incurred continuing medical expenses, sustained continuing personal injuries, impairment of earning capacity and general damages which exceed the unlimited jurisdictional limit of the California.Superior Court(i.e. greater than$25,000.) Please return the cope of this Notice of Claim after being stamped as received in the enclosed, stamped return envelope. Please call me if you have any questions. Ve y Yo s, A NZAL � f EAGlceg C Enclosures: Copy of claim - CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Jan 8, 2002 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 ; CII ' flth915.4. Please note all "Warnings". AMOUNT: $20,000 DEC 2 1 2001 J COUNTY Samuel Tucker MAR COUNSEL ATTORNEY: None DATE RECEIVED: December 20, 2001 ADDRESS: 901 Court St BY DELIVERY TO CLERK ON: December 20 2001 Martinez, CA 94553 BY MAIL POSTMARKED: December 19. 2.001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN Dated: December 21 2001 By: Dep EEe111 '-Z�{: t �s IL FROM: County Counsel TO: Clerk of the Board of Supervisors (4 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: .3 r� Dated �.-.�:,� -� �� � -- ��� By: ��F-�, ' �--�=� .�-�...4 77 ^�f^ County l ptrty Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Aft- inistrator(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. ' Dep uJOHN SWEETEN CLERK, BY Clerk t WARNING (Gov, code secfion 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'... ' rf i j' r s` lrs� ' ` ':; r JOHN SWEETEN, CLERK.By ; , +s Deputy Clerk r S C� 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 loop' 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 Clem of the Board of Supervisors at its office in Room 106, County Administration Building, 631 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 Against the County of Centra Costa : ) ' ' .. ....i 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$. `; ; : <..: and in support of this claim represents as follows: 1. When did the damage or injury occur? (Give exact date and hour) 2. Where did the damage or injury occur?(Include city and county) ., 3 L 3 How slid the damage or injury occur?(Cave full details;use extra paper if required),,,,, f . At C � �, �. ff "^ St.j }.-. f{ .� �' �<f '8.3".{� >vH'{� • f':H• k � T J. ].t Y: n / : j Y 's ;x�- 4. What particular act or omission on the part of county or district officers, servants, or employees caused the... injury or damages t > {' •.,•nae"'" > t:.. X{:�.,.. ✓� j <.: t°`t � - 5. What'are the name's o count 'odiArict officers, servants, or employees causing the damage or injury? ti.. ,. ,. 6. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed. Attach two estimates for auto damage.) f . • 1 v ": �'.:4:� :: <: ,A r< �F 7. How was the amount claimed above computed?(Include the estimated amount of any prospective injury or damage.) /'•" 'r �j. �y' y ..,�:: }, ^.� s ,y f,tom ...,f w.¢r r �' :l' ;.,Y'^rS4 '•.� .�,<e ,�tF. .•fid.S{ -', t,'.,k� i Ny d'` i 1 x ,t .;'; 2:.z' •rya. 8. atris an addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. ;MATE TIME w AMOUNT 0. f .r ,..£y•.'.£"� :.y f�••i? �� ��Ai'�'w kf�� �t `,.�� f� �� k {4 t 3t k v- d<d s `bC> �/.,,a` n !, v� U. P ,t °#r �.; :;�'�4"'` : , ��`: •> ,<, �, k� �''k,>�,. 4 t,.'k't., .$r ., k+<z � r �tf t �:> 5 .as' 1 a P��z4'✓s�i 6" } Gov. Code Sec. 910.2 provides "The claim must be } signed by the claimant or by some person on his behalf." END NOTICES TO: Attorney Name and Address of Attorney } } 4nt Sinture } (Address F y } Telephone No. }Telephone No. NOTICE Suction 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. fiq c Ifir tv L 5H "x":. �[ ( 'k_g '"`i'.• :go,, ' ` `i "Y'''� # Y3"{ f ''. w^'" r:. CW�'Ill l s L : LSiT�MlXyO�S.( ..:-.;. -C � fR 5.:.:. yyf. 805.•Q-d �f,`. �Y 4� �. A'd6'*t / JK : y ,�yA•�gp A. y.,;. .:.: Av AMP 'r Dt y . : � s ` r � . � 4 : • a Y.... �♦S�k♦i �'pS�'�}+ 2.N �,J6+ .. .< .;:t;E �M1 .. .:.. t` ..... �4 41 v r 9 . f ���F_}!fir fi" � $ 4 J'. y � �'• £i � � ry < b,� J .i ca'.d�!y< k � ;m ty. ..s x ^'8'.y'.N"Y.'4+}..{-.S.Y � :.�.F' < J 3 )1•. � y�yZ� �h- t•�aY '� ... ... ... y x 5•.y�i.+>�9 t•3r�� �" d° xs x } �.<:a:.,. __ "��� ���r�� ' �bJ�Fv�'�al 7 Chia 116 .................. ................... .xf" °'Y �.t J• '"iy k ,g "5^t,. 4 �` '�t.fsd +k srF p .. ... ,. -.. ... z tx a r r { t 57 L ....... � ..��' ,�.x� ��fi.:'t },�S"�.. � ,xfiNF}} � £:+..�"•z '<M;3< E 5.<T•�r.!�. N��.. +jam''1C' y. .+ Vim- \ l 3� J • /.) �� ��,. f�� '.' f f °a S .. ::fit. .: ..: . .. J , t vj::$: ..... �d bW... F Yt:. bF{� 'f^ o•+�'� x YY h - ... ........ d� fix„ .... ..... .... .. �J �� {., •� ,� J:} �� .•� '+s,�'!'% :,; ,yam y � ' ! ..., ... { �kr £ 5tmr.il,�IW+"�.`e� ,• �J.... � 2:�J 'NfK^�{� }(((k`�,'{� N'YS` ,� yy ti { ... \v�' :� }f`"'x32 � �ArJx ���� ��". '°f}�! -9•+��,��v �£}•'� a xr ' � � �,�,�-�,���'.sI'a $' 3J`,�,•.,.Au..: i gl,,,}: tr t,,} :.3 x,'{ ^� 3' .��� t .... ........ _....... ......__. _ .......................................................................................................................................................................................................... ............................................................................................................................................................................................................ _ ......... _ _ __ __ _ _ _ _.__...._ _._ __ __ __ 1" 11NWE REQUEST FOR INFORMATM. . MEDIqNL REQUEST C3a#e. # .;z NCxtitt As�Irttrter�fi Q e k tart �:.., )Request 4 )GOevance { AppeW ( }Oder Request .. �. > <`t { :!• + c$l Y •WV { R67tt#ed Ta. A�_B 4 }ASE=t ►V t d l b NI50"Stot on� i Pink s rt tty Inmate Yet ow PAW to nAme #Ithf#e.*1566MV 99 b�T02d; i#M #12/9t Yah � 4. ' y ­.UUNTRA R , � N1 FA IL1,171 (, ltAATE AEE WOR INFORMATION :mELdI�AL REQUE T W, FLax�f Yl t h Y p+.. �5, .`�w �t y t _1 t J } •� Ch ck 3n { ) Request (,A €evarzce t Appeal € OthW R H �.. . � I a r .Y F•. fi All �A#El : )APPROVED { � ©ENDED-(state reason) By Efate: ! f Pin k:fopt 4yinmate YbO w Repty to inmate< White:TflBooking> DE 024...t ESM 112191 a r 171 ff rr IT Ul REQUEST FOR INFOR lIA7`lON { }MEDIC AL.REQUEST P < t .x t _'.;� a• .r°' ty_ Bk9 7F�q'' 77 Inst {' t Housing Assignment # Glcc Carte ( Rsces# Appeal { );Other ;' S .t• � t �/'' ..� k �'! r., - ,tc:? may.i• ° r: > ',% : t ' �r ,+d rs Jnr� .:{: .:�.k M1 f t .<"f r�' .;rr i y F ,>•,c u• �' r I tj t ,. gz .. >#Muted T�. APPROVED DENED-(state rein); #' By: E3AW -------------- Pink;Kept by Inmate Yellow:t ib+to moat V"IW Th Ctrk(t� # CleT112/81 APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACTION Jan 8, 2002 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.) given pursuant to Gov q t Poe motions 911.8 and 915.4. Please note the Claimant: Derrick L. Garcia # } Attorney: Address: 3521 Garvin Ave Richmond, CA 94805 Amount: By delivery to Clerk on Decemeber 18 2001 Date Received December 18, 2001 By mail,postmarked on 1. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Gly r DATED: December I8 2001 JOHN SWEETEN, Clerk, By' `' ` s, - ; / , v De ut Clerk � ' „ p Y II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( ) The Board should grant this Application to File Late Claim(Section 911.6). ( The Board should deny this Application to File Late Claim (Section 911.6). r, DATED: ; fv SILVANO MARCHER, County Counsel, B lice : Deputy III. BOARD ORDER By unanimous vote of Supervisors present (Check one only) ( ) This Application is granted(Section }11.6). (, This Application to File Late Claim is denied(Section 311.6) �I certify that this is a true and correct copy of the Board's OrO r entered in its minutes for this date. "' j JOIINSWEETEN, Clerk, By F >j - . Deputy Clerk DATE:�rh"�� r��s �` � v_ �. o p Y 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 ''' '--JOHNSWEETEN Clerk B y '`" 1 '_4 r ����`�w�� s. ��� �� � Y�� El � � €� � •r �, � 1 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 Claim to: BO tai SUPERVISORS OF NIRA COSTA COUNTY INSTRUCTIONS TO CLAIMANT A. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or before December 31, 1987, must be presented not later than the 100"` day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Govt. Code §911.2. } B. Claims must be filed with the Clerk of elle Board of Supervisors at its office in Room. 106, County Administration Building,651 Pine Street.-Martinm 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 �`` � 1� ) ReservedforClerk's Filing Stamp CEIV _against the County of Contra Costa •�----- --� or DEC' 1 $ 2001 District) ;L '#ii<.E?C pI' D or SUPERViSC�F1S (Fill in Mame) CONTRA COSTA CO. The undersigned claimant hereby makes clam 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 dial the damage or in jury occur:' (Give exact Date and Hour) '. Where did the damage or injury occur' (inctude Citi and Countx ) etrlt y � , �'- ---4------------------------------------------------71-- --------------- _ 3. How did the damage or injury occur? (Give full details; use extra paper if required) a. What particular act or omission on the part of county or „district offiicceers,, servants, or employees caused the injury or damage? �'�•Yl(`) UJ v1 0 "'r. �� Zr t Over),' -aug pure mawuosixdtxt{ Bons gjoq.{q so `(040101S } ssc{{op puesnogj uai'Oulpaana iou jo auU r 1q tuosud aims at{l u{ mamuosudta :iq xo tuIaug pie juauosudim guns gjoq .iq io �( 0()O-IS ) sxu{{op putssnogj auo flurpaaoxa jou jo auk a : q `xuar auo u>sgj axout lou jo pouad a xoj {tuf.ijuno3 agj ui juauiumudtut :iq xapp atqugsrund si 13uptu.ti xo 'xaganoA tunoaaE `{pq 'u=ru{:- jua{npnr.ij xo as{rj .iur minuzi p aunts ag1 .iud xo .ao{{e of paztxotpnr °xaatjjo xa pjeoq 13ujsrp xo uza -.ilunoa :iur of xo 1xa3{jj0 xo pxuoq aiuls :iur of juauieud xoj xo aauu.Ao{{e xoj sluasaxd�pnrujap of juajut qj!b~aq.a uosxad .ixae „ :sap�ioxd apoD teuad agj jo ZL u011oaC 3DI10N + �� ori auogda{a� a auogda{a OWN J (axnxeua.s s,;urmir{,D ) iau.rou'y p ssaxppy pup aumhu ,,'j{>;gaq stq uo uos rad autos.iq xo (.iauxouv) :oi S3Duoj. C .N;as jueuimp aqj.iq pais aq jsnui uuzr,{a ag,j,„ :sapr.�oad v-Ot�i •aas apa� •.ion PQalz alva :.ixnfui xo juaptaae sigj jo junoaau uo apuuj noxi saxtuzpuadza aqj jsz,I ------------------------------------------------------------------------------------- V-4 V110 ia1+ �14ALi7' � Sjmidsoq puu*szojaop jo sassaxppr pur. satur.si -s V _�-_ (•a$autap so.Can(m anwadsoid.Cue jo iunomc patawpsa asp apnlauF) ;,pajndtuoa junow.. paten J:) anOgr agj Sr.ii Aiog XA :7.--(-a'stump oznt soj mnugtsa OAU tpeuv -pauurp sanautep.co saunfui jo juaiZa UN as{g) Lpaj{ttsax tuts{J noe op saunfut xo sa"Drmvp irt{t, -s jv Lianfut xo ant;tuup aqj lursnua saa�o{dtua xo�Sjcmuas 4s nowo jatsjszp xa,iIunoa jo saureu aqj axe jugm °s; APPLICATION TO FILE LATE CLAIM ' P< BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA BOARD ACTION Jan 8, 2002 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 Coded. given pursuant to Government Code Sections 911.8 and 915.4. Please note tl ';;below. Claimant: Timothy Applegate Attorney: Address: 5535 Giant Hiway Richmond, CA 94806 Amount: $1800 By delivery to Clerk on Decemeber 18 2001 Date Received December 18, 2001 By mail,postmarked on December 17 2001 I. FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above noted Application to File Late Clam, DATED: December 18 2001 JOHN SWEETEN, Clerk, By ; !ltDeputy 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). The Board should deny this Application to File Late Claim (Section 911.6). s DATED: SILVANO MARCHESI County Counsel B ( - ` De ut 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) I certify that this is a true and correct copy of the Board's Or&ex entered in its minutes for this date. DATE'S. JOHNSWEETEN, Clerk, By 1 t - t '�. 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 Cade Section 945.4 (claims presentation requirement). See Government Code Section 946.6. Such petition must be Bled 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 Claire in accordance with Section 29703. DATED i Hk V�# . „f JOHNSWEETEN, Clerk, By Deputy Clerk l' 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 Claim to. BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIGTiS TO CLAL'�A�'t` 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 10e 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 ager 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 claire 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 DEC 18 2001 Against the County of Contra Costa or District) � ' l i name) ) >.{ }.. The undersigned. laimant hereby makes claim against the County of Contra Costa or the above-named district in the sura of S f#x 3 y and in support of this claire represents as follows, 1. When did the damage or injury occur? (Give enact date and hour) 2. Where dict the damage or injury occur? (Include city and county) fi C ive full details;use extra paper if required) 3� kowr did the damage or injury occur 4. What particular act or omission on the part of county or district officers, servants, or employees caused the z, injury or damage's 5. What are thenamesof 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.) t .w� •'c � ,. � s A 7. How was the amount claimed above computed (Includee estimated amount of any prospective injury or damage.) s'<f 8. Names and addresses of witnesses, doctors, and hospitals. 9. List the expenditures you made on account of this accident or injury. DATE TIME ATMQI.N-T } Gov. Code Sec. 910.2 provides "The claim must be } SEND NOTICES TO: (Attorney signed by the claimant or by some person on his behalf." Name and Address of Attorney } µ } (Claimant's Si'nature } f ... (Address) sus 3 Telephone No. )Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with inters 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 fiaudWent 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. x s TOP\ I�lu 1- ' `mss ' ' � — -- - x Tr 2-t Ou — -- -pqow4 — 6 --------- ar Inv � f OT r