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MINUTES - 10082002 - C.17
CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION. Oct 8, 2€302 Claim Against the County, or District Governed by ) the Beard.of Supervisors, Routing Endorsements, ) NOTICE TO CLAIMANT and Board Action. All Section references are to } The copy of this document 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 Cade Section 913 and T919av� 915.4. Please nate all "Warnings". AMOUNT: $3000 Iq P 2 5 rtt 0 4 CLAIMANT: Cris Foster COUNTY COUNSEL MARTINEZ CALIF. ATTORNEY: DATE RECEIVED: Sept 23. 2002 ADDRESS: 18 /2 E. 6h St BY DELIVERY TO CLERK ON: Sept 23. 2002 Antioch,CA 94509 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE Dated: Sept 24,2002 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 914 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 vete of the Supervisors present: This Claim is rejected in full. { ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. r fz Y Dated. JOHN SWEETEN, CLERK, By t f < s .,t{ .' , , Deputy Clerk WARNING(Gov. cede section 913) Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6.You may seep 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 Beard Order and Notice to Claimant, addressed to the claimant as shown above. Dated. {t s ~ 'JOHN S"W"EETEN, CLERK By �' �;t � ,; a� a{ .� '�'" Deputy Clerk -_ - _.__. ..... .. ........................................... ...................... Claim to: BOARD OF SUPERVISORS O CONTRA COSTA COUNTY INSMCTIONS Tt7LAT7vlA.L A. Claims relating to causes of action for death or far 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 l0&day after the accrual of the cause of action, Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action.Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Sweet,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, separave claims must be filers against each public entity. B. P'ra d. See penalty for fraudulent.claims,Penal Code Sec. 72 at the end of this form. is+Meir###'iYrisik+l#Jti+Mwt�it�M+MYk##+F+Mf'�flssi+M�1Md'i�r#i#R+Ys/Y+kBt�i/;kiIriicatjYMMrY#rY+YrIR###rY###Y�tt�Y+1+ltk# RE: Claim By Reserved for Clerlr's filing stamp ) RECEIVED Against the County of Contra Costa or ) District) SEP 2 2 2002 (Fill in name). ) CLERK BOARD OF S(1Prq,t7;t;C)RS CONTRA COSTA c, The undersigned1 i ant hereby makes claim against the County of Contra Costa or the above-named district in the surn of S_, and in support of this claire represents as follows: 1. Wlqen did tate damage or injury o=r?CGive,exact date and hour) ho-'r" 2. Where did the damage or injury occur?(Include city and county) 3. How did the damage or injury ccur'?(Give fWl details;use extra paper if required) c +iAtz L�.�" �. �t..i..-✓�t... lac_.- C= --( Cwt.... ''�'� ��' U-)i. IOOQ ASH*ON91AT,S'f E- ),Hf+w y H qnH RO:An Sop 23 CTP- 09:34a Clerk or the Board 925 835 1923 P. 3, 4. What panicular actor omission on the part of county or district officers, servants,or employees caused the j injury or damage�3 - � � ?4V s 1 5. .What a the names of county or district officers, servants„or employees causing the damage or injury? P 6, What damage or injuries do you claim resulted? (Give full extent Of injuries or damages claimed. Attach two estimates for auto damage.) � 0, �rus 1144a 7. How was the amount claimed above corned? (Include the estimated amount of any prospective injury or. damage.)� � ,lr .�-- �, , � ��'(.�I�I�„�. ` AL �,'�k'�.�� 8. rhes and addresses otwitnesses.d and hospitals. e. 9. List the expenditures you made on account ofthis accident or ialury. DAT-E AMOK #sR+t#*!#�itr#�M##Wii#�sii4'#+r####7l��Ir#$�M+r'ii##s*#t�►rk**#M�*.*#4�rr#11tk##+r*##'k+tMti'+K*�It##i#�IrtW�Ys�i#dr�i*#�Y#+Y*# Gov.Cade Sac, 9102 provides"The claim mast be signed by the claimant or by some person on his behalf„ SEND NQJL(M=- Ut—tonlev Name and Address of Attorney ) � 5JAA (Ctai amt`s 5ignaturc) 76L (Addre )j T, Telephone No. Telephone No' NO17C E Secdon 72 of tM PeW Coda pravides: Evray pyo who,with intent to dtfaud,presents for 0004stcc of the paytms"t to awry state board or officer,or to easy cowq,city,or district board or officer,aothorbed to amara or pay the saaee ifgetrwxw,any false or fraarduloat claim,bili account, voticber,or vwitlng,is pwtishable tither by imprisom eat iti the oxay jail for a period of not mora than one yeas,by a the of not tarwtreedfug we thoum3d(sl,ot�j,or by bath Pick iworionment stat fir,arby iuprisbawnt in the state prison„by a flat afoot exoeedibg tat tboasaud dollars($MOM),of by both su&imprisanswent and fes, 7GGtAt 1 Cft`!"Mf C7 7CC'C a ff.YMidK'if i.i 27Y"N,.d Qh!i R 7f,M�7 lTr7.ean CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Oct 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: $3400SEP 2 i x 2002 CLAIMANT: Cris Foster COUNTY COUNSEL MARTINEZ CALIF, ATTORNEY: DATE RECEIVED: Sept 23, 2002 ADDRESS: 18 %E. 6`h St BY DELIVERY TO CLERK ON: Seat 23, 2002 Antioch, CA 94509 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEE j Dated: Sep!24, 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors" This claim complies substantially with Sections 910 and 914.2. ( } 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 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: C. t05TJ..(00n+Untffs nPnT�� l e- { Ai�! # a Dated: 12 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 511.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: (,} This Claim is rejected in full. ( } Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: '; :� :; JOHN SWEETEN, CLERK., By # � s , Deputy Cleric WARNING(Gov. cede section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. " For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF 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, a essed to the claim4nt as shown above. }� f €•� f F f r{ t Dated: }' ,`= JOHN SWEETEN, CLERIC.By Deputy Clerk Y Claim to: BOARD OF S1Jf'MVlrSORS OF CONTRA COSTA COUNTY � .TBIL:. 5 L__ A. Claims relating to Causes of action for death"for injury to person or to personal property or growing crops and which accrue on or before December 31, 198'7, must be presented not later than the 100'day after the accrual of the cause of auction. Claims relating to causes of action for death or for injury to person or to personal property or get Mng crops sod which accrue on or after January I, 1988, must be presented not later than six msarsths after the accrual of the cause of action. Claims relating to any other cause ofaction must be presented not later than one year after the accrual of the cause of action, f (Gov't Code 911.2.) I B. Claims must be filed with the Clerk of The Board of Supervisors at its office in Rooms 106, County Administration Buildin& 651 Phut Street,Martinez,CA 94553, C. if e:laim is against a district governed by the Board of Supervisors,rather than the County,the name of the District should be filled im � u : D. If the claim is against more than one public entity, separate claims must be filed against each,public entity. E, EcIW, See penalty for fraudulent.claims, Penal Code Sec. 72 at the end of this form. i fir:ass*+rrk+qac*,�ri�+rsr+F+rss�a�ss�*.srt�r*+r#M+�Ywa**��ycss�ra**,r+,�*fx*��rs�k�txarsss+���rr�r+Y�esr,�r*�crrewr�rst�s�r RE: Claim By Reserved for Clerk's filing stamp RECEIVED Agit the County of Contra Costa or } SEP 2 4 2002 District) CLERK BOARD Or"SUPERVISORS (Fill in name) ) colo�ISA COSTA�O. The undersigned tai crit hereby makes claim against the County of Contra Costa or the above-n ims:cl district in the sure of S and in support of this claim represents as follows: L When did the damage or injury ocvxl(Give exact date and hour) ,A Z. Where did the damage or injury occut'tsuclttde»city and county ffvAft3 U&M- h8fk, 3. How slid the damage or injury ocrtur?(Give#`ulY details;use extra paper if required) NWWI� l' �. . Mt WJ CYCYY'_G'C ,c. 7&NM.%1rU JzrJU t3►+'t7f31 -,.rXB�rho r�t ""`.r Sep 23 02 09:34a Clark of tho Hoard US 335 1913 4. 'tiW"hst partioular aft o 01M ion on th part of k►�un or dia of'iwsr servant or employees caused the injury Or dl Lrndge���1 U r' �r� -"Cena t . U4 al 5. .Wmes orc n or dis*n : cors, serva�or employees causing the damage ur injury? 6. What damage or injuries&do you claim r sttl 7(Give full extent of injuries or damages claimed. Attach . two estimates for auto damage.) � �`� E � 5 7. H was the A t c atrrYcd a ve computed?(Snrdude the estimated amount of any prospective injury or. damage. . A %, 8. N m s ars ddresses of witnesses, doctors. d hospitals. 47V 'V 9. List the expenditures you nude,on a erne of this accident or injury. *2«ww�twi�w+�rwtrsrr�rt*�«**w**i�w**w+r+►*w*w+�rwwawtrt»�vw*+w*.s*wwt�w*wx�w*w*wrwwsw•�#a,ctr*wwww+wf*w*****rs Gov. Code Sec. 914.2 provides"The claim crust be signed by the claimant or by some person on his behalf."' Narne and Address of Attorney ) ( aimant's Sigrtttture (Adre ) Telephone No. �Telep#mnt;.Nt� •w�+teen+�swtr*«tw*w+►-s+►*+yaw*r*a*ws�+renis+t�ettwseerwt*ss*wwss�*wwr+►v��r.*tsrwws*t++�►wss,r,swww wssawt�*stt+eww NOTICE Sacdou 72 of tbt Pool Coote provides: Evoy pemon wbo,with Went to defraud,premu for aliawasc or the P"Meat to arry4 4ste board or ofD aer,or to any county,o ty,or diaric+t Ward or of Uzr,auftrizod to atlaw or pay the am it vnuiiie.arty blot or fraudulent claim,b4 accowt, voucher,w wr tW&,Is pwdshhsbk thherr by Impisorm att in the coaq jail for a pxiad of not=Qra than one year,by a fim of trot exceeding ante ftumd 01,0001 or by bath such imprhgvm=acrd fr»e,or by ftuptimeniew in the owe peisaa,by sib*of toot v=edbg tm tliou nd donors($1%000),.or by both bv4b im prisc»wnt a»d hm i t CXiSR/t 3 CYA'flAt 2 FKr"n r U Lri'Y.t CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY do AF BOARD ACTION: Oct 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 54 Board of Supervisors. (Paragraph IV below), given PH, Pursuant to Government Code Section 913 and 915.4. Please note 1 "W�PMall "Warnings". 2002 AMOUNT: $10,806.67 COUNTY COUNSEL CLAIMANT: Kemper Insurance MARTINEZ CALF ATTORNEY: DATE RECEIVED: Sept 24,2002 ADDRESS: P.O. Box 526007 BY DELIVERY TO CLERK ON: Sept 24.2002 Sacramento, CA 95852 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWE Dated: - Sept 24, 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervise s { This claim complies substantially with Sections 910 and 910.2. { ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) Claim is not timely fled. The Clerk should return claim on ground that it was filed late and send warning of claimant's right to apply for leave to present a late claim(Section 911.3). { ) Other: Dated: Y 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: (�o 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. �. Y�L� Dated i .k ; 6 JOHN' SWEETEN CLERK B �'#i��;{,`� i �` s , 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 ,- a t r` F ., ; JOHN SWEETEN, CLERK By J i",s ' Deputy Clerk -1011r : . .., _: . Claire to: BOAP.D OF sJ?VMW 5 OF t w'EA a=A Cowry iNSMCPZM TO CLADWC A. Claims relating Lo causes of action for death or for injury to person or to per- sonal property or growing crops and -Mich accrue on or 'before December 31, 1987, must be presented not later th.arr faire 100th clay ager the acct l of the cause of action. Claims relating to cawof acticz for-death or for injury to person or to personal property or growing crops arsd Crich accrue on or after January 1, 1988, trzt be presented not later than six m nths after the accrual of the cause Of action. Claims relating to any other cause of action wst be presented not later tharr we year after the acerwa of the cause of actioa. (Govt. Code §911.2.) B. Claims must be filed with the Clark of the Boatel of Supervisors at its,office in Ro= 106, C=ty Administration Building, 551 Pine Stm t, Martinez, CA 94553. C. if claim is against a district governed by tte Board of Supervisors, rather than the CoLmty, the name of the District should be filled in. D. If the Claim is against more tha:s One public entity, separate ciairs must be filed against each public entity. S.' Fraud. See penalty for fraudulent claims, Fetch:..Code Ser. 72 at the erd of this o M. Maim By ) Reserved for Clerk's fill. ORE UVED rr Agairsst a rty o evsraor j SEP 2 4 2002 District) CLERK BOARD OF SUPERVISORS CONTRA COSTA CO. iin name) The tmtrdersiped clai=tnt hereby =ekes claim' i_ t .the, ty of Contra Costa or the above-rased District in the sum of and in support of this claim represents as ,follows: 1. When did the damage.Gr injury o;;anr7 (Give exact date and hour) By Where didr the dageor irrtr7 oamar,.7 (include city and county) 3. How did the damage or i j occur? (Cave de la; use. a pat r required) � ter occur? ctir In #. What partioular act or omission on the part of =Lnty or district orficers, -74 M7 �.the,iCi,�ur'�, p3. �? w. .,,. y Zo*CJTet,T si~ sus -N3WE)uNb t ASIN :)Do .s 2!00Z-4T-d3S 5. What W'e t4e nam or comfy or district ofriaers, servants or employees Causing the damage or injury? eK 5. that damage or injuries do you Claim t-oulted? (Give full extent of injuries or dazages Claimed � ttach two estimates for auto damage. 7. How oras the amount clamed above (Include(Include the est' ted oma a of prospective injury or damage.) �, 6 �� r. $.� Names and ad resses of vdasses, doctors and hospitals. 9. List the expenditures you made on account of this accident or injury. DA'T'E ! AWJNT It iF !F * * # i iF #-# *.i # ! Gay,. Code Seo. 910:2 provides: ^�,7ri 1:� rclaim must be signed by the claimant SM NOT.°IMS TO- (A.ttorne ) Cr on his.behalf." Nana and Address of Attorney G2aimant°s Signa ure Telephone Pio. TelephonePro. � `�f NOTICE Sectio 72 of the Pena. Code provides.- "Every rovides."Every person Who, with intent to defraud, presents for allowance or for PaYmWt 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 imprisoriment in the county �ail"fo- a period of not more th= one year, by a fine of not exceeding Me thousand ($1,000), or by both suoh' imoriso t and tine;-or by imprisonment in the state prison, by a fine of not exc ding tett thousand dollars ($10,000, or by ``-"'t atrnh imori3onment and fine tet?T SEE GZ6 Jun . 7, 2002 2:47PM L&S REPORT SERVICE 602-271 -0161 P. 1/8 L & S REPORT .SERVICE, INC. Order Date P.O. BOX 9874 05/30/2002 Phoenix, AZ 85068.9874 (642) 943 - 7474 924 .66 INVOICS# 924166 Company dame KS KEMPER INSURANCE - SACRAMENTO File # or Insured 786 Adjuster163124 IRE 1111111111111111111111 ICS Location HWY 4 County City & State BAY POINT CA Date Of Lass 05/24/2002 Time 01:0 Type of Loss TRAFFIC ACCIDENT 05/24/2002 Investigating Agency CHP MARTINEZ, CA (9324) Report Number 5-928 Parties Involved: DOB. R.ODRIGUEZ* BRENDI / D2189966CA Additional information FAX V1 IN FAST LN. IVSD SAW ACCIDENT TO ONE SIRE. V2 CROSSED IN FRONT OF VI AND STOPPED FOR ACCIDENT AND V1 TRIED TO AVOID *** FAX # (800) 800-0985 *** 786 DATE RECEIVED 06/07/2002 Number of Pages Including This Page (888)679-1839 S?ATEOF.un , 7. 2002 2:48PM L&S REPORT SERVICE 602-27'i -0161, 1Z No-a975 P. 2/8 CHP$55 2m i(Re—v.-&97) OPI 042 - pw5 SpleCUA.CONDITIONS MIAltKtawm C1TY .IUDIC1AL DtsTRICr LOCAL REPCi14T NUMSSN YUUACQ }!tY>+K 1 '" 7J RR>QLLSdtgti.MNt COUNTY LN/{! lREPORTING DisTR1CT 5 CCi It ak- ON MO. DAY YEAR TIME 6240% NC#CF flfP1C1SN kD. tl 5 2 W EPOST INFORMATION DAY OF WE__Ee�RTOW AWAY PHOTOGRAPHS SY: �NONE tC-t) ` fE,ETAiKii�' of S M 'T 'W TtOS YES NO VAT INTERSECT"WITH STATE?MPI REL S OR: PEETAr�4Si a► C"J�`f YES [] NO ' PARTY MAN$LSCewle MUM" IstAy$ CLASS ISAMTY WH,YEAR 1+ARfJF10i5E.i%CAI...OWI LICENSE NtANEER STATE CIA 49 lkk NA JE SAME AS ORIVER KuzMo 8TRE.LR ADDRCSS _ i [iY p OY.N6tSADORE$S SAME AS DRIVER rAN�o CITtlSTA7E121P �f"&TORI L_! JA-,17A- AV4 C4 9 T ds tr aF 4 a6g oN oRms or: OFFICER DRP41M OTtJER NC!- SEx HAIR. ems "WHT MIGHT � S.�$ Yrr RACE •�+"�• �L+�E T !�'3�7"77�T yrs RJc� ytf .moi 7'3� Frno>;�cn o ECTa K**APPAR& REFE7tT0NARRATNE tiCR#PrN�ONS ry {�/�y r� SUffidNEB$ANOfIE VLklt11�tC;'EMT�ICAT}OFf NUMEtfJk J s+1.43{r+"�Ar+. f Ci#'USS OM.Y DSSCRIN WENKA.E DAMWE SNAGS INOAMA @O AREA MWtANCE C'AlrIM FOUCYP*#AWR VEtflCLEType LINK ®NONE L_..f"NOR f ( MOVMAJOR[3 fiO(.t-PWER fJ f 1 D1N Of YflA4£L CN ST141�.°T ON Hif#itAVtY SPEP 11AlTT CA atTT � J� CAL.T 7CPWSl: MC1Iow J PARTY DR711ePC3 L1CL'N6E NIAMEER STATW CLAR$ SAPM H.YEAR MAKOMOOOLCOLOIR WCII W NUMM STATE 84t11P. lt'"d JA r-.1 c OWNEWS NAME SAME AS ORNER LVM /,?go mv o. �d� . av`► �y��AyanaEsa ( � SAMEASDRWERPAMM t ('`''� CITY14TATO"yffloat /p Ofd 6 ef77J s L ! f'YjAt,QTtrJ aJ OAPOSIVONof"vrt"=ONORDERSot: OFFICER g]DRnMR[]OTHER ICY 4E7( HAN! EYES HEICIRfT WEIGHT $IIETH7ATE RA49 !Z6 R10R MECHANICAL DEFECTS NONE APPAREkT R>FER Tp NARRA7NE CT411 Mo"PROW aAeWE13S PHO^t�tE ']I «� y vEH1CiE fDENT7fiCAT70N NUMKR: 1 CHP Use ONLY DESCRIBE VEHICLE DAMAGE SKUW IN DAMAGED AREA iNSURANCECANRISA PWCYMAOSER VEHICLE TYPe '11uNK NONE X]MINOR ( � DMOO. I__.I MAJOR ROLL-OVER /r V OP TRAVEL.ON ST31pE,eT HICH'NAY $PEED LIMIT CA DOT t CAL-T 7CNCM1c I PARTY ORii "LICEN8S k17MSFJt SYATF CLASS SAPVY' YEAR LiC6N$fi NUMSEI! STATE --- ----- ---- - ---- amoo NAME 0WITT,MoCov.LAST) D. O;"MR's NAME SAME AS ORWER SMET. STREET'ADORE= ER's ADDRESS SAME AS DRIVER PAW* CRYIBTAT2aW DiEPOSITION OP VEMICLES"ORDM OF: f 3 OFFICER DRIVER OT"ER $EX flA1R EYEtl HetOHT W76RINT � �DA7F Y>� RACS �•t ® PRIOR MEOHAWAL DEFECTS: W)NE APPARENT REFER TO NAARATNE lTi01 NOME P1ffSNE $U$1HEi$PYgNEV00OLe MREtmFICATTDN NUMBER CHP I"ONLY DESCRIBE veHICLE DAMAGE SMAOE 1N DAMAGED AREA INSURANCE CARRIER POLICY WiMSER VEMCLE TYPE Cl LINK. F"NONE ©MIKOR ®MOD. MAJOR[]ROLL-4WER /��~�� OIR Of TRAYEL{DN STREET OR HIGHWAY >k+EEO 61MIT � CA DOT CAL.T upmsC Mtwo-Y. PREP'AR'E"NAME DISPATCH NOTIFIED E OA E MLX A ! j K YES []NO MIA4aLs z Jun , 7 . 2002 2:4SPM LAS REPORT SERVICE 6P . SIS STATE Of V TRAFFIC COLLISION CODING GIMP 555 P 2 ev,8.97 OPI 342 4An bR cc"IsKJN<MO DAY YAR) TVA 124M MGIC,t opriCBF 10 �fAStAt+t£it o nsrtAAlE scswe�RSAtaoAEsB r+c r� PROPERTY A)LA _ i j YEs 40 DAMAGE 0"cix PTON Of SOS SEATING POSITION SAFETY SCARPMENT EJECTED FROM VEHICLE OI+CClfAANTS L-AIR SAG DEPLOYED Yt�!C EYiGYGL •NSLMET -Hlt ltd C+EHtGL - NOT DEPLOYED R 4-1 LOT EJECTED A OTHER I-FULLY EdEGTgD C-LAP BELT USED P•NOT REQUIRED V-NO 2-PARTIALLY EJECTED D-LAP BELT NOT USED W_YES 3-UNKNOWN € 1 2 3 1-DRIVER E-SHOULDER HARNESS USED 2 TO 4-PASSENGER$ F.SHOULDER HARNESS NOT USED CHtW RE3TRAENT PASSENGER 4 5 I37-STATION WAGON REAR G•LAFit��IOULDER HARNESS USED, � EKED X-NO 9-REOCC.TRK OR VAN H•LAPISHOULDER HARNESS NOT USED R-IN VENICLE NOT USED Y YES AR 9-POSITION UNKNOWN 1-PASSIVE RESTRAINT USED S.tN VEHICLE Use UNKNONM i 7Q K.PASSNE RESTRAINT NOT USED U_IIWN VEHICLE PER USE OTHER t taHSGLE SSf ITEM MARKEW uvL OW FOLLOWED E'Y AN Ui.D BE EXPLAINED IN THE NARitl4TIVIE i PAWA Y COLustom FACTOR TRAItno CONTROL Dwom � 2 � TYPE OF VEHICLE 1 2 1 3 MOVEMENT PRECEDING LIST 8ER A O#PARTY AT FA T t A Yc scan*u+ar wpm: ar eK CAR A CONTROLS FUNCTIONING PASSENGER t STATION WAGON A "PED I vZ . fT�t. Y COKtRCStBbKTTFCTIONiNG PASSENGOCARWNTRAILER 8PROCEx9iNCs OTHER IMPROPER DRIVING, CONTROLS OBSCURED C MCI CLE I$COO R C RAN OFF ROAD ND CONTROLS PRESENT t FAGTM* PIC R PANEL MAK R3 TURN c OTHER THAN WVER` TYFL°OF CT�.L38ION N FAA�L I£w TRAILERfPASSINGOTHERVEHiCLE ; � E MU+3t G LEFT TURN #'}UNKNOWN" A HP.A✓Q,ON F CK OR KTRAGTOFt !=MAtSttNG U TURN FELL ASLEEP` S SVNPE TRUCK 1 TRAM TOR VW TRM 8A1G7CMKi RL'AREND N Se out I# `SLOWINGISTOPPING WIATME* 1 TO 2 SROAOStDE I O Bus A CLEAR HNT 08JEGT i odEmwmcyveJ CHANGING LANES 13 CLOUDY F OVERTURNED I H Cowill.Eaummew PAMNOMANIEUVER RATNTNG WHIC /PEDE ft OL 81CYCLS L ENTERING TRAFFIC SNOVONG 4t M-0—T—m— E M OTHER UNSAFE FOG 1 VlS38iUTY FT P RtAdt N XNWG INTOOPE'OSSN4 LANE F OTH>E4' MGlt)FIVVGttBBCIE1tiVti9tY 1187it o m ED I",,,1` PARKED VWINON-COLLI$K3N P MERGING P EIRP-W a TRAVELING VWONQ AtkY XIA DAYLIGHT C MIR MOTOR VEHICLE OTHSA AI67ttrMWO FAGTOR(SI R OTHER.' DUSK.DAtVWN MOTOR VEHICLE DN OTHER ROAilWAY (MARK f TO 2(mus) I C DARK-STREETLIGHTS PARKED MOTOR VEHM A vc seenenwa�c� To DARK Vt3 STREETLK3HiS TRA#6 G �=DARK•STREET LIGHTS NOT 3lGYCL E B'�WtCu voaxtpwr c na YES FUNCTIONING• H ANIMAL:. 1 � �� 308RIm-aftu G + N[t3ADNtAY$73RFACE C axamu+aounar IMYOCAL DRY FIXED OSSECT DIRK T TOltEAAS) A HAD NOT aEN DRmmm C SNOVWY-ICY j OTHER OluECT: E VISION OSSCUPAMENT: I 8 PSD-UNDER INFLUENCE SLIPPERY DOY DiLY C. F INATTENTION— C HUD-NOT UNDER WFLLWNCE' ROADWAY Cts#DM" G STOP&Go TRAFFIC D H$p-IMPAIRMENT t NXNOVWN• (0ow Y TO 2ITEM$) PEpE3TfdANtSAGFAN# ENTERING t LEAVtNC:RAMP E UNDER DRUG INFLUENCE` HOl£s,DEEP RUT' ANO PEDESTRIANS INVOLVED PREVEOUS COLLINsK1N F IMPAti�NT LOOSE MATERIAL ON ROADWAY` #9 GROSSING IN CROSSWALK � UNFAMILIAR WITH ROAD is IMPAIRMENT NOT KNOWtt C 08STRUCTION ON ROADWAY' AT INTERSECTION K DEFECTFIE VEH.EtiUIF. CITED H NOT APF1 iCABLE D CONSTRUCTION-REPAIR ZONE C CROSSING IN CROSSWA X-NOT �Yes I SLEEPY i FA RfOUCED ROADWAY WIDTH AT tNTERSECTION NO 3F ECIAL INWtlMATKIN F FLOODED' D CRO$StNG-NOT IN CROSSWALK L UNINVOLVED VEH?CLE A HAXARDDUs mAnmIAL Ca OTHER" IN ROAD-INCLUDE SHOULDER OTHER" _ N NO UNUSUAL CONDITIONS F HOT t1W RtIAD NONE APPARENT APPROACMI[4G 1 EA-MING SCHOOL BUS RUNAWAY VEHICLE H W'�d °" SKETCH +l-lia � MtScEuANeoU3 j T IPiC11CA'tIC NdTTYYi � - + rYit� P i wxLa .__.-Cts 19C cli? DA Po/so J n7. 2002 2,49PM L.&S REPORT SERVICE 602 271 -0161 No6976 P . 418 STATE Dlz_.._.......,» INJURED l WITNEW PASSENGERS_4HP 555 Page 2(ROV,6471 00 212 p4g24r at� 047E OF OMLl9 M 4Mtl OAY YlAJLi TMW{2460) NcsC i OFFiC£R :+ f r� Q t dJ. ✓ . EXTENT CIF INJURY("X"ONE) INJURED WAS(V-ONE) PARTY $ZAT EAr-TY VaTNESS pAsseNdl64 EJBGTBa AO[ EEX 1 NtA#BEk POd. EOtpP- t ONLY t)FE-Y FATAL B@V�Rfi QTNBiCVlif6t,! C4Ft4PWNT flRNER PAdi. PID. �b14<YGLIifT 0T7f8.R tNJGKY MliURY N{JVRY UP PAMI Q# ❑ , r ❑ ❑ 111 ❑ ❑ ❑ ❑ / / G zg- NAME10.0.a.rAaaRiss TELEPHONE. f>N.1LQ4E0 ONLY)TRANOPIDAM BY• TAKEN M LANrG D&ECRtBE ViJtiRl}v.E t VICTIM OF=LEW CRV.W NoTnrl 4 #{ ❑ ❑ ❑ ❑ ❑ TT-37-11 ❑ ❑ ❑ NAME 10.0.B.1 A00RE.I'B TELEPHONE jiN 9JRF.0 064Y)TRAN8P0RTE0 9Y: TAKEN TG QE9CRiBE,kiri as .. VIG57M OF VXXAN TCRUS NOTWRM NAME i D 0.B,t AMPS" TELMIMOW Ouurka4ONLY)TRANSPORMW. TAKEN To: MCRt86 44AM93 VfOTIM OF VIOLENT CRIME NDTIFIEO 110D ❑ El ❑ ❑ ❑ 11 F-1 11 ❑ NAME r0.a&tA0W "e+ (WQUAW OHLYi TRAWPORTEt3 BY; TAKEN TO: OLSGRRD&tNJLrfNE$ Y 'ACT*CAF NAOLMT CRIME NOTWWD NAME J 0.0.®.f AAORM YELlPFIONE �9NJUREO ONf.Y;TRANSPORTEO by: TAKEN TO: DUCROME AS AWA SAMTVA OF kkXANTCRIUE N"PIEa cl NAVE t 0.0,9.r AFXYlESs; YELEPHON@ fEO ONLY}TRAN$POH`PEO BY: TAKiN T0: `OEBO#t8E 1Ntt7FtkE3 VCrM OF VKSLW CRIME NOTfFNM PREPAM I MAMA: f.C.NLWRRR M0. DAY YEAR. oteva BRA NAME MO. DAY YElAx lJI.,� ltG�3e3' 1?S x.41 a z. - jun. 7. 2702 2:60PM L&S REPORT SERVIOE 602-2111 -0161 No .7975 P . 6/8 STATE f7F a.nerrv`nw FACTUAL LNAGRAM "7 C3tn 2S of BATE Oi WCl{itx9N daD. cm, YMNq liME{moi NpCi i OftlCtk xt7. ��� k " /- 8 S- a fid` Ati ris"um"W=AM APPOMWA7R ALIO par To wAw Fllium sum tscAu• ? • _ 144 .7 4195.TLW +pirom .StluC Y�,.�.aN Wwt/ �zr tz' wN�� '.carr-s'�r- �+v4At6 t�►� )ZI 4- /at ��1�4Y Allh�" J E ' ft.SA�AtJ sr�Or+Z4x9�'. R?YAkBiJ d'! ,J i.B.MUtMFJE >fi0. pAY YEM 4— skemrwws mom "a. OAY yrm Jur . 7 . 2002 2.504 L&S REPORT SERVICE 602-271 -0161 N-o•5975 P . 6/8 STATE OF CALIFORNIA . NARRATIVE/SUPPLEMENTAL PAGjo 7 of DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 45/24/02 1258 9320 12688 5-298 01 Facts 02 Morl cation 03 04 A collision call with unknown details was dispatched to Officer Warner i#13548 at 1256 hours. After she had arrived at the scene she requested another unit to assist and 1 responded from Port Chicago 05 Highway at Riverside Rd. and arrived at the scene at approximately 1312 hours. After my arrival, it 06 was determined that this collision had occurred after the original collision(5-294)that Officer Warner investigated. 07 08 Times, speeds and measurements were approximate. Measurements were made by vehicle odometer and estimation. 09 10 Some 11 SR-4 w/b w/of Willow Pass Rd. (Bay Point)is a 5 lane freeway and a posted 65 mph zone. Prior to 12 this collision there had been another collision with an involved vehicle in the center median and partially blocking the#1 lane and another involved vehicle on the right shoulder w/of it. For farther 13 details, refer to the factual diagram. 14 Parties 15 16 P-1 (Rodriguez)was located standing on the right shoulder of SR.-4 w/b w/of Willow Pass Rd. (.Bay Point). P•1 was identified by his CA drivers license and his own statements as the driver of V-1. 17 18 V-t had been driven to the right shoulder by P-1 after the collision and prior to CHP arrival. V•1 had 19 moderate damage to its left front bumper, grill,fender and its left front wheel assembly was missing. 20 P-2(Remick)was located standing in the lanes directing traffic around vehicle debris upon my arrival on SR.-4 w/b w/of Willow Pass Rd.(Bay Point). He was contacted on the right shoulder and he 21 identified by his CA drivers license and his own statements as the driver of V-2. 22 V 2.had been moved to the center median prior to CHP arrival by P-2 and after my arrival to the right 23 shoulder. V Zhad miner damage to its left rear corner which included the bumper, door and body. 24 Its left rear fender was damaged as well as the exhaust pipe. 25 26 27 28 PREPARED 8Y LD.NUMBER DATE REVIEWEKS NAME DATE mala, J. 12688 05/27/02 Jun. 7 , 2002 2:5OPM L&S REPORT SERVICE 602-271 -0161 No,6975 P, 7/8 STATE OF CALIFORNIA . NARRATIVEISUPPLEMENTAL PAGE4of7 DATE OF INCIDENT TIME NCIC NUMBER OFFICER I.EJ. NUMBER 05124/02 1258 9320 12868 5-298 01 Statements 02 P-1 (Rodriguez) was contacted at the scene. P-1 related he was driving V-1, w/b SR-4 w/of Willow 43 Pass Rd. (Bay Point), in the 41 lane,at an unknown speed. P-1 observed V-2 suddenly pull out in 04 front of him from the left: He braked V-1 hard but was unable to stop in time and the left front of V-1 collided into the right rear of V-2. P-1 was able to steer V-1 to the right shoulder and stop. 05 06 P-2 (Remick) was contacted at the scene. P-2 related he was driving V-2, w/b SR-4 w/of Willow Pass Rd. (.Bay Point)at approximately 65 mph, in the#1 lane. P-2 observed the previous collision 07 ahead of him so he began to brake V-2 and steer left towards the center median. P-2 observed V-1 08 approaching him from behind in the#2 lane at a fast rate. V-1 then collided into the rear of V-2 after which, P-2 drove V-2 into the center median and stepped. 09 10 W-1 (Levine)was contacted at the scene. W-1 related she had stopped her vehicle in the center median of SR-4 w/b w/of Willow Pass Rd.(Bay Point)to assist the parties of the previous collision. 11 She observed V-2 stop in the center median in front of her. V-2 then pulled out into the#1 lane in an 12 attempt to get to the right shoulder as V-1 approached at approximately 70 mph in the#1 lane. V-1 braked hard but was unable to stop in time and the left front of V-1 collided into the right rear of V-2. ` 13 14 Opinions and +CQncluslnns 15 Summury 16 P-1 (Rodriquez)was driving V-1,w/b SR-4 w/of Willow Pass Rd. (Bay Point),in the#1 lane,at 17 approximately 65 mph,approaching the previous collision scene. P-2(Remick)was driving V-2, 18 which was stopped in the center median of SR.-4 w/b w/of Willow Pass Rd.(Bay Point),w/of the previous collision scene. P-2 accelerated V-2 while steering right entering the#1 lane in front of V-1. 19 P-1 braked V-1 but was unable to stop in time and the left front of V-1 collided into the right rear of 20 V-2. After the collision,P-1 steered V-1 to the right shoulder and stopped and P-2 steered V-2 to the center median and stopped. 21 22 area of Impact(AQJI 23 AUl was approximately 3468 feet w/of the a/edge of Willow Pass Rd. (Bay Point)u/e and 24 approximately 4 feet n/of the s/roadway edge of SR-4 w/b. This was based on statements and vehicle damage. 25 26 27 28 PREPARED£3Y I.D.NUMBER DATE REVIEWERS NAME BATE Moia, J. 12688 05/27/02 Jr . 7 , 2002 2:61P'i� L&S REPORT SERVICE 602-271 -0161 No -6875 P. 818 STATE OF CALIFORNIA, NARR,l4TIVE/SUPPLEfll1ENTAL. PAGE&7 LATE OF INCIDENT TIME NCIC NUMBER OFFICER I.D. NUMBER 05124/02 1258 9320 12688 5-298 01 Cause 02 P-2 (Remick)caused this collision by being in violation of Vehicle Code section 22107VC (unsafe 03 turning movement). P-1 (Rodriquez)was an associated factor in this collision by driving at an unsafe 04 speed for conditions(previous collision scene/partially blocked lane) in violation of22350VC. This was based on statements,vehicle damage and the nature of this collision. 45 06 Recommendations 07 None. 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 PREPARED BY I.D.NUMBER DATE REVIEWER'S NAME GATE Mo(a, J. 12688 05/27142 VEHICLE ACCIDENT REPORTf' � -a DAVE" TIME ..�,�� ACCIDENT LOCATION 4 �-� IA- Vehicle Equipment No.�. Lic. Plate No. ' " Year/Make/Type Ira C-vrn ` ...�. County .Driver: Other Driver: Name the,rt W Name •C6c4,L COo - Home Address . agQ M"sV Home Address 4115 CVN ��t r Home Phone # ,162 �ksl 25ta Nome Phone # Work Phone # CV7.� �� x� � - j�4 Phone # a� Driver's License �s`, Driver's License # C G-112. Car: Year-Sl Make � Model P If Personal or Rental Vehicle, Registered Owner LO,' Name & Address of Agent Address �.4Is, C . Phone License Plate # D CAS5 S2- Insurance Company Me Police Report Taken: Yes No Address Policy 0 „ t v Police Dept. _ '-2-D Agents *wftL- 7.. � List Injured Parties: List Witnesses. 1. Nameva 1. Name . Phone Phone Address Address Street Street City State Zip Code City State Zip Code 2. Name 2, game Phone p Phone Address Address Street Street City State Zip Coe City State Zip Co e 3. Name 3. Name Phone z! Phone Address Address Street Street City State Zip Code City State Zip Code Seat Belt Worn By County Driver: Yes 'A. No Damage to County Vehicle '�Ao Damage to Other Vehicle `Bre M:VAREPI IIJI/88 PREPARE SKETCH OF ACCIDENT SCENE: Indicate direction, street names, traffic signs , landmarks, etc. (1 = County Vehicle 2 = Other Vehicle) 1. Number vehicles, show travel direction by arrows. <----r 2. Show path before accident with solid line. —.,, 3. Show path after accident with broken line. '---> => 4. Show pedestrians by ----•-o 5. Show railroad: tracks by44�t.��t. DESCRIBE HOW ACCIDENT OCCURRED: Include approximate speeds of involved vehicles, whether any parties appeared to be under the influence of substances , etc. (Add another page if necessary.) � ^+ f q me- C Lop- �v1 y �a EL I& V10 C, v `qr-o - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SUPERVISOR'S _ _ - - _ _ _ _ — .- _ _ _ _ _ _ _ _ _ — _ _ _ _ _ _ — _ _ — w _ _ _ _ _ — - - _ _ _ _ _SUPERVISOR'S INVESTIGATION S r-( PCO SUPERVISOR'S RECOMMENDATION 4= ACTION COMPLETED - Yes X- NO d11- SUPERVISOR'S SIGNATURE DATE M:VAREP2 Send Original Report To Risk Management And A Copy 9/6/88 To General Services Fleet Management Immediately __ .. ...... . _ . _ _ ...._ ............................................................................................................................................................................................................................................................................................................................ PREPARE SKETCH OF ACCIDENT SCENE: Indicate direction, street names , traffic signs , landmarks, etc. (1 = County Vehicle 2 Other Vehicle) 1.. Number vehicles, show travel direction by arrows. -;� < 2. Show path before accident with solid line. ---+ E:> 3. Show path after accident with broken line. E 4. Show pedestrians by -----� 5. Show railroad tracks by - - --¢- - DESCRIBE HOW ACCIDENT OCCURRED: Include approximate speeds of involved vehicles, whether any parties appeared to be under the influence of substances , etc. (Add another page if necessary.) w '2-Lk S��t e.i� I CpAktA0 A4-N- LAP qnwir&AL to w� ' t �1" dr14 4` - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - SUPERVISOR'S INVESTIGATION L1-00' '�- SUPERVISOR'S RECOMMENDATION ACTION COMPLETED - Yes No SUPERVISOR'S SIGNATURE DATE + M.VAREP2 Send Original Report To Risk Management And A Copy 9/6/88 To General Services Fleet Management Immediately i L VEHICLE ACCIDENT REPORT DATE _ LJ ME } ACCIDENT LOCATION , � + c ' Plate filo SS Year/Make/Type Vehicle Equipment No. .--- ---� � - County Driver: other Driver: Name �� `� Names got Home Address Home Address e - - t�T + Z $51O Name Phone # Home PhoneLN Work Phone i q-L,5 F. ltd Phone 6 AnI � Driver's License LA3321 Driver's License # C-504212- Car: Year"S k Make �_._..r Model r If Personal or Rental Vehicle, Registered Owner LAak •��, �v ' - Name & Address of Agent Address tAg.,s ----- Phone # W License Plate C-Asb$ -� Insurance Company fnercL4Ade Police Report Taken: Yes �` No PPoliccysI .A.. 651)FV 1 Police Dept. % Agents *anter ' - 4� �1� - -- List Injured Parties: List Witnesses: 1. Name o 1. Name Phone p Phone z Address Address Street Street City State Zip Code City State Zip Code 2. Name 2. Name Phone 49 Phone Address Address Street Street City State Zip Coe City St _EeTP Code 3® Name 3. name Phone g Phone a ------- Address dress Street AdStreet City State Zip Code City State Lo, Code Seat Belt Worn By County Driver: Yes No Damage to County Vehicle '�AO Damage to other Vehicle M:vAREPI ;iI`BB STATE OF CALIFORNIA DEPARTMENT OF CALIFORNIA HIGHWAY PATROL COLLISION REPORT INFORMATION 0 CHP 419 Rev.6-58 OPI 042 F" y` , 5 11 ;A a W DATE TIME 6 8 o-3 10 Maltinez, California " YOUR VEHICLE WAS REMOVED TO: �CnJ t C A copy of the collision report can be obtained from the address above and will normally be available within 10 days from the date of the collision. A request by mail is preferred and must include: date,time,NCIC � number,and Officer's I.G.number printed above. The certification for purchase information(see reverse) f must also be completed,signed and attached to your written request with your check for payment. Make your personal check or money order payable to the California Highway Patrol(CHP)for$8.00. Reports may also be obtained in person during the office hours stamped above. Please call to determine if the report is ready. In the event the cost exceeds$8.00,you will be notified. Reports are retained 4 years. t CERTIFICATION FOR PURCHASE C RPEP O BY MAIL. Please lete the below and attach to Mur.written reguest for a report coo} . # I certify that I am a party of proper interest under Vehicle Code Section 20012 Check one: 0 Driver ❑ Passenger CE Owner L Family ❑ Pedestrian } REQUESTER'S NAME(PRINT) 5lGtVATURE STREET ADDRESS ^ CITY,STATE AND ZIP CODE FINANCIAL.RESPONSIBILITY INFORMATION California's Financial Responsibility Law requires you to report to the Department of Motor Vehicles(DMV)any traffic accident which results in damage to the property of any person in excess of$500 or in bodily injury or death. Use Foram SR-1 which is available at all CHP and DMV offices. Law enforcement reports do not satisfy the DMV report requirement. Failure to submit the Form SR-1 to DMV may lead to the suspension of your driving privilege. OSP 98 9952 3TKFE OF CAOFORNIA DEP.ARTM£NT OF:CALIFORIMA HIGHWAY PATROLi COLLISION AEROAT INFORMATION ^HP 418,Rev.6.981 OP1042 DATE i'`;ME t h NCE. U. BER OFP'1C,ER .D.NUMBER.. S LW Y YOUR V_H.iCLE WAS REMOVED TO: A copy of the col:ision rapad can be obtained from the address above and will ncrmaity be available within 10 days from the date of the collision. A request by real} s preferred and must include_ date,time,NOiC number,and Off€cees i.rJ.number printed above. The cediftcation for purctlase information(sea reverse} must also be completed,s gred and alfached to your written request with your check;or paymerL Make your personal c acit or monay order payable to the Ce:forma Higy,vay Patrol(CHP)for MOO. Reports may a#so be obtainad n.person during tl:e office`ours stamped above. Please call to deterrnine f 8 report is ready, ir, ba e'v6r-t CCs!exceeds$$.00,yci}Mil t34 rfolvlad. RepotS are retained 4 years. .......................... ....................... _ . _ _......................................_._ ......... ......... ......... _......................................................._. ..._ w Nn V), aSo 8 0 cc (10 � x J G1 � y \\"000, CLAIM '.•►f BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD AC'T'ION: Oct 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 2 I�R Board of Supervisors. (Paragraph IV below), given Pursuant to Government Code Section 913 and P , .Y 915.4. Please note all "Warnings". AMOUNT: Exceeds $10,000 COUNTY COUNS L A4ARTINEZ CALIF CLAIMANT: Daniel, Anna&Emily Nunez ATTORNEY: Clyde Butts DATE RECEIVED: Sent 23, 2002 ADDRESS: 122.5 Alpine Rd#204 BY DELIVERY TO CLERK ON: Sept 23. 2002 Walnut Creek, CA 94596 BY MAIL POSTMARKED: Sept 20, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ; ; JOHN SW EET,EE7�l; e Dated: Sept 24 2002 By: Deputy i! # li• 1 ,,f r •_. 11. FROM: County Counsel TO: Clerk of the Board of Supervisors (X This claim complies substantially with Sections 910 and 910.2. ( ) This Claim FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The Board cannot act for 15 days (Section 910.$). ( ) Claim is not timely 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: 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 CORDER.: 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. w h Dated: s, OHN SWEETEN, CLERK, By '' i f1 ` r' ,'Deputy Clerk WARNING(Gov. code section 913) Subject to certain exceptions,you have only six(6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned,have been a citizen of the United States, over age 18, and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: �r`R , � - t3HN SWEETEN, CLERK $y �''tr',` '% %�"" 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 Iater than the 100"' day after the accrual of the cause of action. Claims relating to causes of action for death or for injury to person or to personal property or growing crops and which accrue on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B. Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street; Martinez, CA 94553. C. If claire 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: Claire By DANIEL P. NUNEZ Reserved for Clerk's filing stamp ANNA MARIE NUNEZ (minor) ) EMILY RACHAEL NUNEZ (mirror) } RECEIVED Against the County of Contra Costate and } Deputy H. Davis (Chief of Lafayette P.D) SEP 2 3 2002 Deputy K. Ramirez (Lafayette P.D. )District) CLERK BOARD OF SUPERVISORS (Fill in name) Co.Co.Co. Sheriff 's Dept. ) CONTRA COSTA CO, City of Lafayette ) CLAIM EXCEEDS $10,000. Unlimited Jurisdiction of the Superior Court.. 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) April 26 , 2002 at approx: 1138 hrs. 2. Where did the damage or injury occur?(Include city and county) 3205 Stanley Blvd. , Lafayette, CA. , Contra Costa Co. 3. How did the damage or injury occur? (Give full details; use extra paper if required) See attachment 4. What particular act or omission on the part of county or district officers, servants, or employees caused the injury or damage? See attachment 5. What are the names of county or district officers, servants, or employees causing the damage or injury? Contra Costa County Sheriff ' s Deputy ' s H. Davis, .K. Ramirez and Does 1-50. See attached Sheriff ' s Dept. report number 02-11757 (7pages) (Exhibit 1). b. What damage or injuries do you claim resulted? (Give full extent of injuries or damages claimed, Attach two estimates for auto damage.) See attachment 7. How was the amount claimed above computed? (Include the estimated amount of any prospective injury or damage.) Monetary damages for the aforementioned injuries have yet to be determined. S. 'dames and addresses of witnesses, doctors, and hospitals. See Exhibit 1 attached hereto. 9. List the expenditures you made on account of this accident or injury. DATE TIME A-MOUNT Claimant Daniel Nunez has incurred approximately $45,000.00 in,,costs to date .for private investigator fees and attorney fees. ) Gov. Code Sec. 910.2 provides "The claim must be ) signed by the claimant or by some person on his behalf" SEND NOTICES TO: (Attorney Name and Address of Attorney ) Clyde Butts } 9/20/02 Lacy Offices of Clyde I . Butts } 1225 Alpine Road., Suite 204 Walnut Creek, CA 94596 ) (925) 943--1850 } (925) 943-7994 fax } (Address) } ) Telephone No. }Telephone No. NOTICE Section 72 of the Penal Code provides: Every person who,with intent to defi-aud,presents for aUow�ance 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 waiting, 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{ 1,400}, or by both such imprisonment and fine,or by imprisonment in the state prison,by a fine of not exceeding ten thousand dollars(Sl 0,000),or by both such imprisonment and fine. ATTACHMENT TO CLAIMS OF DANIEL P. NUNEZ, ANNA MARIA NUNEZ (MINOR)AND EMILY RACHAEL NUNEZ(MINOR) No. 3 How did the damage or injury occur? On April 26, 2002, at approximately 11:30 a.m. Claimant Daniel P.Nunez received a telephone call from Ms. May Yen, owner of the Happy Days Learning Center, located at 3205 Stanley Blvd., Lafayette, California, who advised Mr. Nunez that his two daughters,Anna Nunez, age 6 years old, and Emily Nunez, age 4 years old, had just been abducted from the daycare center by their mother, Kelli Nunez. Mr.Nunez, who had Court Ordered sole custody of his two daughters, immediately rushed over to the daycare center and met with Deputy K. Ramirez, a Lafayette Police Officer. Deputy Ramirez had responded to the scene for a reported call of"possible child stealing". Mr.Nunez explained to Deputy Ramirez that on April 9, 2002, Judge Craddick of the Contra Costa County Superior Court had issued an Order which provided that his ex-wife, Kelli Nunez, was not allowed visitation rights with the children unless they were arranged by Mr. Nunez and supervised through"Safe Exchange". Mr. Nunez also told Deputy Ramirez that he had sole custody of his daughters,that his ex-wife had just abducted his daughters from the daycare center, that she was in violation of the Court's Order and that his daughters were missing. Mr. Nunez requested Deputy Ramirez' assistance. Deputy Ramirez refused to provide any assistance to Mr. Nunez, stating that it was a "civil matter". Mr.Nunez also provided Deputy Ramirez with a copy of the Court's Order dated April 9, 2002,however, Deputy Ramirez claimed that the Order had expired and was not valid. 1. ATTACHMENT TO CLAIMS OF DANIEL F. NUNEZ,ANNA MARIA NUNEZ (MINOR)AND EMILY RACHAEL NUNEZ(MINOR) Deputy Ramirez then told Mr. Nunez that he would contact his supervisor to obtain a "second opinion". Deputy Ramirez telephoned his supervisor, Sheriff s Deputy H. Davis,who is the Chief of the Lafayette Police Department, and informed Deputy Davis of the incident, advising that Mr.Nunez was requesting their assistance to locate the children. Deputy Davis also refusedto provide any assistance for Mr.Nunez and instructed Deputy Ramirez not to take a report but, rather, to treat the matter as a"civil matter". Deputy Ramirez then advised Mr.Nunez to obtain a current court order and bring it to the Lafayette Police Department. Approximately three hours later Mr.Nunez obtained another Court Order and delivered it to Deputy Davis and Deputy Ramirez at the Lafayette Police Department. Again, however, Deputy Davis and Ramirez refused to assist Mr. Nunez and refused to accept a missing persons report, telling Mr. Nunez that if his daughters did not show up over the weekend,he should come back to the police department on Monday and they would take a report. On Monday, April 29,2002, Mr.Nunez again went to the Lafayette Police Department and spoke with Deputy Davis and Deputy Ramirez, again requesting their assistance in locating his daughters. Deputy Davis and Ramirez again refused to provide any assistance to Mr. Nunez, refused to accept a missing person report and refused to help locate his children, still claiming that,"it is a civil matter". 2. ATTACHMENT TO CLAIMS OF DANIEL P. NUNEZ,ANNA MARIA NUNEZ (MINOR)AND EMILY RACHAEL NUNEZ(MINOR) No: 4 What particular act or omission on the part of County or District Officers,servants, or employees caused the injury or damage? Deputy Davis and Deputy Ramirez repeatedly failed and refused to fulfill their duty as law enforcement officers to Mr.Nunez by failing to immediately assist Mr. Nunez and by failing to accept a report of missing persons. The acts of Deputy's Davis and Ramirez deprived Mr. Nunez the critical advantage of law enforcement assistance in helping to locate and recover his children, which assistance was desperately needed especially within the critical minutes,hours and days after the abduction occurred. TO THIS DATE, Mr.Nunez' daughters, Anna and Emily Nunez remain missing. Deputy Davis and Deputy Ramirez failure to provide assistance to Mr.Nunez is a clear and direct violation of State and Federal laws including,but not limited,to California Penal Code Sections 14205, 14206 and 14210. No: 6 What damage or injuries do you claim resulted? As a proximate result of Deputy Davis and Deputy Ramirez' violations of State and Federal law, and their negligence, Claimants Daniel Nunez, Anna Nunez and Emily Nunez have suffered severe emotional distress. The full extent of Claimants injuries and damages are not yet ascertained, but are anticipated to include permanent psychological damage and injuries to Claimants, and each of them. 3. FjFace'}tga CONTRA C u.rA COUNTY SHERIFF'S DEPARTMENT , 4070000 Beat 40 Lj CpntinUsaicn P.o. Box 391,Martinez, CA 945593-0039 tr� ClSuppta r�ntat c DY ❑H.RO lI ansa, MS; 1.DRNo. 2.City Cada 3.Crims/Classi4ication 4.Det" 1. 1734 5-more 02-11757 LAF/40 Civil 2- Persons 6.Day/Data I7 me of Cccurrenoa 7.Date/Tih*Aeponad 8.Employee No. Fri. 04/26/02 at 1138 Hrs. 04/26/02 at 1135 Hrs 53215 9.Rectassi- 11 Address 1 Location Of Occurrsncs fication 3205 Stanle Boulevard (Ha [�a s Learnin Canter Lafa etre 94549 F1 11. EPA! _ �vsc WIT# [ MSP RLf- [�sL;s 12. Name,fL,F,M) 13. Race 1 Sax!Age 14. DOB IS.Driver license No. Nunez Danny P, W / M 141 04/10/61 N7468144 16.Address (Zip Code) 17.Noma Phone 17 Senthill Court Lafayette CA 94549 925 935-5446 Woric Phone +s.Emptbyed By or School 19. Refused 0925 376-6800 203 Hair 1 21.Eyes 1 22.Ht. 23.Wt. 24.AKA/Maiden Fume 25.social Security No. Bro Bro . 5-10 1.95 Nene N/A-N-N/A 26.Further Description (Scars,Tattoos,Manhensma,Clothing.Etc.) 27.Booking or Cite No. NIA �- N/A 28. opm []Vic# OW7, # C]MSP# �rtUN i SUS# r(LEAD# ZCthar 29. Name(L,F,M) 30. Puce f Sex I Aga 31, DUs32.oriver ucensa No. Nunez Kelli W / F /38 02/17/64 00402316 33.Address (ZIP Code) 34.Home Phone State Parole/Concord 925 459-8355 35.Employed By or School . : 36.Work Phone State Parole 925) 459-8355 37,Nair 38.Eyes 39.HL 40.Wt, 41.AKAJ Maiden Narna 25.Social Security No, Bln Btu 1 5-07 140 None 554-47-5973 43.Rinher Description (Scars,Tattoos,Mannerisms,Clothing,Etc.) 27.Booking or Cite No, N/A N/A 45. C]PRI OWC¥ [1W i;# Elms;# RUN 0 y:SUS# []LEAD If 46. Nams(L,F,M) 47. Race I Sax 1 Aga 48. DUs var;.icensa No. 50.Address (Zip 51.Horne Phone 52.Employed By or School 53.Work Phone 54.Nair 55.Eyes 56.Ht. 57.Wt. AKA/Maiden Name 59.Social Security No. 6v.Fu;'Ifer Uescrtr .c�:.+itoos,MaMansmS,Clothing,Etc.) �..-.....�_�- •�•�,••.�- a.ciwking ur;;4. :lv 82.Vert.I Ves. 53.Uc.No. (State) 64.Year 65..Make 66,Model 67.Body Style 86. [Is ❑Vict. Bottom 69. Status 70.Registered Owner ddress lD Left (� impound 72.Towed to or M.Who has Keys? 74.Evill. ] Yea 75 F J PYes 76.Dispo of Evidence 77,Missing 78,Damaged No Z No NIA NIA N/A 79. Brief Synopsis of Incident This report concerns a civil matter between PRI---Nunez, Danny and CATH--Nunez, Kelli. Danny is requesting police action; but; because of the lack of valid court documents, the Lafayette Police Department is treating this incident as a civil matter. 86.Distribution 81.Additional Flouting []B- i7C rlDA I- [ L ❑O 71 SA 0V Investigation []Vice v Narcotics ❑Juvenile OCoronar 92.ROrpning Deputy tPr}nt) 83,Datelrrre Written 84.Dispo. a Property Cleric -;t ACS (,7 Intelligence ❑8.0. EISHC K. Ramirez 04/29/02 at 1400 Hrs- Cleared 0 Patrol Canton 0 Comp air.Office 5C]Mari..^.e Patrai f7l DV'Jnit 55.Approving Supv. {Print} 66.Supv.No. 87.DData 88.Page. ®cowunuation CO NTRA,COS T A COUNTY SHERIFF'S DEPARTMENT CAu07OOOO seat 40 Supplemental RO. Box 391,Martinez,CA 94553-0039 [� O.V. [ HRo Arrest S.I. 1.DR Nc. 2.City Code 3.CA na 1 Classification d.Detail 1. 1734 5.Peciassi 02.11757 1 L.AF/40 Civil 2. ticat an 6.Victim Name(L F,,tt) 7.Date Orig.Report 8.Employee No. 53215 I S.Address,/Location of Occurrence 10.Suspect's Name(L F,M) t".Properly Description: Impounded,Recovered,Found,Lost,Stolen-Item Number,Article,Quantity,Srand/Make?Manufacturses Modal Nurrtier,Serial Numcer,Miscellaneous Description,Location Where Taken,Value, i Include Total Loss-LIST tN FOLLOWtNG ORDER:A Currency,Nates:13)Jawelrr,C)Clothing,Furs;D)Vehicles:E)Office Eauiament;F)Radio,7Vs,atc.:G)P.rearm;H)Household Goods:I)Misc. x 72.Recovered Property S 13.Narrativa/Statements On 04-26-02, at approximately 1136 hours, I was dispatched to 3205 Stanley Boulevard (Happy Days Learning Center) reference a possible child stealing. Upon my arrival, I spoke with PRI—Nunez, Danny. Before I was able to ask Danny the reason he had called, Danny placed a piece of paper in front of my eyes and said, "My ex has abducted my children! Do something!" I told Danny that before I took action I would have to review the paper work he was placing in front of my eyes. Danny handed me the piece of paper and i read the information. The paper Danny gave me was an expired (April 27, 2032) "Temporary Order for Supervised Visitation" (please see attachment number one). After I read the expired order, I asked Danny why he was handing me this expired order. Danny said because it was a court order that was still enforceable, which prohibited his wife (OTH---Nunez, Kelli) from visiting their children without supervision. Danny added that his wife had just violated this order by corning to the Happy Day Learning Center and, without supervision, seized the children. I again told Danny that I was unable to take any police action since (1) this was a civil matter between Danny and Kelli, (2, there was no existing court order that explicitly stated the orders agreed upon by the court and both parties, and (3) Danny was unable to produce any court documents that granted him full custody. However, Danny was not pleased with my response and began yelling, "Are you telling me that my ex-wife has just abducted my children and you are doing nothing!" I told Danny that I would contact my supervisor in order to receive a second opinion. I :.rent out t^ rnYr p4 rpl vehicle and contacted Chief Davis. Ager contacting Chief Davis ind advising hirn of the details, he congdered with my actions. I walked back inside (Happy Days Learning Center) and told Danny that until he was able to produce current court documents I could not take any police action. Danny said that he understood the reason for no police action but would later come by the Police Department and produce the current court order. On 04-�6-02, at approximately 1500 hours, Danny carne to the Lafayette Police Department and once again produced an "Order to Show Cause" that was not current and expired on April 10, 2002. This expired order once again raised several inconsistencies which Danny was not able to explain or resolve. These inconsistencies included: (1) the inability to produce an existing court order that explicitly stated the orders agreed upon by the court and both parties and (2) Danny's apprehension in producing any court documents that granted him full custody of both children. 14.Distribution - 15.Additional Routing �_q L,C ,7 DA DDE rL ®O r7 SS Qv Q h v®stig�a Q Vice Q Narcotics ❑Juvenile [Coroner 16.Reporting Deputy 130m) 17.Data' me Written 18.Dtspo. Property clerk 17 Acs ❑,ntsligenca I]R.O. CsHC K. Ramirez 04/29/02 1400 Hrs. Cleared r�?2,cl Captain ❑Cct:tplaint O?flca 07 Marine Patrol ❑ Dv unit i9.Approving Supv, (Qnntj 20,Supv.No. 2..Date 22.Page ot- ar n f [] Face Page CONTRA CO, k.COUNTY SHERIFFS DEPARTMENT L 370000 seat 40 ❑ Suppleilent P.O. Box 391, Martine,CA 94553-0039 �tPPlet$errtat ' ❑OV ❑HRO ❑Arrast ❑Sl '•OR No. 2.City Code 3.Cr.mefClassification 4.Detail 1. 27$,5 5.More 02-11757 LAF/40 Violation of Custody/Visiting Custody/VisitingRi hts 2. Persons 6.Day r Date f Tme of Occurrence 7.Date/Time Reported 8.Employee No. Fr). 04/26/02 at 1138 Hrs. 04/26102 at 1138 Hrs 47498 9.Repiassi- 10.Address/Location of Occurrence ficatio 3205 Stanley BI Lafayette (Hap2y Chas Learning Center 11. ❑FrRl IC#1 ❑WIT# ❑MSP# ❑RUN# '❑SUS# ❑LEAD# ❑OTHER 12. Name(L,F,M) 13. Race 1 Sex/Age 14. DOS 15,Driver License No. NUNEZ, Anna Marie W ( F 1 6 04/06196 1 NA I6.Address . (Zip Code) 17.Home Phone 17 Benthill Ct Lafayette 925 035-5446 18.Employed By dr Sdnool 19.Work Phone HapDayj_ys Learning CenterNq- 20.Hair 21,Eyes 22.Ht. 23.Wt. 24.AKA f Maiden Name 25.Social Security No.. Bro $ro 3-10 48 26.Further Description (Scars,7atteos,Mannerisms,Clothing,Etc.) 27.Booking or Cite No. Last seen wearing: Blue pants & white shirt with flowers 28. ❑PR! ZVIC#2 ❑WIT# ❑MSP# ❑RUN# ❑SUS# ❑LEAD# ❑Other 29. Nane(L,r=,M) 30. Race f Sex/Age 31, 0O9 32.Oriver License No. NUNEZ, Emily Rachael W I F (4 12/27197 NA 33.Address (Zip Code) 34.Nome Phone 17 Benthill Ct Lafayette 925 935-5446 35.Employed By or School 38.Work Phone HaM f38. s Learnin Center NA- 37.Hair Eyes 38..H. 40.Wt. 41.AKA/Maiden Name 25.Social Security No. Brnrn 3-7 32 _ 43.Further Description (Scars.Tattoos,Mannerisms,Clothing,Etc.) 27.Booking or Cite No. LSW: Jersey style shirt w/ ur le sleeves & stri ed ants 45. ❑PR! ❑V1C# EWIT#I ❑MSP# []RUN# ❑SUS# ❑LEAD# IZOther 45. Name(L,F,M) 47. Race I Sex 1 Age 48. DOS49.Driver License No. BLACKI`>r1ORE, Valerie B / F / 36 01/25/60 U6124088 50,Address (Zip Code) 51.Home Phone 2701 Clover Ct Antioch 925 776-4807 52.Employed By or Schcoi 53.Work Phone 54.Hair 55.Eyes 56.Ht. 57,Wt. 58,AKA/Maiden Name 59.Socia!Security No. Brn Brn 5-3 135 _ _ c;:-t a.,Descr;„^.tio. {SM ,aA;os,Mannenorrz,Cto'hing,Etc) t ti 1.8aokin;or Ciie No. 52.Veh.f Ves. 83.L c.No. (State) 64.Year 65.Make 68.Model 67,Body Style 68.Color Top Black FIs ❑Vrc. I Ink (-A f Ink { arliliar i Ink �t rip Bottom 69, Status 70.Registered Owner 71, R.Q.Address C Left Unk Unk Impound 72.Towed to or Released to 73.Who has Keys? ❑ Stored NA �i NA 74.Evid. C Yes 75.F 1 P ❑Yes 76.Dispo of Evidence 77,Mlsstng78.Damaged 0140 No NA NA NA, 79. Brief Synopsis of Incident This supplemental report concerns my investigation into this matter. A 2"d report number was drawn for the abduction of NUNEZ, Emily: 02-12144. FCN's: NUNEZ, Anna: 1420212100233 NUNEZ, Emily: 1420292100232 80.tDr-iis1itribution 8 ❑C ❑DA Ci D.- 0 i ❑0 f'1 SR ❑V 81.Additional Routing ❑Mvesttgatlon ❑V t.r Narcotics ®Juvenile Elcoroner 82.Reporting f eputy (Print) 83.Dateli<me Wratten 84,Disco. ❑ProzertyCierk ACS ❑inteitigence ❑R.O. ❑SHC D. Nugent 05/03/02 at 1000 Hrs. Cleared oh,-f Captain ❑Complaint Office !,❑. Marne Patrol ❑ DV Unit 85.Approving pv, (Print) 86 88 pv 87.Date � � 88,page rG.�.J�ifj 4.J . " I of ., 0 Face Page C ONTRA CQ:. A COUNTY SHERIFF'S DEPARTMENT C. ,1370000 Beat 40 Con0nuatlon P.O. Box 391,Martinez,CA 94553-0439 r��1 �j Supp!emental CI DV L'HRO t A rest Q$1 I.OR No. 2.City Code 3.crime/Classification 4.Detail 1. 27$.5 5.More 02-11757 LAF/40 Violation of Custody/Visiting Custody/VisitingRights 2. Persons 6,Dap i Date i Mme of Occurrence 7.Date i Tirne deported S.Employee No. Fri. 04/26102 at 1138 Firs. 04/26/02 at 1108 Hrs 47418 s.dscsass'- 10.Address i Location of Occurrence iicatf n 3205 Stanley BI Lafayette (Happy Das Learning Canter 11. EIPRI [lVfc# SWIT#2 Elms?# QRUN# ©SCIS# CLEAD# [ OTHER i3. Race i Sex 1 Age 14, DOB 5.Driver License No. 12. Marne(L,>.M} A 1 F / 61 04/21/41 Bfl548142 YEN, May FM1Sin 18.Address (Zip Code) 17,Home Phone 3205 Stanley B1 Lafayette 18.Employed By or School 19.Work?hone Nap Das Learning Center-Owner 92 932-8088 20.Halr 21.Eyes 22.Ht. 23.WL 24.AICA i Maiden Name 25.Sodet Security No. Blk I Bro j 5-2 112 26.Further Description (Scars,Tattoos,Mannerisms,Ciothing,Etc.) �ft_,I t�t 27.Sooking or Cite No. 28. C]PRI ETIC# WiT# EIMSP# RUN# SUS#_ ©LEAD# Zother 29. Name(L,F,M) 30. dace/Sex/Age 31. DOB 32.Driver License No. ZEFF, Sharon W / F / 35 11110166 A3481375 33.Address (Zip Code) 34.Hume Phone 17 Benthill Ct Lafayette 925 935-5446 35,Employed By or School 36.Work Phone Advent Software- San Francisco 41 645-1546 37.Hair 1 38,Eyes 39.Ht. 40.Wt. 41.AKA t Mmiden Nacre 25.Social Security No. Brn Gin 5-9 L145 43.Further Description (Scar,Tattoos.Mannerisms.Clothing,Etc.) � rr�tt 27.Booking or Cite No. LI 45. C]PRI []VIC# MWiT# [IMSP# []RUN# SUS# FTEAD# 0Oiher 46. Name(L,F,tet) 47. Dace/ Sex/Age 48. DOB 49.Driver License Nc. ST. HILL, Undsa Janae W / F / 13 01/13/89 NA 50.Address (Zip Code) 51.Home Phone 3519 Wren Ct Concord Unk- i52.E•naloyed By or School 53.Work Phone Unk W 54.Ha,,r es So.t}L 57.Wt. 58.AKA i Maiden Name 59.Social Security No. 60.Further 0e4enpiian (Scars,Tattoos.Mannerisms,Cic4trrr:g,-Etc:)-. .- .t rti a772 or 77,37'.. 62.Veh.t Ves. 62.Lic.No. (State) 64.Year 65,Make 65,Model 67.Body Style 68.Color Top LAS Cl Viet. Bottom 69, Status 70.Registared Owner 71. R.O.Address Lest i...i impound 72.Towed to or Released to73.Who has Keys? Stored 74.End. Yes 75.F/F Yes 16,Dispo of Evidencs 77,Massing 78.Damaged 0 No No NA, NA NA 79, Brief Synopsis of Incident See page #1 80.Distribution. 81.Additional Routing ©B f3C F1DA []DE r_7L [ 0 r-1 SR M 7 Investigation r-1vice 0 Narcotics C]Juvenile [7Coroner 82.Reporting Deputy (Print) 83.DataiTime Written 84.Dispo. Property Clerk C]ACS [3 intelligence []R.O. QSHC D. Nu en 05/03/02 at 1 000 Hrs Cleared C(Patrol Captain 0 complaint Office 0 Marine Patrol 6I OV Unit $5.Approving (Pr n' 86.Supv.No. 87.Date $5.Page r7 Other 2 of 3X O C....+.A IDn.• �tOpl E]Continuation CONTRA COS', t,AOUNTY SHERIFFS DEPARTMENT CA 10000 seat 40 Is P.O. Box 391,Martinez, CA 94553-0039 Supplemental ❑ DM. ❑HRO ❑Arrest ❑ S.I. 1.DR No, 2.City Code 3.Crime I Classification 4.Detaii 1. 27&5 5.Rerlassi- 02-11757 1 LAF/40 Violation of Custodv/Visitina Rights 2. 6aation 8.Victim flame(L.F,M) 7.data Orig.Report 8.Employee No. See "A" page 04/26/02 47418 3.Address/Location of Occurrence 10.Suspect's Name(L,F,M) 3205 StanleyB# Lafayette NUNEZ, Kelli Jean 11.Property Description: impounded,Recovered,Found,Lost,Stolen-[ism Number,Arttcle,Quantity,BrandlMake/Manufacturer's Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value, nalude rctai Loss-LIST;N FOLLOWING ORDER:A)Cwencv,Notes;B)Jewelry;C)Clothing,Furs;D)Ven;cies;E Office E u orreni;F Radio.TVs.etc.;Cs Firearms;N Household Goads;1).tvkso. 12.Recovered Property$ 13.Narrative f Statements Can 4-30-02 1 received and reviewed this report, this is a supplemental report.concerning my investigation into this matter. I contacted the Family Law Court Clerk to clarify the custody and visitation orders for this matter. The Clerk told me that Sheriffs Office Civil Bureau Sgt WEIKEL was there at that time to also clarify the orders, I spoke with Sgt WEIKEL who told me that he would speak to Judge CRADDICK and call me back. Sgt WEIKEL called me back approx. 1 hr later and advised me that Judge CRADDICK had told him that (S) NUNEZ, Kelli was in violation of Superior Court order#D98-03617 and that she had illegally abducted Anna and Emily NUNEZ. Sgt WEIKEL later faxed me the most recent/current court documentation (see attached copies), Sgt WEIKEL told me that he would be handling the Civil end of this matter through his office. On 5-1-02 1 spoke to (PRI) NUNEZ, Daniel by phone, I asked him to recount the events that lead to the abduction of Anna and Emily for me and he told me the following: On 4-19-02 at 0830 hrs Daniel and Kelly appeared in the Family Law Court in front of the Honorable Judge J. CRAM, Judge CRAM ordered that Kelli have no unsupervised visits with Anna and Emily. On 4-26-02 Kelli went to the Happy Days Learning Center and removed Anna and Emily from the center in violation of the court order. Daniel told me that he believes that Kelli has left California with the children, I asked him why he thought that and he told me that his lawyer received correspondence from Kelli on 4-27-02 that was postmarked from Las 11egas, the corres on-dance is a UCt Financing Statemeiii. Tile Sa-01e Staterilent was mailed to the ' Lafayette Police Dept, it was received on 4-29-02 and had no return address (see attached copy). Daniel also told me that Kelli had contacted a friend of hers, (W-1) BLACKMORE, Valerie by phone on 4-30-02 at approx 1300 hrs. BLACKMOREIS caller 1D showed that the phone call had come from a Colorado phone number, Daniel did not have the number with him but believes that Kelli has a maternal grandmother in Denver, Colorado. I asked Daniel what type of vehicle Kelli was driving and he told me that he did not know. Cpl L. SELIGA#47421 and i drove to Keilis residence at 3519 Wren Av, Concord. When we arrived an Animal Control Vehicle was pulling into the driveway. We spoke to Animal Control Officer R. PACHECO #65329 who told us that he was there because his dispatch had received an anonymous call that Kelli had fled the state because she was running from the police and she had abandoned 2 dogs in the house. We looked through the windows and saw 2 dogs inside the house, we knocked several times and there was no answer. While looking through the windows we could see that there was stili property inside the house, such as a computer and a microwave, We left the residence while Ofcr PACHECO was still trying to gain entry. 14..Distribution 15.Additional Routing 018 El ❑DA ❑DE 0 ❑O ❑SR ❑V investigation ❑Vice a Narcotics ❑Juvenile []Coroner 16.Reporting Deputy (Print) 17.Datefr!me Written 18.Dispo. PronertyCierk E]ACS 17 Intelligence [3 t] R.O. SHC D Nu ent 05/03/02 at 1000 Hrs. Cleared ❑Patrol Captain ❑Comolaint Office r�r Marine Patrol ❑ DV Unit 19.Approving Su . (Print) 20.Supv.No. 21.Date 22.Page Omer 3 0f 3 FORMS , (Rol.1169) Ccnfinuaticn CONTRA CO�L .COUNTY SHERIFF'S DEPARTMENT C. j70000 Beat 40 l suppiemena P.O. Box 391, Martinez, CA 94553-0039 ® D.V. [,]HRO C1 Arrest [1 S.I. 1,uR No. 2.City Code 3.Crm ,'Classification 4.Detail f. 278.5 5,Reciassi- 02-11757 LAFi40 Violation of Custodv/Visitina Richts 2. fication S.Victim Name SL.F,M) 7.Date Ong,Report 8.Employee No, t ( See "A" a e 04/25/02 47418 7' 9.Address I Location of Occurrence 10.Suspect's Name(L,F,M) 3205 Stanley BI Lafayette NUNEZ, Kelli Jean '?_property Description: Impounded,Recovered,Found,Last,Stolen-Item Number,Article,Quantity,BrandlMakelManufacturer's Model Number,Serial Number,Misceitaneaus Description,Location Where Taken,Value, include Total Loss-LIST IN FOLLOWING ORDER:A Curran ,Notes;B Jewel ,C)Ctothin ,Furs;0 Vehicles:E Office Equipment;F)Radio,TVs,etc.;G)Firear ns;H Household Goods:I)Misc. 12_Recovered Property$ 13.Narrative f Statements We then went to the Happy Days Learning Center and spoke with the owner, (W-2) YEN. YEN told us that she and her staff had been advised by Daniel about the custody situation, on 4-26-02 at approx 1125 hrs YEN was in her office, YEN'S office has a window that looks out into the playground. YEN saw the gate from the parking lot open and Kelli an'd (0) ST. HILL walk very quickly into the playground, ST. HILL is Kelli-- daughter from a previous marriage. Kelli and ST. HILL split up, ST. HILL went to Emily classroom and told Emily that she had a present for her and she needed to go with her to get it, Emily's teacher told ST. HILL that Emily was not allowed to leave but ST. HILL ignored her and left with Emily. Kelli went to Anna's classroom and took Anna out, Anna's teacher told Kelli she was not allowed to take Anna. Kelli shoved a bunch of papers in the teachers face and told her she had the right to take her daughter, Kelli then rushed out of the room with the teacher following her. YEN met Kelli in the yard and told her she could not take Anna, Kelli walked around YEN, YEN continued to try to step in front of Kelli to stop her but Kelli kept going around her. YEN and several teachers followed Kelli to the parking lot and watched as Kelli and Anna got into an older model black Cadillac, the Cadillac was backing out o€the parking lot as Kelli was still trying to get into it, YEN wrote down the license plate number. The plate number is registered to an Acura out of Southern California, it appears that YEN wrote down the wrong plate number. YEN said that the Cadillac was being driven by a white male, 50-60 yrs old, stocky build, olive complection with curly dark hair. After the Cadillac left YEN went into her office and called Daniel and the police. After speaking with YEN we returned to the police dept. I attempted to contact Daniel for further information, I spoke with Daniels girlfriend, (4) ZEFF. ZEFF told me that she had spoken to BLACKMORE and was told about the dogs abandoned at Kellis house and that she was the anonymous caller to Animal Control. ZEFF provided me with BLACKMORES phone number. I called BL.ACKMORES number, there was no answer. I left a message for her to call me back. BLACKMORE called me back approx. 1 hour later, she told me that she is friends with Kelli and has known her for approx 3 years. BLACKMORE told me that Kelli called her on 4-30-02, her caller ID showed the number (303) 256-5102. BLACKMORE said that Kelli told her she took the kids because they were being sexually molested and abused and that nobody was listening to her about it. Kelli also told BLACKMORE that the Judge on the case and Daniel's lawyer are good friends so she keeps losing motions and Daniel keeps winning. Kelli.did not tell BLACKMORE where she is, she only told her that she is moving from state to state and that a group called "Moms for Justice" is helping her by filing paperwork on her behalf that will exonerate her in this matter. Kelli told BLACKMORE that if the paperwork exonerates her she will return for their next scheduled court date, if it does not then she will send a letter to the Judge pleading innocent. I told BLACKMORE about the correspondance from Las Vegas and she told me that she thinks Kelli has a brother living there. BLACKMORE said that she has seen bruises 14.Distribution 15.Additional Routing M 1 IAC L DA FDE M ®0 ❑SR E]V LClnvestigation Vice ®Narcotics D Juvenile r-Coroner 16.Reporting Deputy ("nt) 17.0ate me Written 1a.Dispo, Property Clerk 7,ACS ❑intelligence 7,R.C. ❑SHO D. Nugent 05/03/02 at 1000 Hrs. Cleared t_a Patrat Captain 7 Complaint Office E]Marine Patrol Q DV unit 19.Approving Supv. nt 20.Supv.No. 21.Date 22.Page E]Other 4 of FORM 8 , (REV,1189) ❑Continua;ton CONTRA'CO_' .COUNTY SHERIFF'S DEPARTMENT C. J70000 Beat 40 I Supplemental P.O. Box 391, Martinez,CA 94553-0039 ❑ D.V. ❑HRO ❑Arrest ❑ S.l. 1.DR No. 2.City Code 3.Crime t Classification 4.Detail 1. 278.5 b.Reclassi- 02-19757 -1-LAF/401 Violation of Custodv/Visitina Riahts 2. ftcation 5.Victim Name(L.F,M) 7.Date Ong.Report 8.Employee No. � t See"A" pages 04/25/02 47413 9.Address/Location of Occurrence 10.Suspect's Name(L,F,M) 3205 Stanley Bl Lafayette NUNEZ, Kelli Jean 11.Property Desmption: Impounded,Recovered,Found,Lost,Stolen-item Number,Art! te,Quantity,Brand/Make/Manufacturer's Model Number,Serial Number,Miscellaneous Description,Location Where Taken,Value, Include Total Loss-LIST IN FOLLOWING ORDER:A)Ourrenc,Nates;8 jewelry:C)Clothing,Furs:D)Vehicles Office Eoui went;P Radio,?Vs,etc,;G)Firearms:H)Household Goods;ll Misc. 12.Recovered Property$ 13.Narrative t Statements on the children that Kelli has said that Daniel and ZEFF have caused but she does not know for certain if they were caused by them or they were just normal children injuries. I called the number provided by BLACKMORE from her caller 1D, f got a recorded message saying "You are returning a call to a prepaid calling service system and the party that called you cannot be reached at this number". f called information and found that 303 is an area code in Colorado but 256 is not a listed prefix. 1 had Anna and Emily placed into the Missing/Unidentified Persons System (see attached): Anna: 9420292100233 Emily: 1420212100232 Sgt WEIKEL had a No Bail warrant for Pc 166.4 placed into the system for Kelli NUNEZ` arrest (see attached). Can 5-2-02 f sent an e-mail to Kelli using ande-mail address from the original report (see attached). Case referred to the District Attorneys Office for review. Attachments: 1) Declaration of Writ of Habeas Corpus/Request for Warrant (4 pages) 2) Order besetting Hearing and Continuing Temporary Orders for Supervised Visitation (2 pages) 3)Writ of Habeas Corpus (2 pages) 4) Warrant for Arrest (1 page) 5) Order for Warrant of Attachment for Contempt (1 page) 6) Warrant of Attachment (1 page) 7) UCC Financing Statement (16 pages) 8) Missing/Unidentified Persons System entry- NUNEZ, Anna (1 page) 0) Missing/Unidentified Persons System entry- NUNEZ, Emily (1 page) 10) Copy of email sent by me to Kelli (1 page) 11) Copy of warrant for NUNEZ' arrest 14.Dis:nbutlon r—� 15.Additional Routing Ca CC MDA []DE OL CO MSP CIV ❑tnvestlgation ❑Vice ❑Narcotics ❑Juvenile ❑Coroner #S•Reporting Dapu'.y(Print) 17.Daiefrime Written 18.Dispc. Property cleft( [I ACS M Intelligence t�R.O. ❑SHCD. Nugent 05/03/02 at 1000 Hrs. Cleared ❑; Patrol Captain r7 u Complain!Office []Marine Patrol E] OV Unit 19 Approving Supv. Int) 20.Supv.No. 21.Date ?2.Page ED Other 5 of FORIA 9, (REJ.1189} APPLICATION TO FILE LATE CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY CALIFORNIA CJ BOARD ACTQ Oct 8, 2002 Application to File Late Claim ) NOTICE TQ 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. " , iven pursuant to Government Code Sections 911.8 and 15.4. Please note the "WARNING"below. w Claimant: Evelyn Haskins ::BOUNTY COUNSEL, Attorney: Trudy Martin f ART N Z CALIF, Address: 1010 Grayson St#2 Berkeley, CA 94710 Amount: excess of$10,000 By delivery to Clerk on Sept 23, 2002 Date Received Sept 23, 2002 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 ILe, �r By 4 f ` u.-Deputy Clerk DATED: SeP t 24 2(}02 JOHN SWEETEN Clerk B ` II. FROM: County Counsel TO: Clerk of the Board of Supervisors i ( } The Board should grant this Application to File Late Claim(Section 911.6). The Board should deny this Application to File Late Claim(Section6). DATED: MARCHESI, County Counsel, B6�J�� Deputy IM BOA 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 311.6) I certify that this is a true and correct copy of the Board's Or r entered in its minutes,for this date. '' DATE �`` JOI[NSWEETEN Clerk "(��B �,. y Deputy Clerk WARNING(Gov. Code §311.8) 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 from 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. j DATED `; ;fi�; t 'JOHNSWEETEN, Clerk, Byr, � '` ; � ` 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 Law Offices of _ TRULY LYNN MARTIN ` al, 1010 Grayson S treet, S rite Two Berkeley, California 94710 SEP 2 3 2UO2 OF SUpp September 23, 2002 ct C 7RD 'ER AC0ACC7I3S CONTRA COSTA COUNTY Office of the Clerk Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 Attn: Brette, Clerk board of Supervisors Re: Claim of EVELYN HASKINS Pursuant to Government Code § 900, et seq. TO WHOM IT MAY CONCERN: This letter is to advise you that EVELYN HASKINS, ("CLAIMANT"), hereby makes .her claim against the CONTRA COSTA COUNTY, CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF- CORONER WARREN E. RUPF, (known collectively herein as "RESPONDENTS"), and their agents, for the reasons set forth in this. letter. The mailing address and telephone contact for CLAIMANT is c/o Law Offices of Trudy L. Martin, 1010 Garay son Street, Suite Two, Oakland, CA 94710, (510)843-4300. CLAIMANT'S mailing address is 266 So. 41st Street, Richmond., CA 94804. Contact with CLAIMANT may be made through Law Offices of Trudy L. Martin, at the above address. The date and location of the circumstances and occurrences relating to the claims as set forth below is September 24, 2001, at or about the central Morgue, 1960 Muir Road, Martinez California, and at other locations presently unknown to this CLAIMANT. The circumstances which ,give rise to the claim are the conduct of Sheriff-Coroner Warren E. Rupf, Deputy L. Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others, including presently unidentified deputy coroners, employees or officers of and/or related to the CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF-CORONER, and other unidentified officers or and/or agents, each of which at all times relevant hereto operated in their individual capacities and as agents of said SHERIFF-CORONER, (herein collectively referred to herein as "agents" and/or "Respondents"), and, as such, engaged in such actions and inaction, all in the course and scope of the official duties of said entities and agents. TELEPHONE(510)8434300 FACSIMILE(510)843.4311 E-MAIL-trndyhnar6ngearthhnL.net CLAIMANT: Evelyn Haskins September 23, 2002 page two The conduct complained of was that RESPONDENTS, agents and each of them was engaged in negligent, inappropriate conduct in violation of clearly established constitutional, statutory and other civil rights, including but not limited to California Government Code 27471, subdivision(a), et seq., which damaged CLAIMANT, by failing to make reasonable efforts to locate next of kin of CLAIMANT'S son, LOR.ENZO OALLEY, JR., who died September 24, 2001. CLAIMANT is informed and believes and alleges thereon that RESPONDENTS had actual or constructive custody and/or control of her son's body from about 1:00 a.m. on the date of his death, September 24, 2001, until and through the an autopsy performed at about 8:00a.m. that same day, however, at no time undertook to notify family of his death. Such failures and omissions violated statutes promulgated in the State of California, including but not limited to Government Code section 27471, subdivision (a), and Government Code section 27492, as interpreted in DAy Y. C &f US Ameles (1996) 50 Cal.App.4th 137, 57 Cal. Rptr. 651, providing for a mandatory duty by RESPONDENTS, including SHERIFF-CORONER to make a reasonable effort to locate and notify family members, including CLAIMANT of the death of her son LORENZO OALLEY, JR.'S death, having the effect of and purpose to protect CLAIMANT from additional injury as a consequence of her son's death. Further, RESPONDENTS failed to prevent and/or halt these practices or otherwise to control, supervise or train RESPONDENTS, including RESPONDENTS' agents, to avoid the negligent and inappropriate practices identified herein, all of which resulted in damage to CLAIMANT, in particular, in causing her severe emotional distress in not knowing her son's whereabouts, not knowing of her son's death, not having the opportunity to view her son prior to an invasive and distorting autopsy, and otherwise, all the consequence of a pattern and practice of discrimination against CLAIMANT on the basis of her son's ethnicity and or other impermissible practices. Each of the actions and/or failures to act was improper and in violation of established civil and/or statutory rights at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The above actions constitute, inter alia, negligence, negligent infliction of emotional distress, intentional infliction of emotional distress, violation of rights interpreted as following from Government Code section 27471 (a), et seq., and Government Code section 27941, and otherwise, violation of 42 U.S.C. §1983, et seq., deprivation of civil rights and conspiracy to effect such a deprivation and negligence, including negligent hiring, negligent training, negligent retention, negligent supervision, all as to the affirmative actions and failure to undertake affirmative actions with respect to the agents, among other claim. Each such claim is brought against each agency and agent thereof named herein. The actual names of officers and individuals acting in the manner described hereinabove will be specified when such is ascertained. By listing these legal theories on which CLAIMANT' claims are brought herein, CLAIMANT is not admitting nor claiming that he was required to file a notice of tort claim as to any or all of the above claims, nor is the within claim limited to these enumerated violations and, rather, includes all violations expressly alleged and inferred which flow from the conduct described herein. CLAIMANT: Evelyn Haskins September 23, 2002 page three The conduct which is the subject of this claim includes actions, each of which was improper at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The agents and entities above engaging in this conduct took action with the encouragement, consent, and/or ratification of each of the other agents and their agencies herein described. The amount claimed exceeds $ 10,000.00 as to each RESPONDENT and jurisdiction over the claim would rest in the Superior Court. The damages to this CLAIMANT include anxiety, fear, shock, and extreme emotional distress due to being subjected to and perceiving the events described herein. In addition, CLAIMANTS' damages include future expenses associated with the conduct described herein, including future medical and other expenses to treat and mitigate such damage. As the occurrences in this claim occurred over six months prior to this date, this also will support and constitute an application for leave to present a late claim, pursuant to Government Code section 911.4. Please process this claim at your earliest opportunity. I will accept a file-stamped copy of the claim as acknowledgment that this claim as to all respondents is properly lodged with your office on this date. Very truly yours, LAW OFFICES OF TRUDY L. MARTIN Tru L. M m T'LM:clf cc: Application for Leave to Present Late Claim on behalf of Claimant, Evelyn Haskins, attached I Trudy L. Martin, SBN 148515 LAW OFFICES OF TRUDY LYNN MARTIN 2 State Bar No. 148515 1010 Grayson Street, Suite Two 3 Berkeley, CA 94710 (510)843-4300 4 5Attorneys for Plaintiff EVELYN HASKINS RECEIVED 6 Ei- 3 2002 7 CL�CONTRA BOARD F SUPERVI�,ORS COSTACO- 8 Claim of EVELYN HASKINS, ) APPLICATION FOR LEAVE TO PRESENT 9 LATE CLAIM ON BEHALF OF CLAIMANT EVELYN HASKINS (Govt Code Section 10 912.4) vs. 11 12 CONTRA COSTA COUNTY, CONTRA ) COSTA COUNTY SHERIFF'S ) 13 DEPARTMENT, SHERIFF- CORONER } WARREN E. RUPF, Duty L. Martin, ) 14 Deputy W. Brinks, Brian L. Peterson, M.D., ) and others presently unknown, as described 15 herein. ) 16 }} 17 18 To the BOARD OF SUPERVISORS, CONTRA COSTA COUNTY: 19 1. Application is hereby made,under Government Code Section 921.3, for leave to present 20 a late claim foundedon causes of action for Negligence, Negligence Per Se, Negligent Infliction of 21 Emotional Distress and Intentional Infliction of Emotional Distress, which accrued on September 24, 22 2001, for which a claim was not presented within the 6-month period provided by Government Code 23 Section 911.2. For additional circumstances relating to the causes of action, reference is made to the 24 proposed claim attached to this application. 25 2. The facts pertinent to this application for in Application is hereby made, under 26 Government Code Section 911.3, for leave to present a late claim founded on causes of action for 27 Negligence, Negligence Per Se,Negligent Infliction of Emotional Distress and Intentional Infliction of 28 TRUDY L MARTIN Attarmy at Law 1010 Qrwson St..suw, SerkeWV,CA 84710 (SI 0)843-4300 1 I Emotional Distress, which accrued on September 24, 2001, for which a claim was not presented within 2 the 6-month period provided by Government Code Section 911.2. For additional circumstances relating 3 to the causes of action, reference is made to the proposed claim attached to this application. 4 3. This application and the accompanying claim, pursuant to express authorization of the 5 Clerk of the Boars! of Supervisors, Contra Costa County, is directed to the Clerk of the Board of 6 Supervisors, for and on behalf ofall named entities and individuals, including specifically Contra Costa 7 County, Contra Costa County Sheriff's Department, Sheriff Coroner Warren E. Rupf, Deputy L. 8 Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others presently unknown, as described in 9 the attached claim. 10 4. The failure to present this claim within the 6-month period specified by Government Code 11 Section 911.2 was through mistake, inadvertence, surprise and/or excusable neglect, and Contra Costa 12 County, Contra Costa County Sheriffs Department, Sheriff Coroner Warren E. Rupf, Deputy L. 13 Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and ethers presently unknown, and each of them 14 was not prejudiced by this failure, all as more particularly shown by the attached declaration of Evelyn 15 Haskins. 16 17 WHEREFORE, it is respectfAy requested that this application be granted and that the attached 18 proposed claim be received and acted on in accordance with Government Code Sections 912..4-913. 19 20 21 22 Dated September 23, 2002 Respectfully Submitted, 23 24 T LYNN MARTIN 25 Attorney for Plaintiff EVELYN HASKINS 26 27 28 TRUDY L.MARTIN Attomay at Low 105 0 t3aoyoon St.,$to' Swke*y,CA 84750 (6101843-4300 2 Lacy Offices of TRUDY LYNN MARTIN 1010 Grayson Street, Suite Two Berkeley, California 94710 September 23, 2002 CONTRA COSTA COUNTY Office of the Clerk Board.of Supervisors 651 Pirie Street, .Room 106 Martinez, CA 94553 Attn: Brette, Clerk board of Supervisors Re: Claim of EVELYN HASKINS Pursuant to Government Cade § 900, et seq. TO WHOM IT MAY CONCERN: This letter is to advise you that EVEL'YN HASKIN , ("CLAIMANT"), hereby makes her claim against the CONTRA COSTA COUNTY, CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF- CORONER WARREN E. RUPF, (known collectively herein as "RESPONDENTS"), and their agents, for the reasons set forth in this letter. The mailing address and telephone contact for CLAIMANT is c/o Law Offices of Trudy L. Martin, 1010 Cray son Street, Suite Two, Oakland, CA 94710, (510)843-4300. CLAIMANT'S Mailing, address is 256 So. 41st Street, Richmond, CA 91804. Contact with CLAIMANT may be made through Law Offices of Trudy L. Martin, at the above address. The date and location of the circumstances and occurrences relating to the claims as set forth below is September 24, 2001, at or about the central Morgue, 1960 Muir Road, Martinez California, and at other locations presently unknown to this CLAIMANT. The circumstances which give rise to the claim are the conduct of Sheriff-Coroner Warren E. Rpf, Deputy L. Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others, including presently unidentified deputy coroners, employees or officers of and/or related to the CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF-CORONER, and other unidentified officers or and/or agents, each of which at all times relevant hereto operated in their individual capacities and as agents of said SHERIFF-CORONER, (herein collectively referred to herein as "agents" and/or "Respondents"), and, as such, engaged in such actions and inaction, all in the course and scope of the official duties of said entities and agents. 7ELEPHON113(510)843-4300 FACSIMILE(510)843-4321 E-I+4A L truJy1rnar6n@aarthhnh.nrt CLAIMANT: Evelyn Haskins September 23, 2002 page two The conduct complained of was that RESPONDENTS, agents and each of them was engaged in negligent, inappropriate conduct in violation of clearly established constitutional, .statutory and other civil rights, including but not limited to California Government Code 27471, subdivision(a), et seq., which damaged CLAIMANT, by failing to make reasonable efforts to locate next of kin of CLAIMANT'S son, LORENZO OAKLEY, 3R., who died September 24, 2001. CLAIMANT is informed and believes and alleges thereon that RESPONDENTS had actual or constructive custody and/or control of her son's body from about 1;00 a.m. on the date of his death, September 24, 2001, until and through the an autopsy performed at about 8:00a.m. that same day, however, at no time undertook to notify family of his death. Such failures and omissions violated statutes promulgated in the State of California, including but not limited to Government Code section 27471, subdivision (a), and Government Code section 27492, as interpreted in Davila,-, al= yr_CQun y of Lus Air (1996) 50 Cal.App.4th 137, 57 Cal. Rptt. 651, providing for a mandatory duty by RESPONDENTS, including SHERIFF-CORONER to make a reasonable effort to locate and notify family members, including CLAIMANT of the death of her son LORENZO OAKLEY, JR.'S death, having the effect of and purpose to protect CLAIMANT from additional injury as a consequence of her son's death. Further, RESPONDENTS failed to prevent and/or halt these practices or otherwise to control, supervise or train RESPONDENTS, including RESPONDENTS' agents, to avoid the negligent and inappropriate practices identified herein, all of which resulted in damage to CLAIMANT, in particular, in causing her severe emotional distress in not knowing her son's whereabouts, not knowing of her son's death not having the opportunity to view her son prior to an invasive and distorting autopsy, and otherwise, all the consequence of a pattern and practice of discrimination against CLAIMANT on the basis of her son's ethnicity and or other impermissible practices. Each of the actions and/or failures to act was improper and in violation of established civil and/or statutory rights at all times and which was known to be improper or should have been so,known by said agents at the time of the incidents. The above actions constitute, inter glia, negligence, negligent infliction of emotional distress, intentional infliction of emotional distress, violation of rights interpreted as following from Government Cale section 27471 (a), et seq., and Government Code section 27941, and otherwise, violation of 42 U.S.C. §1983, et seq., deprivation of civil rights and conspiracy to effect such a deprivation and negligence, including negligent hiring, negligent training, negligent retention, negligent supervision, all as to the affirmative actions and failure to undertake affirmative actions with respect to the agents, among other claims. Each such claim is brought against each agency and agent thereof named herein. The actual names of officers and individuals acting in the manner described hereinabove will be specified when such is ascertained. Ey listing these legal theories on which CLAIMANT' claims are brought herein, CLAIMANT is not admitting nor claiming that he was required to file a notice of tort claim as to any or all of the above claims, nor is the within claim limited to these enumerated violations and, rather, includes all violations expressly alleged and inferred which flow from the conduct described herein. i CLAIMANT: Evelyn Haskins September 23, 2002 page three The conduct which is the subject of this claim includes actions, each of which was improper at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The agents and entities above engaging in this conduct took action with the encouragement, consent, and/or ratification of each of the other agents and their agencies herein described. The amount claimed exceeds $ 10,000.00 as to each RESPONDENT and jurisdiction over the claim would rest in the Superior Court. The damages to this CLAIMANT include anxiety, fear, shock, and extreme emotional distress due to being subjected to and perceiving the events described herein. In addition, CLAIMANTS' damages include future expenses associated with the conduct described herein, including future medical and other expenses to treat and mitigate such damage. As the occurrences in this claim occurred over six months prior to this date, this also will support and constitute an application for leave to present a late claim, pursuant to Government Code section 911.4. Please process this claim at your earliest opportunity. .1 will accept a file-stamped copy of the claim as acknowledgment that this claim as to all respondents is properly lodged with your office on this date. Very truly yours, LAW OFFICES OF TRUDY L. MARTIN Tru L M in o*_�!__' TLM:cIf cc: Application for Leave to Present Late Claim on behalf of Claimant, Evelyn Haskins, attached I Trudy L. Martin, SBN 148515 LAW OFFICES OF TRUDY LYNN MARTIN 2 State Bar No. 148515 1010 Grayson Street, Suite Two 3 Berkeley, CA 94710 (510) 843-4300 4 5 Attorneys for Plaintiff EVELYN HASKINS R E CSIV E D 6 SEP 2 3 2042 7 CLERK BOARD OF SUFERViSt;S CONTRA COSTA CO. 8 Claim of EVELYN HASKINS, ) 9 DECLARATION OF EVELYN HASKINS IN 10 SUPPORT OF APPLICATION FOR LEAVE vs. TO PRESENT LATE CLAIM (Government 11 Code Section 911.4) 12 CONTRA COSTA COUNTY, CONTRA COSTA COUNTY SHERIFF'S ) 13 DEPARTMENT, SHERIFF- CORONER } WARREN E. RUFF, Deputy L. Martin, ) 14 Deputy W. Brinks, Brian L. Peterson, M.D., ) and others presently unknown, as described ) 15 herein. ) 16 17 18 19 The undersigned Evelyn Haskins, does declare on the basis of personal knowledge, as follows: 20 1. I am the Claimant named in the attached Claim, dated September 23, 2002, directed to 21 the Clerk,Board of Supervisors. I bring this claim arising from each of the facts identified in said Claim 22 for damages to me as the mother and next of kin of Lorenzo Oakley, Jr., who died on September 23, 2002. 23 24 2. I also have caused to be filed the within Application for Leave to Present Late Claim on 25 Behalf of Claimant Evelyn Haskins(Govt Code Section 911.4). The facts pertinent to this application 26 for leave to present late claim are as follows: 27 3. 1 have recently been informed, after retaining legal counsel,Law Offices of Trudy Lynn Martin 28 on September 19,2002,that I have a cause of action against the Sheriff-Coroner arising from the TRWY L.MARTIN Attamey M Law 1010 Grayoon St.,Sta. Herkelay,CA 84710 (SIO)843-4300 1 I delay in notifying me of the death of my son, during and following the time that his body was in the 2 possession and/or control of the Sheriff-Coroner. This information includes that the Coroner had custody 3 and/or control of my son's body from at least 1:00a.m., September 24, 2001, yet I was not notified of 4 his death until after 9:30 a.m., which was done by Detective Greco, Richmond Police Department. At 5 the time I received notification of my son's death,the Coroner already had performed an invasive autopsy 6 of my son's body. 7 4. On about July 12, 2002,I received a copy of the report of the Coroner for the first time. 8 From my review of the Coroner's report, it reflects that the Coroner had the right to retrieve my son's 9 body on September 24, 2001, from about 1:00a.m., physically had his body at about 3:00 a.m., and 10 thereafter performed an autopsy beginning close to 8:00 a.m. It does not reflect that the Coroner 11 undertook any efforts, at any time, to identify my son's next of kin. This information would have been 12 readily available to the Coroner, since in my son's wallet, there was a business card with the words on 13 the back, "Evelyn Haskins, Mother"together with my then-existing telephone number. At the time of 14 these events, I had a message machine on my phone, which was in working order. I also recall being 15 present in my residence after midnight and through the morning of September 24, 2001. At no time after 16 midnight and before Detective Greco arrived at my home at about 9:30 a.m. on September 24, 2001, did 17 I receive any call from any individual about my son's death or other related matter. 18 5. The information about a cause of action against this public entity was not available to me 19 before I retained Ms. Martin. Though I tried diligently to obtain representation, I contacted over ten 20 attorneys before Ms.Martin, and each stated they did not have the time or ability to represent me in my 21 claims. I can provide the names of these counsel, with verification of my contact with each, if so 22 requested. These investigations by potential counsel were apparently thorough, since at least one lave 23 firm undertook efforts to obtain government records and in fact did receive title and deed of trust 24 documents, as well as business license and fictitious business documents and other information in the 25 course of evaluating my claims. In each of my conversations with counsel, I explained that there was a 26 delay in notifying me as next of kin, and that no one had called me to inform me of my son's death 27 between the time of his death near midnight and Detective Greco's arrival at my home. At no time did 28 any of these attorneys inform me that I had a potential claim against a public entity or that there was a TRUDY L.MARTIN Attomay*1 1— ay 1010 Grw'St.,Sta. B"kaky,CA 94710 !6101 843.4300 2 I statute oflimitations for filing such a claim, nor dict they specifically, generally or in any ether way refer 2 to the Government Tort Claims Act, 3 6. Due to the forgoing circumstances, I was altogether ignorant of the need to file any claim 4 naming Contra Costa County or the Sheriff Coroner, until this date. On the basis of the facts stated 5 herein, I am informed and believe and allege thereon that my ignorance of the legal requirement and that 6 it would be implicated by the facts relating to my son's death and my lack of notice thereof, constitute 7 inadvertence,mistake, surprise or excusable neglect,as the courts of this state have interpreted that term, 8 and in particular,from UCS Owen(1983)35 Cal.3d 427, 197 Cal.Rptr. 601, permitting relief from 9 filing of a late claim. 10 7. In presenting this Application for relief from late claim filing, under Government Code 11 Section 911.3,there is no prejudice to Contra Costa County. This is so because the conduct by Contra 12 Costa County and its employees, including the Sheriff-Coroner as alleged in my claim, which gives rise 13 to my damages,fully concluded by the time I had actual notice of my son's death. Thus, the delay in filing 14 the within claim did not cause any increase in damages relating to this claim. Further, the ability of Contra 15 Costa County to investigate this claim was not prejudiced at any time, since the Contra Costa Sheriff- 16 Coroner prepared a full report of all events relating to the contact of the Sheriff Corner with my son and 17 related events,so that at all times,including the date on which the six months period following September 18 24, 2001 elapsed, through and including the present, the information necessary for investigation of the 19 pertinent facts existed and was not lost by reason of any late claim filing. 0 6. On the basis ofthis information,I respectfully request that I be given leave to present the 1 within claim and that Contra Costa County and related agencies and individuals named herein, proceed 22 to fully investigate said claim. 23 24 The forgoing is true and correct under penalty of perjury under the lave of the State of California, 25 executed this 23rd day of September, 2002. 26 27 28 AIrn *, TRUDY L.MARTM Aitomoy of Law 1010 Grs"an St..ste. Swke*y,CA 84714 (610)643-4304 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNT' BOARD ACTION: Oct 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 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: Exceeds $10,000 CLAIMANT: Evelyn Haskins ATTORNEY: Trudy Martin DATE RECEIVED: Sept-23, 2002 ADDRESS: 1010 Grayson St#2 BY DELIVERY TO CLERK.ON: Sept 23, 2002 Berkeley, CA 94710 BY MAIL POSTMARKED: FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ; JOHN SWEE1r Dated: Sept 24, 2002 By: Deputy lf; ` �...., ; £ 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}11.3). ( ) Other: Dated: By: Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( ) This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated: JOHN SWEETEN, CLERK., By , Deputy Clerk WARNING (Gov. code section 913) Subject to certain exceptions, you have only six (6)months from the date this notice was personally served or deposited in the mail to file a court action on this claim. See Government Code Section 945.6. You may seek the advice of an attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so immediately. *For Additional Warning See Reverse Side of This Notice. AFFIDAVIT OF MAILING I declare under penalty of perjury that I am now, and at all times herein mentioned, have been a citizen of the United States, over age 18; and that today I deposited in the United States Postal Service in Martinez, California, postage fully prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above. Dated: JOHN SWEETEN, CLERK.By Deputy Clerk Law Offices of TRUDY LYNN MARTIN RECE W11 , " . 1010 Grayson Street, Suite Two R -. Berkeley, California 94710 2 � 3 September 23, 2002 ; CONTRA COSTA COUNTY Office of the Clerk Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 Attn: Brette, Clerk board of Supervisors Re: Claim of EVELYN HASKINS Pursuant to Government Code § 900, et seq. TO WHOM IT MAY CONCERN: This letter is to advise you that EVELYN HASKINS, ("CLAIMANT"), hereby makes her claim against the CONTRA COSTA COUNTY, CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF- CORONER WARREN E. RUPF, (known collectively herein as "RESPONDENTS"), and their agents, for the reasons set forth in this letter. The mailing address and telephone contact for CLAIMANT is c/o Law Offices of Trudy L. Martin, 1010 Cray son Street, Suite Two, Oakland, CA 94710, (510)843-4300. CLAIMANT'S mailing address is 266 So. 41st Street, Richmond, CA 94804. Contact with CLAIMANT may be made through Law Offices of Trudy L. Martin, at the above address. The date and location of the circumstances and occurrences relating to the claims as set forth below is September 24, 2001, at or about the central Morgue, 1960 Muir Road, Martinez California, and at other locations presently unknown to this CLAIMANT. The circumstances which give rise to the claim are the conduct of Sheriff-Coroner Warren E. Rupf, Deputy L. Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others, including presently unidentified deputy coroners, employees or officers of and/or related to the CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF-CORONER, and other unidentified officers or and/or agents, each of which at all times relevant hereto operated in their individual capacities and as agents of said SHERIFF-CORONER, (herein collectively referred to herein as "agents" and/or "Respondents"), and, as such, engaged in such actions and inaction, all in the course and scope of the official duties of said entities and agents. TELEPHONE (510)843-4300 1 ACSIMILE(510)843-4311 r-IAML:trudylmartin@earthliniz.net CLAIMANT: Evelyn Haskins September 23, 2002 page two The conduct complained of was that RESPONDENTS, agents and each of them was engaged in negligent, inappropriate conduct in violation of clearly established constitutional, statutory and other civil rights, including but not limited to California Government Code 27471, subdivision(a), et seq., which damaged CLAIMANT, by failing to make reasonable efforts to locate next of kin of CLAIMANT'S son, LORENZO OAKLEY, JR., who died September 24, 2401. CLAIMANT is informed and believes and alleges thereon that RESPONDENTS had actual or constructive custody and/or control of her son's body from about 1:00 a.m. on the date of his death, September 24, 2001, until and through the an autopsy performed at about 8:00a.m. that same day, however, at no time undertook to notify family of his death. Such failures and omissions violated statutes promulgated in the State of California, including but not limited to Government Code section 27471, subdivision (a), and Government Code section 27492, as interpreted in DY.ila.A alt v County of Us Angeles (1995) 50 Cal.App.4th 137, 57 Cal. Rptr. 651, providing for a mandatory duty by RESPONDENTS, including SHERIFF-CORONER to make a reasonable effort to locate and notify family members, including CLAIMANT of the death of her son LORENZO OAKLEY, JUS death, having the effect of and purpose to protect CLAIMANT from additional injury as a consequence of her son's death. Further, RESPONDENTS failed to prevent and/or halt these practices or otherwise to control, supervise or train RESPONDENTS, including RESPONDENTS' agents, to avoid the negligent and inappropriate practices identified herein, all of which resulted in damage to CLAIMANT, in particular, in causing her severe emotional distress in not knowing her son's whereabouts, not knowing of her son's death, not having the opportunity to view her son prior to an invasive and distorting autopsy, and otherwise, all the consequence of a pattern and practice of discrimination against CLAIMANT on the basis of her son's ethnicity and or other impermissible practices. Each of the actions and/or failures to act was improper and in violation of established civil and/or statutory rights at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The above actions constitute, inter glia, negligence, negligent infliction of emotional distress, intentional infliction of emotional distress, violation of rights interpreted as following from Government Code section 27471 (a), et seq., and Government Code section 27941, and otherwise, violation of 42 U.S.C. §1983, et seq., deprivation of civil rights and conspiracy to effect such a deprivation and negligence, including negligent hiring, negligent training, negligent retention, negligent supervision, all as to the affirmative actions and failure to undertake affirmative actions with respect to the agents, among other claims. Each such claim is brought against each agency and agent thereof named herein. The actual names of officers and individuals acting in the manner described hereinabove will be specified when such is ascertained. By listing these legal theories on which CLAIMANT' claims are brought herein, CLAIMANT is not admitting nor claiming that he was required to file a notice of tort claim as to any or all of the above claims, nor is the within claim limited to these enumerated violations and, rather, includes all violations expressly alleged and inferred which flow from the conduct described herein. CLAIMANT: Evelyn Haskins September 23, 2002 page three The conduct which is the subject of this claim includes actions, each of which was improper at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The agents and entities above engaging in this conduct took action with the encouragement, consent, and/or ratification of each of the other agents and their agencies herein described. The amount claimed exceeds $ 10,000.00 as to each RESPONDENT and jurisdiction over the claim would rest in the Superior Court. The damages to this CLAIMANT include anxiety, fear, shock, and extreme emotional distress due to being subjected to and perceiving the events described herein. In addition, CLAIMANTS' damages include future expenses associated with the conduct described herein, including future medical and other expenses to treat and mitigate such damage. As the occurrences in this claim occurred over six months prior to this date, this also will support and constitute an application for leave to present a late claim, pursuant to Government Code section 911.4. Please process this claim at your earliest opportunity. I will accept a file-stamped copy of the claim as acknowledgment that this claim as to all respondents is properly lodged with your office on this date. Very truly yours, LAW OFFICES OF TRUDY L. MARTIN Tru L. Mart n TLM:clf cc: Application for Leave to Present Late Claim on behalf of Claimant, Evelyn Haskins, attached I Trudy L. Martin, SBN 148515 LAW OFFICES OF TRULY LYNN MARTIN 2 State Bar No. 148515 1.010 Grayson Street, Suite Two 3 Berkeley, CA 94710 (510) 843-4300 _4 Attorneys for Plaintiff EVELYN HASKINS RECEIVE D 5 6 SEP 2 3 2002 7 CLERK SOAAD OF SUPERils OR5 CONTRA COSTA CO. Claim of EVELYN HASKINS, } APPLICATION FOR LEAVE TO PRESENT 9 LATE CLAIM ON BEHALF OF CLAIMANT EVELYN HASKINS (Govt Code Section 10 ) 911.4) 11 vs. � ) 12 CONTRA COSTA COUNTY, CONTRA. ) COSTA COUNTY SHERIFF'S ) 13 DEPARTMENT, SHERIFF- CORONER ) WARREN E. RUPF, Deputy L. Martin, } 14 Deputy W. Brinks, Brian L. Peterson, M.D., ) and others presently unknown, as described ) 15 herein. ) ) 16 ) 17 18 To the BOARD OF SUPERVISORS, CONTRA COSTA COUNTY: 19 1. Application is hereby made, under Government Code Section 911.3, for leave to present 20 a late claim founded on causes of action for Negligence, Negligence Per Se, Negligent Infliction of 21 Emotional Distress and Intentional Infliction of Emotional Distress, which accrued on September 24, zz 2001, for which a claim was not presented within the 6-month period provided by Government Cade 23 Section 911.2. For additional circumstances relating to the causes of action, reference is made to the 24 proposed claim attached to this.application. 25 2. The facts pertinent to this application for in Application is hereby made, under 6 Government Code Section 911.3, for leave to present a late claim founded on causes of action for 27 Negligence,Negligence Per Se, Negligent Infliction of Emotional Distress and Intentional Infliction of 28 TRUDY L.MARTIN Attorney at Law 1010 Grayson 5t.,Ste. Berkeley,CA 84710 15101 843-4300 1 I Emotional Distress, which accrued on September 24, 2001, for which a claim was not presented within 2 the 6-month period provided by Government Code Section 911.2. For additional circumstances relating 3 to the causes of action, reference is made to the proposed claim attached to this application. 4 3. This application and the accompanying claim, pursuant to express authorization of the 5 Clerk of the Board of Supervisors, Contra Costa County, is directed to the Clerk of the Board of 6 Supervisors, for and on behalf of all named entities and individuals, including specifically Contra Costa 7 County, Contra Costa County Sheriff's Department, Sheriff- Coroner Warren E. Rupf, Deputy L. 8 Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others presently unknown, as described in 9 the attached claim. 10 4. The failure to present this claim within the 6-month period specified by Government Code 11 Section 911.2 was through mistake, inadvertence, surprise and/or excusable neglect, and Contra. Costa 12 County, Contra Costa County Sheriff's Department, Sheriff- Coroner Warren E. Rupf, Deputy L. 13 Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others presently unknown, and each of them 14 was not prejudiced by this failure, all as more particularly shown by the attached declaration of Evelyn 15 Haskins. 16 17 WHEREFORE, it is respectfully requested that this application be granted and that the attached 18 proposed claim be received and acted on in accordance with Government Code Sections 912..4-913, 19 20 21 22 Dated September 23, 2002 Respectfully Submitted, 23 24 TRbTrY LYNN MARTIN 25 Attorney for Plaintiff EVELYN HASKINS 26 27 28 TRUDY L.MARTIN Attorney at Law 1010 Grayson St.,Ste. 6arkeley,CA 84710 IS 101,843-4300 2 Law Offices of TRUDY LYNN MARTIN 1410 Grayson Street, Suite Two Berkeley, California 94710 September 23, 2002 CONTRA COSTA COUNTY Office of the Clerk Board of Supervisors 651 Pine Street, Room 106 Martinez, CA 94553 Attn: Brette, Clerk board of Supervisors Re: Claim of EVELYN HASKINS Pursuant to Government Code § 900, et seq. TO WHOM IT MAY CONCERN: This letter is to advise you that EVELYN HASKINS, ("CLAIMANT"), hereby makes her claim against the CONTRA COSTA COUNTY, CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF- CORONER WARREN E. RUFF, (known collectively herein as "RESPONDENTS"), and their agents, for the reasons set forth in this Ietter. The mailing address and telephone contact for CLAIMANT is c/o Law Offices of Trudy L. Martin, 1010 Gray son Street, Suite Two, Oakland, CA 94710, (510)843-4300. CLAIMANT'S mailing address is 266 So. 41st Street, Richmond, CA 94804. Contact with CLAIMANT may be made through Law Offices of Trudy L. Martin, at the above address. The date and location of the circumstances and occurrences relating to the claims as set forth below is September 24, 2001, at or about the central Morgue, 1960 Muir Road, Martinez California, and at other locations presently unknown to this CLAIMANT. The circumstances which give rise to the claim are the conduct of Sheriff-Coroner Warren E. Rupf, Deputy L. Martin, Deputy W. Brinks, Brian L. Peterson, M.D., and others, including presently unidentified deputy coroners, employees or officers of and/or related to the CONTRA COSTA COUNTY SHERIFF'S DEPARTMENT, SHERIFF-CORONER, and other unidentified officers or and/or agents, each of which at all times relevant hereto operated in their individual capacities and as agents of said SHERIFF-CORONER, (herein collectively referred to herein as "agents" and/or "Respondents"), and, as such, engaged in such actions and inaction, all in the course and scope of the official duties of said entities and agents. TELEPHONE(510)843-43o0 FACSIMILP(510)843-4311 MAIL trur(yhnartin@earth)ink.net t CLAIMANT: Evelyn Haskins September 23, 2002 page two The conduct complained of was that RESPONDENTS, agents and each of them was engaged in negligent, inappropriate conduct in violation of clearly established constitutional, statutory and other civil rights, including but not limited to California Government Code 27471, subdivision(a), et seq., which damaged CLAIMANT, by failing to make reasonable efforts to locate next of kin of CLAIMANT'S son, LORENZO OAKLEY, JR., who died September 24, 2001. CLAIMANT is informed and believes and alleges thereon that RESPONDENTS had actual or constructive custody and/or control of her son's body from about 1:00 a.m. on the date of his death, September 24, 2001, until and through the an autopsy performed at about 8:00a.m. that same day, however, at no time undertook to notify family of his death. Such failures and omissions violated statutes promulgated in the State of California, including but not limited to Government Code section 27471, subdivision (a), and Government Code section 27492, as interpreted in Davilaa-f,1 al. v ounly of Lm Angeles (1996) 50 Cal.App.4th 137, 57 Cal. Rptr. 651, providing for a mandatory duty by RESPONDENTS, including SHERIFF-CORONER to make a reasonable effort to locate and notify family members, including CLAIMANT of the death of her son LORENZO OAKLEY, JR.'S death, having the effect of and purpose to protect CLAIMANT from additional injury as a consequence of her son's death. Further, RESPONDENTS failed to prevent and/or halt these practices or otherwise to control, supervise or train RESPONDENTS, including RESPONDENTS' agents, to avoid the negligent and inappropriate practices identified herein, all of which resulted in damage to CLAIMANT, in particular, in causing her severe emotional distress in not knowing her son's whereabouts, not knowing of her son's death, not having the opportunity to view her son prior to an invasive and distorting autopsy, and otherwise, all the consequence of a pattern and practice of discrimination against CLAIMANT on the basis of her son's ethnicity and or other impermissible practices. Each of the actions and/or failures to act was improper and in violation of established civil and/or statutory rights at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The above actions constitute, inter alis, negligence, negligent infliction of emotional distress, intentional infliction of emotional distress, violation of rights interpreted as following from Government Code section 27471 (a), et seq., and Government Code section 27941, and otherwise, violation of 42 U.S.C. §1983, et seq., deprivation of civil rights and conspiracy to effect such a deprivation and negligence, including negligent hiring, negligent training, negligent retention, negligent supervision, all as to the affirmative actions and failure to undertake affirmative actions with respect to the agents, among other claims. Each such claim is brought against each agency and agent thereof named herein. The actual names of officers and individuals acting in the manner described hereinabove will be specified when such is ascertained. By listing these legal theories on which CLAIMANT` claims are brought herein, CLAIMANT is not admitting nor claiming that he was required to file a notice of tort claim as to any or all of the above claims, nor is the within claim limited to these enumerated violations and, rather, includes all violations expressly alleged and inferred which flow from the conduct described herein. ' CLAIMANT: Evelyn Haskins September 23, 2002 page three The conduct which is the subject of this claim includes actions, each of which was improper at all times and which was known to be improper or should have been so known by said agents at the time of the incidents. The agents and entities above engaging in this conduct took action with the encouragement, consent, and/or ratification of each of the other agents and their agencies herein described. The amount claimed exceeds $ 10,000.00 as to each RESPONDENT and jurisdiction over the claim would rest in the Superior Court. The damages to this CLAIMANT include anxiety, fear, shock, and extreme emotional distress due to being subjected to and perceiving the events described herein. In addition, CLAIMANTS' damages include future expenses associated with the conduct described herein, including future medical and other expenses to treat and mitigate such damage. As the occurrences in this claim occurred over six months prior to this date, this also will support and constitute an application for leave to present a late claim, pursuant to Government Code section 911.4. Please process this claim at your earliest opportunity. I will accept a file-stamped copy of the claim as acknowledgment that this claim as to all respondents is properly lodged with your office on this date. Very truly yours, LAW OFFICES OF TRULY L. MARTIN h Tru L. Martin TLM:clf cc: Application for Leave to Present Late Claim on behalf of Claimant, Evelyn Haskins, attached I Trudy L. Martin, SBN 148515 LAW OFFICES OF TRULY LYNN MARTIN 2 State Bar No, 148515 1.010 Grayson Street, Suite Two 3 Berkeley, CA 94710 (510) 843-4300 4 Attorneys for Plaintiff EVELYN HASKINS 6 SEP 2 2002 7 CLM 859"RD-CF SuPERv1s RS CONT;' r7 COSTA C£7. 8 Claim of EVELYN HASKINS, } 9 } l0 ) DECLARATION OF EVELYN HASKINS IN } SUPPORT OF APPLICATION FOR LEAVE vs. } TO PRESENT LATE CLAIM (Government I 1 Code Section 911.4) 12 CONTRA COSTA COUNTY, CONTRA } COSTA COUNTY SHERIFF'S } 13 DEPARTMENT, SHERIFF- CORONER } WARREN E. RUPF, Deputy L. Martin, ) 14 Deputy W. Brinks, Brian L. Peterson, M.D., } and others presently unknown, as described } 15 herein. } 16 } 17 18 19 The undersigned Evelyn Haskins, does declare on the basis of personal knowledge, as follows: 20 1. I am the Claimant named in the attached Claim, dated September 23, 2002, directed to 21 the Clerk, Board of Supervisors. I bring this claim arising from each of the facts identified in said Claim zz for damages to me as the mother and next of kin of Lorenzo Oakley, Jr., who died on September 23, 2042. 23 24 2. I also have caused to be filed the within Application for Leave to Present Late Claim on 25 Behalf of Claimant Evelyn Haskins{Govt Code Section 911.4}. The facts pertinent to this application 26 for leave to present late claim are as follows: 27 3. I have recently been informed, after retaining legal counsel, Law Offices of Trudy Lynn 28Martin on September 19, 2002,that I have a cause of action against the Sheriff-Coroner arising from.the Attorney at Law 1010 Grayson 5t.,Sta. 8erkafay,CA 94710 f510)943-4300 1 I delay in notifying me of the death of my son, during and following the time that his body was in the 2 possession and/or control of the Sheriff-Coroner. This information includes that the Coroner had custody 3 and/or control of my son's body from at least 1:00a.m., September 24, 2001, yet I was not notified of 4 his death until after 9:30 a.m., which was done by Detective Greco,Richmond Police Department. At 5 the time I received notification of my son's death, the Coroner already had performed an invasive autopsy 6 of my son's body. 7 4. On about July 12, 2002, I received a copy of the report of the Coroner for the first time. 8 From my review of the Coroner's report, it reflects that the Coroner had the right to retrieve my son's 9 body on September 24, 2001, from about 1:00a.m., physically had his body at about 3:00 a.m., and 10 thereafter performed an autopsy beginning close to 8:00 a.m. It does not reflect that the Coroner 11 undertook any efforts, at any time, to identify my son's next of kin. This information would have been 12 readily available to the Coroner, since in my son's wallet, there was a business card with the words on 13 the back, "Evelyn Haskins, Mother" together with my then-existing telephone number. At the time of 14 these events, I had a message machine on my phone, which was in working order. I also recall being 15 present in my residence after midnight and through the morning of September 24, 2001. At no time after 16 midnight and before Detective Greco arrived at my home at about 9:30 a.m. on September 24, 2001, did 17 I receive any call from any individual about my son's death or other related matter. 18 5. The information about a cause of action against this public entity was not available to me 19 before I retained Ms. Martin. Though I tried diligently to obtain representation, I contacted over ten 20 attorneys before Ms. Martin, and each stated they did not have the time or ability to represent me in my 21 claims. I can provide the names of these counsel, with verification of my contact with each, if so 22 requested. These investigations by potential counsel were apparently thorough, since at least one law 23 firm undertook efforts to obtain government records and in fact did receive title and deed of trust 24 documents, as well as business license and fictitious business documents and other information in the 25 course of evaluating my claims. In each of my conversations with counsel, I explained that there was a 26 delay in notifying me as next of kin, and that no one had called me to inform me of my son's death 27 between the time of his death near midnight and Detective Greco's arrival at my home. At no time did 28 any of these attorneys inform me that I had a potential claim against a public entity or that there was a TRUDY L.MARTIN Attorney at Law 1010 Grayson St., to. Barketey,CA 94710 16101 843-4300 '� I statute of limitations for filing such a claim, nor did they specifically, generally or in any other way refer 2 to the Government Tort Claims Act. 3 6. Due to the forgoing circumstances, I was altogether ignorant of the need to file any claim 4 naming Contra Costa County or the Sheriff Coroner, until this date. On the basis of the facts stated 5 herein, I am informed and believe and allege thereon that my ignorance of the legal requirement and that 6 it would be implicated by the facts relating to my son's death and my lack of notice thereof, constitute 7 inadvertence, tnistake, surprise or excusable neglect, as the courts of this state have interpreted that term, 8 and in particular, from Ebersol v. Cowen(1983)35 Call.3d 427, 197 Cal.Rptr. 601, permitting relief from 9 filing of a late claim. 10 7, In presenting this Application for relief from late claim filing, under Government Code 11 Section 911.3,there is no prejudice to Contra Costa County. This is so because the conduct by Contra 12 Costa County and its employees, including the Sheriff Coroner as alleged in my claim, which gives rise 13 to my damages, fully concluded by the time I had actual notice of my son's death. Thus, the delay in filing 14 the within claim did not cause any increase in damages relating to this claim. Further, the ability of Contra 15 Costa County to investigate this claim was not prejudiced at any time, since the Contra Costa Sheriff 16 Coroner prepared a full report of all events relating to the contact of the Sheriff-Comer with my son and 17 related events, so that at all times, including the date on which the six months period following September 18 24, 2001 elapsed, through and including the present, the information necessary for investigation of the 19 pertinent facts existed and was not lost by reason of any late claim filing. 20 6, On the basis of this information, I respectfully request that I be given leave to present the 21 within claim and that Contra Costa County and related agencies and individuals named herein, proceed 22 to fully investigate said claim. 23 24 The forgoing is true and correct under penalty ofpedury under the law of the State of California, 25 executed this 23rd day of September, 2002. 26 27 mm 28 TRUDY L.MARTIN Attorney at taw 1010 Grayson St.,Ste, Berkeley,CA 94710 1510)843-4300 3 CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY • BOARD ACTION: Oct_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: $300,00 ee 2. �# } CLAIMANT: Lamos Wayne Sturgis ATTORNEY: DATE RECEIVED: Sept 23, 2002 ADDRESS: 901 Court St BY DELIVERY TO CLERK ON: Sept 23, 2002 Martinez, CA 94553 BY MAIL POSTMARKED: Sept 19, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEET ?,� cy k Dated: _ Sept 23. 2002 By: Deputy II. FROM: County Counsel TO: Clerk of the Board of Supervisors ( j This 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: y: 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. ;- Deputy Clerk Dated. s-u= JOHN SWEETEN, CLERK, By - . 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. f•I``f �r�'. `�. i 3,r � � ri ��-�JOHN SWEETEN, CLERK By / ��Via{ �r^ Deputy Clerk ............ ...... Claim to: BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO C 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 acme on or after January 1, 1988, must be presented not later than six months after the accrual of the cause of action. Claims relating to any other cause of action must be presented not later than one year after the accrual of the cause of action. (Gov't Code 911.2.) B Claims must be filed with the Clerk of the Board of Supervisors at its office in Room 106, County Administration Building, 651 Pine Street,Martinez, CA 94553. C. If claim is against a district governed by the Board of Supervisors, rather than the County, the name of the District should be filled in. D. If the claim is against more than one public entity, separate claims must be filed against each public entity. E. Fraud. See penalty for fraudulent claims, Penal Code Sec. 72 at the end of this form. RE: Claim By Reserved for Clerk's filing stamp LA�4,ai wAyba SM" 1A Against the County of Contra Costa or SEP P 3 2002 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$_3LQ.oto: and in support of this claim represents as follows: I. When did the damage or injury occur?(Give exact date and hour) 0 N S c Cl 10 2. 4A,4- IrA PO I p 2. Where did the damage or injury occur?(Include city and county) A-C —liff- C-OW-RA Co_&TA JA-, L ',Y-) mar+,mz. I How did the damage or injury occur?(Give full details; use extra paper if required) ON 7r'SCF+1t02_ a� o�P P ne+vro ' L1,641 -filom -MzkK?'rJ1 0-ty PR-0 prt� 4Aw, clue— +,o Are_ss -T>e0', k-F 've-k ^"J Y A '4A5 C'Alle_j 0,V13 be';.k'J v.4 ;ejt' e le-A LJ 0,S Ti> mom_ylf�l 4. What particular act or omission on the part of county or district officers, servants, or employees caused the ipjury or damage? Viz: if:s � �.:� {��• Gr.1.-� � rd ,� r:•. 5. Whif are the names of county 6f distric't' tiers, servants, or empI yees causing the dalAage or injury? 5. What damage or injuries do you claim resulted?(Gine full extent of injuries or damages;claimed. Attach two estimates for auto damage.) ;, r' y 7' r Al ?. How was the amount claimed abovecomputed?(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 TMffi AMOUNT Gov. Code Sec. 914.2 provides"The claim must be signed by the claimant or by some person on his behalf." SEND NOTICES TQ- Agornty Name and Address of Attorney ) 4. ) (Claimant's Stgnatur�) ' u (Address) ) Telephone No. Telephone No. NOTICE Section 72 of the Penal Cade 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 bath 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. ..........._._............_ f' ---------- ....... _--- .- .....__... .,.....' 'ir- -.P'i;... �._....�.� ..._.:.. -.- Y/ ............. ............. 4f�-R.4.- .. ��}��..�__ 4...::..,,._.....,-��-..,.......� 6:J!..,--•-_..._�. _....:. ,Y�_ .,,;�..i:.,�,�G.� ...L3,t.......d a�iria...x........:,........�_.::. ............................: ......... ......Y'.F.:�I/.:h:"_....��4.:��L...ist'.�......�Y'i.}R. �:.........��.._M-'ar+d'.,p� �3........,,.,.�,.....��.'lY....,....�.yp. �.�-fn.,R•....v.._.�:t A�,�. �.......... Fq F {s { t M. . . s t ff f >: f r � t w ' r, �4 r f 3 t , h , , F f .......... .... -,: ..:L.`.../..q. ...,._�.:y.�. .x.._:_. -f:,:'•irk; `F...y.,,,s. r y � `�f... of 6...... ..:........�..af:J.....,.,...a�...a�:i.n. .......... __.��.`:....,..,...��a�. '..3&`..•......,ixid7�.5��.':. ......,.. .....:...,..:... .......: _.�r!`� .......... ....jw. i S L•J^N.-. ........ ... :3: -..: �� ..' ...-> _ ......... ... .... .f ....,a.L .,,(��t* r ........... ............... .... ..:..._ .y .?.,tl.., .:.::. ....»m.:..„f: .... ,..1'h,.'S..✓..:C.G�. ...�1�..,.,.`..�. p-p=t,. -.w,...,. •'9_+� ,f,.v''•,h t-.. f^ / t ! ....,,ea,c.5:..,:.. ......,•i;•.. .._x.d -.RSD-.Sr.:...e.a'�,.......,.:... .3+'.a�.:.......�.:y.....YE. ... ... ..... ._.__ lz y' o oie h f" A. ` 2 ..:. ..,.._.. .mak..-_ •e E::"•'. :�.'�r-.�-':�-fi � ,rf"` t�' 4%-• sd'�.., -+�tyf { .....�..,..�...c'�t„ay'�w f ,y ._.:... .-...... ,....: J�J<y: .{ f.fes` 3 ..$... R..:...... ..... # CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY BOARD ACTION: Oct 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 E . ;K h 915.4. Please note all "Warnings". u;, AMOUNT: $3403.73Uum; ' ~ :' ` r N CA'£ . CLAIMANT: State Farm Mutual Auto/Reyna Vazquez ATTORNEY: DATE RECEIVED: Sept 20, 2002 ADDRESS: P.O. Box 6403 BY DELIVERY TO CLERK ON: Sept 20,2002 Rohnert Park,CA 94927-6403 BY MAIL POSTMARKED: Sept 17, 2002 FROM: Clerk of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. JOHN SWEETS , Dated: Sew 23 2002 By: Deputy , IL 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: y_ AA 1VUJIr Dated: 2W2- By. Deputy County Counsel III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2) ( ) Claim was returned as untimely with notice to claimant(Section 911.3). IV. BOARD ORDER: By unanimous vote of the Supervisors present: ( This Claim is rejected in full. ( ) Other: I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date. Dated] L � 3�..�,''JOHN SWEETEN, CLERK., By ' � ' < _ 4' �s .-'3> puty 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. f Dated � L.,,}kr� JOHN SWEETEN,CLERK By Deputy Clerk STATE FARM Mate Farm Insurance Companies INSURANCE 1% Claim Central Subrogation 6400 State Farm Drive September 16, 2002 P.O. Box 6403Rohnert Park, CA 94927-6403 Sir Clerk Of The Beard Of Supervisors/County Admin Bldg 651 Pine St Rm 105 Martinez, CA 94553 S M P t 2222 RE: Claim Number: 05-4789-326 ^J8`�=n" Date of Loss : June 21, 2002 Our Insured: Reyna I . Vazquez Dear Sir: State Farm Mutual Automobile Insurance Company, on behalf of Subrogee, Reyna I . Vazquez hereby makes a claim for $3403 . 73 and makes the following statements in support of claim: 1 . Notices concerning this claim should be sent to: State Farm Insurance Companies PO Box 6403 Rohnert Park, CA 94927-6403 2 . The date of the accident occurring on June 21, 2002 at 901 J St, at 12 :30pm. 3 . The circumstances giving rise to this claim are as follows: Our insured' s parked & unoccupied vehicle was hit by Tito Lopez driving a County of Contra Costa vehicle . 4 . The injuries reported consisted of the following: none 5 . Our total claim is as follows : Company' s Net Payment $2356 . 12 repairs/partial rental insured' s Deductible Int $1047 . 61 ded/out of pocket rental Total Property Damage $3403 . 73 HOME OFFICES: BLOOMINGTON, ILLINOIS 61710-0001 Clerk Of The Board Of Supervisors/County Admin Bldg Page 2 September 16, 2002 NOTICE: This form is to provide notice of our claim for damages in accordance with the 180 statute. If this form is not acceptable for compliance with the statute, please rush the necessary form to my attention for proper filing. In order to assist you in evaluating and processing the subrogation claim we are asserting, we may provide nonpublic personal information about our customer. We are sharing this information to effect, administer, or enforce a transaction authorized by the consumer. However, you are neither authorized nor permitted to: (1) use the customer information we provide for any purpose other than to evaluate and process the subrogation claim, or (2) disclose or share the customer information we provide for any purpose other than to evaluate and process the subrogation claim. State Farm Mutual Automobile Insurance Company Bated: September 16, 2002 By: Employee Name �— mployee Title )- t� Employee Phone 2mber Sincerely, Kim Rostak Claim E pedi.ter (800 440-6177 ext . 7 State Farm Mutual Automobile Insurance Company kr PS: Loss location: 901 1 St in Antioch, Ca at 12 .30pm RB Z 0 0 0 3 H date : 09-11-02 page : 1 .. ...... � �... STATE FARM MUTUAL AUTOMOBILE INSURANCE COMPANY AUTO PAYMENTS ............................................. '." .: .:_.'..< policy number `:'..ai 'sY <':::' ;>: .. .. 0402 > 2 named insured date of loss V.A.t QUEz I-HnzwA S 045 -21 —C72 C denotes consolidated payment E denotes EFT payment P denotes previous data payment number payee total amount issued status 102711017Q REYNA I . VAZQUEZ 2 , 165 . 69 08-26-02 PAID E 102316047K ENTERPRISE RENT A CAR 190 .43 07-23-02 PAID Date: 8/26/02 09:51 AM Estimate ID: 05-4789-32601 Estimate Version: 0 Committed Profile ID: *ANTIOCH (PCP) STATE FARM INSURANCE 333 Civic Drive Pleasant Hill, CA 94523 (925) 680-4100 Fax: (925) 680-4170 Damage Assessed By: JOE BRAZ Appraised For: CLAIM PROCESSOR TEAM 5 (800) 440-6175 Type of Loss: Collision Date of Loss: 6/21/02 Deductible: 1,000.00 Claim Number: 05-4789-32601 Insured: REYNA VAZQUEZ Address: 217 W 8TH ST PITTSBURG, CA 945-65-2401 Telephone: Work Phone: (925) 383-8162 Home Phone: (925) 427-9487 Mitchell Service: 913622 Description: 1994 Ford Mustang Body Style: 2D Conv Drive Train: 3.8L Inj 6 CytA VIN: 1FALP4441RF174608 License: 4SCZ269 CA Mileage: 95,781 Color: RED Options: Alum/Alloy Wheels, Air Conditioning, Power Steering, Power Brakes, Power Windows, Power Door Locks, Cruise Control, Electric Defogger, AM-FM Stereo, Automatic Transmission, Deep Tinted Glass, Compact Disc Player-Mutti, Center Console, Power Remote Mirror, Soft Top, 2-Door, Convertible, Driver Front Air Bag. Line Entry Labor Line Item Part Type/ Dollar Labor Item Number Type Operation Description Part Number Amount Units 1 300760 BDY REMOVE/INSTALL FRT BUMPER COVER INC 2 320143 BDY REPAIR FRT BUMPER COVER Existing 0.5 3 AUTO REF REFINISH FRT BUMPER COVER C 2.6 4 301110 BDY REMOVE/REPLACE GRILLE MOUNTING PANEL F7ZZ 8A284 AA 110.50 2.2 # 5 AUTO BDY CHECK/ADJUST HEADLAMPS 0.4 6 319863 BDY REMOVE/REPLACE GRILLE NEW 72.45 INC 7 301160 BDY REMOVE/REPLACE GRILLE PANEL EMBLEM XR3Z 8A224 AA 21.08 INC 8 301200 BDY REMOVE/REPLACE R GRILLE PANEL BRACKET F4ZZ 8B455 A 3.67 INC # 9 301210 BDY REMOVE/REPLACE L GRILLE PANEL BRACKET F4ZZ 86455 A 3.67 INC # 10 301390 BDY REMOVE/REPLACE R H/LAMP ASSEMBLY F4ZZ 13008 E 156.00 INC # 11 301500 BDY REMOVE/REPLACE L H/LAMP ADJUSTING SCREW F4ZZ 13032 A 4.67 12 301520 BDY REMOVE/REPLACE L H/LAMP ADJUSTING SCREW F4ZZ 13032 B 4.82 13 301540 BDY REMOVE/REPLACE L H/LAMP ADJUSTING SCREW F4ZZ 13032 D 5.75 14 301610 BDY REMOVE/REPLACE R PARKLAMP ASSEMBLY F4ZZ 13200 A 66.13 INC 15 900500 BDY* REMOVE/REPLACE HOOD BRA New 45.00 * 0.1 * 16 900500 BDY* REMOVE/REPLACE PAINT OVERSPRAY COVER New 5.00 * 0.2 * 17 936000 ADD'L COST FREON & OIL 45.00 * ESTIMATE RECALL NUMBER: 8/26/2002 09:51:20 05-4789-32601 UttraMate is a Trademark of Mitchell International Mitchell Data Version: AUG_02 A Copyright (C) 1994 - 2002 Mitchell International Page 1 of 3 UttraMate Version: 4.8.011 ALL Rights Reserved Date: 8/26/02 09:51 AM Estimate ID: 05-4789-32601 Estimate Version: 0 Committed Profile ID: *ANTIOCH (PCP) 18 301620 BDY REMOVE/REPLACE L PARKLAMP ASSEMBLY F4ZZ 13201 A 65.77 INC 19 302040 BDY REMOVE/REPLACE HOOD PANEL F6ZZ 16612 BA 551.20 1.2 20 AUTO REF REFINISH HOOD OUTSIDE C 2.7 # 21 AUTO REF REFINISH HOOD UNDERSIDE C 1.4 22 302110 BDY REMOVE/REPLACE HOOD PRIMARY LATCH BRACKET F4ZZ 16707 A 29.82 0.4 # 23 320146 BDY REMOVE/REPLACE HOOD PRIMARY LATCH F42Z 16700 A 32.22 INC 24 302800 MCN REMOVE/REPLACE EVACUATE & RECHARGE AIC -M 1.4 25 302810 MCN REMOVE/REPLACE A/C REFRIGERANT RECOVERY -M 0.3 26 320619 MCH REMOVE/REPLACE AIR GOND CONDENSER -M F7SZ 19712 BA 209.10 0.9 # 27 303450 REF BLEND R FENDER OUTSIDE C 0.8 28 303460 REF BLEND L FENDER OUTSIDE C 0.8 29 300420 BDY REMOVE/INSTALL R FENDER SIDE MLDG 0.3 30 300433 BDY REMOVE/INSTALL L FENDER SIDE MLDG 0.3 31 303690 BDY REMOVE/REPLACE R FENDER ADHESIVE EMBLEM YR3Z 16228 AA 12.20 0.2 32 303700 BDY REMOVE/REPLACE L FENDER ADHESIVE EMBLEM YR3Z 16228 BA 12.20 0.2 33 319902 BDY REMOVE/INSTALL R FENDER ANTENNA BODY AND CABLE Existing 0.4 *# 34 SET BACK 35 936012 ADDIL COST HAZARDOUS WASTE DISPOSAL 2.00 * 36 936014 ADDIL COST FLEX ADDITIVE 5.00 * 37 AUTO REF ADDIL OPR CLEAR COAT 2.3 38 933003 BDY* ADDIL OPR TINT COLOR 0.5 * 39 933005 BDY ADDIL OPR RESTORE CORROSION PROTECTION 2.00 * 0.2 * 40 AUTO ADDIL COST PAINT/MATERIALS 296.80 * * - Judgement Item # - Labor Note Applies C - Included in Clear Coat Caic ESTIMATE RECALL NUMBER: 8/26/2002 09:51:20 05-4789-32601 ULtraMate is a Trademark of Mitchell International Mitchell Data Version: AUG-02 A Copyright (C) 1994 - 2002 Mitchell International Page 2 of 3 ULtraMate Version: 4.8.011 ALL Rights Reserved Date: 8/26/02 09:51 AM Estimate ID: 05-4789-32601 Estimate Version: 0 Committed Profile ID: *ANTIOCH {PCP} Add'L Labor Sublet I. Labor Subtotals Units Rate Amount Amount Totals II. Part Replacement Summary Amount Body 7.1 62.00 2.00 0.00 442.20 Taxable Parts 1,411.25 Refinish 10.6 62.00 0.00 0.00 657.20 Sales Tax @ 8.250'% 116.43 Mechanical 2.6 62.00 0.00 0.00 161.20 Total Replacement Parts Amount 1,527.68 Non-Taxable Labor 1,260.60 Labor Summary 20.3 1,260.60 III. Additional Costs Amount IV. Adjustments Amount Taxable Costs 346.80 Insurance Deductible 1,000.00- Sales Tax @ 8.250% 28.61 Customer Responsibility 1,000.00- Non-Taxable Costs 2.00 Total Additional Costs 377.41 I. Total Labor: 1,260.60 II. Total Replacement Parts: 1,527.68 III. Total Additional Costs: 377.41 Gross Total: 3,165.69 IV. Total Adjustments 1000.00- Net Total: 2,165.69 Inspection Site: RESIDENCE Inspection Date: 8/26/02 REPAIRS TO THIS VEHICLE MAY REQUIRE SPECIFIC WELDING EQUIPMENT AS RECOMMENDED BY THE MANUFACTURER REINSPECTION FAX HOTLINE FOR BODY SHOPS ONLY 925-680-4165 WARNING: Accidental air bag deployment is possible. Personal injury may result. Avoid area near steering wheel and instrument panel even if air bags have deployed. Dual-stage air bag modules may be present that could contain an undeployed stage. When disposing of a deployed duaL-stage air bag, always treat it as a "Live" module. See appropriate MITCHELL(R) AIR BAG SERVICE & REPAIR MANUAL, or OEM information. ESTIMATE RECALL NUMBER: 8/26/2002 09:51:20 05-4789-32601 UltraMate is a Trademark of Mitchell International Mitchell Data Version: AUG-02_A Copyright (C) 1994 - 2002 Mitchell International Page 3 of 3 UltraMate Version: 4.8.011 ALL Rights Reserved . Enterprise Rental Agreement 0897190 - 2332 t rivnt a-car 2580 SYCAMORE DRIVE ascription Rate Amount ■■■r ANTIOCH CA 94509-2909 10 DAYS 21.99 219.9 SALES TAX% 8.25 18.14 Bill To: 690G741OBtl7!l0000iF7777ETt7751 STATE FARM-ROHNERT PARK SVC IST ATTN. TEAM 5— { 6400 STATE FARM DRIVE ROHNERT PARK CA 94926 cc Date Out Date M 7/02/02 7/11/02 Renter Home Phone REYNA VASQUEZZ 925-427-9487 Address Office Phone 217 W 8TH ST 925-427-4401 City State Zip PITTSBURG CA 94565-2401 Driver License State Expires N8590277 CA 3/03/04 DOB 8/03/57 Additional Driver OTA:. CHARGES 238.04 Names ESS AMOUNT RECEIVED 47.61 NO OTHER DRIVER PERMITTED Age Driver License State Expires AMOUNT ME•. . ..... . . . . . . 19Q.4 Calor License No. Claim #/Policy #/P.O. # Billing SILVER 4UMV815 054789325 9 In uiries Call Fed Tax ID # Model Unit # Insured 925-757-0777 36-3041733 02 NEON XG0066 VASQUEZ* REYNA• Billing Information Date of Loss Type of Loss 6/24/02 INSURED Type of cat NEED shop Thank You For Choosing Enter MUSTANG NEED TO GES* g rise�? VISIT US AT OUR WEB SITE WWW.ENTERPRISE.COM CL ■ ■ ■ ■ ■ ■ ■ ■ ■ r ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ ■ Please Return This Portion with Remittance AMOUNT NE. . . .... . . . . . . . jop► 190.43 Remit to: ENTERPRISE RENT A CAR Paid by: ATTIC. ACCTS RECEIVABLE STATE FARM-ROHNERT PARK SVC IST PO BOX. 5666 ATTN. TEAM 5** CONCORD CA 94524-0666 6400 STATE FARM DRIVE ROHNERT PARK CA 94926 Customer# Rental Agreement Amount GPBR 07/12 STF2351 D897190 190.43 2332 -� S z1199 - 77 Claim toe BOARD OF SIIPERVOORS OF CONTRA COSTA COUNTY INSTRUCTIONS TO QA94A1hT 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 perama or to personal property or growing crops and which accrue on or after January 1, 198!1,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 Superv4sors at its office in Room 106, County Administration Building,651 Pine Street,Martinez,CA 94553. C. H 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. L .Fraud. See penalty for fraudulent claims, Penal Code Sec.72 at the end of this form. * * � ,� * ae et � �'rr x ,e * � r * * * * a * * * 1e x.* � � � * � � � * rt * ,t x * * * � * * * � �► �t * * * * � x RE: Claim by Reserved for Clerk's Filing Stamp Aa/_ Against the County of Contra Costa 95-4sao-7" Pa or District) (Fill in Name) The 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: 1. When did the damage or injury occur? (Give exert Date and Hour) =' _ :"----- � - --------------------------- __-_-_-----__-_ 2. Where did the damage or injury occur? (include city*ad county) 3. How did the damage or in jury orcin? (Give unit dete#in use extra •per tf required) ------------------------------------------------'--------------------_-----_________ _ 4. What particular actor omission on the part of county or district officers, servants, or employees caused the Injury or damage? e (Over) ' i S. What are the names of county or district officers,servants,or employees causing the damage or Injury? .............. ------------------------------------- 6. What damages or injuries do you claim resulted? (Give tan*=tent ofinjuridr or da"es clawed. Attach two efmattr for atgAo da�aa�s. T. How was the above Claimed ount computed? (Indude the endo ated amoent of ans+ y praspcti ve Injury or deftoge.) CA- C, L. LCAsem?f--------------------------------------------------------------------------- R. Names and addresses of witnesses,doctors,and hospitals. 9. .List the expenditures you made on account of this accident or injury: TEEM AM(3UA T Gov.Code Sec. 910.2 provides: "The claim must be signed by the claimant SEND NOMES TO: (Attorney) or by some person on his behalf." Name and Address of Attorney (Clai is Signature) a (Address) 0� CN Telephone No. Telephone No NOTICE Section 72 of the Venal Code provides: "Every person who,with intent to defraud,presents for allowance or for payment to any state board or officer,or to any county,city or district board or officer,authorized to allow or pay the same if genuine,any false or fraudulent claim,bill,account,voucher,or writing,Is punishable either by imprisonment in the county jail for a period of not more than one year,by a fine of not exceeding one thousand dollars($1,000),or by both such imprisonment and fine,or by imprisonment In the state prison,by a fine of not exceeding ten thousand dollars(S10,000), or by both such imprisonment and fine. Y F S / r UN MR " /{ FY `{+ f y' F•. / 15 ,c Fffl rFFF,� r!/ �f Wk .lW.�y,,"r! w y � .g F. F a {:Y is p.'� "G " # rF IMP.- Wo. 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F + f;. y, .... . : NX �� \ &\\ § \ VX ------------ CAD � . : ± ±^ / ? % : �\ �} - - .� CLAIM BOARD OF SUPERVISORS OF CONTRA COSTA COUNTY tt BOARD ACTION: Oct 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 _P)V —,,._ Board of Supervisors. (Paragraph IV below), given '` - }s Pursuant to Government Code Section 913 and , � L, 1 915.4. Please note all"Warnings". AMOUNT: Unknown u0U .°y c %SSE CLAIMANT: Wayne&Cathy Simpson ATTORNEY: Sheila Reid DATE RECEIVED: SeRt„23, 2402 ADDRESS: 153 Townsend St#950 BY DELIVERY TO CLERK ON: Sept 23 2002 San Francisco, CA 94147 BY MAIL POSTMARKED: FROM: Cleric of the Board of Supervisors TO: County Counsel Attached is a copy of the above-noted claim. ; JOHN SWE C Dated: Sept 23,.2042 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: y: Deputy County Counsel III. FROM: Clerk ofthe 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 5ntered in its minutes for this date. n> ` Dated f ; r j ' JOHN SWEETEN, CLERK, By � f/ #' � Deputy Clerk .i:l:, 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 Cade 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. Y . -:3 JOHN SWEETEN, CLERK.By f 4 rf{' �' ,s _ Deputy Clerk. THE SCOTT LAW FIRM 153 Townsend Street, Suite 950 San Francisco, California 94107 John Houston Scott Telephone Sheila A. Reid (415)442-5100 Shannon E.Thorne Facsimile (415)442-5108 September 23, 2002 t ': ED Via Hand Delivery SEP 2 3 2002 Clerk of the Board of Supervisors Contra Costa County CLERK BOARD OF SUPERVISORS County Administration Building CONTRA cosrA co. 651 Pine Street, Room t06 Martinez, California 94553 Re: Claim To Board of Supervisors of Contra Costa County by Wayne E. Simpson, Cathy Simpson, and the Estate of Wayne Michael Simpson To Whom It May Concern: This firm represents claimants Wayne E. Simpson, Cathy Simpson, and the Estate of Wayne Michael Simpson and hereby makes this claim against the County of Contra Costa on their behalf. In support of this claim claimants represent as follows: I. Date of damage or injury: March 26, 2002. 2. Where damage or injury occurred: Crestwood Center, 295 Pine Breeze Drive, Angwin, California 94508 Telephone: (707) 965-2461 Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 2 3. How damage or injury occurred: Claimants' decedent Wayne Michael Simpson ("Michael") had a history of mental illness spanning back to his childhood. He had been successfully treated over the years and, although his illness usually required that he live in a controlled psychiatric setting, he enjoyed a relatively quiet and healthy existence. Michael was bright, enjoyed working no matter how menial the task, liked the arts, and showed a talent for writing. He was well liked by his caretakers and peers. In October 2001, while placed in a Contra Costa County group home, Michael suffered a seizure that required hospitalization. To his family's knowledge, it was the first seizure this 46 year-old had experienced. He fell while hospitalized, apparently from another seizure, and required stitches on his head. Michael was again hospitalized in November 2001, this time in the Contra Costa Regional Medical and Psychiatric Center, due to acting out and delusional behavior. He had not exhibited such behavior in years. He was transferred to Heritage Oaks Hospital in Sacramento and remained hospitalized until January 2002. He was once again hospitalized at the Contra Costa Regional Medical and Psychiatric Center from February 14, 2002 to February 25, 2002, following an episode where he was banging his head on his bedroom wall. Claimants are informed and believe that Michael fell additional times and exhibited symptoms of slurred speech, dry mouth and shakiness while at the County Regional Medical facility. Claimants are further informed and believe that Michael's falls, seizures and physical distress to the point of banging his head on the wall were caused by a lethal combinations and dosages of psychotropic medication, which the County failed to diagnose and treat. The County Conservator, William Walker, M.D.,transferred Michael from the County Regional Medical Center to Crestwood Geriatric Treatment Center in Angwin, California on February 25, 2002. Michael's parents were not notified of the transfer, which they objected to, until after it had been accomplished. Crestwood is a private institution for mental disease which contracts with the County to provide inpatient psychiatric care. Crestwood is not a medical facility and was unequipped to care for and treat Michael's serious medical needs. Michael's parents, Claimants Wayne and Cathy Simpson, requested that the County transfer Michael to "The Avenues," a partial-hospitalization program, where Michael had previously resided and had been successfully treated. Although there was space available at The Avenues, the County refused to place Michael there. County employee Gloria Hill lied to Michael's parents that the facility was for forensic patients only. Ms. Hill also advised Mr. and Mrs. Simpson that Michael could not be readmitted to Napa State Hospital, where he had successfully resided and been treated for years, on the same grounds. Mr. and Mrs. Simpson later learned that the County had Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 3 arranged for at least one non-forensic patient to be readmitted to Napa State Hospital from Crestwood during this time period. The County and Crestwood neglected and ignored Michael's obvious symptoms and serious physical side effects from the overmedication, such as the repeated falls, slurred speech, shaking, and dry mouth. Michael continued to experience these symptoms at Crestwood. He was hospitalized at least once during his confinement there after a fall that again required stitches to his head. Claimants are informed and believe that the on-call physician at Crestwood, Dr. Raymond Jennings, discontinued Michael's seizure medication on or around March 20, 2002, and commented to the head of nursing services, Karen Cortese-Duenas,that Michael "was on too many meds anyway." On March 26, 2002, Michael was found dead in his bed at Crestwood. Claimants are informed and believe that Michael fell at least three times the night he died. Although Crestwood mental health worker Clarence Howell claims he checked decedent every half hour during the night, Michael was discovered at 7:15 a.m. in an advanced state of rigor mortis. The coroner was not contacted until three hours later. The autopsy toxicology examination revealed blood serum levels of Quetiapine at 2400 nanog/mL and Clozapine at 2200 nanog/mL, well above the lethal limit. The coroner declared the cause of death to be "polypharmacy overdose (Quetiapine & Clozapine)." 4. Acts or omissions on the part of the County or district officers, servants, or employees which caused the injury or damage. The County, its officers, servants or employees failed to perform their mandatory duty to provide appropriate and adequate medical care and treatment to Wayne Michael Simpson while in their custody and care, including but not limited to their duties mandated by Govt. Code § 855.4 to use due care in the provision of medical services; Govt. Code § 855(a)to provide adequate or sufficient medical equipment, personnel or facilities; Govt. Code §855.8 to use due care in prescribing for mental illness and in administering treatment prescribed for mental illness; § 856 for negligent acts and omissions in carrying out the conditions of confinement for mental illness; and Welf. & Inst. Code §§ 15600 et seq. to provide medical care for the physical and mental health needs of a dependent adult. Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 4 Said acts and omissions furthermore violated Claimants' rights protected by the Fourteenth Amendment to the Constitution of the United, including but not limited to rights to a safe and humane custodial environment, the right to adequate medical and treatment in a custodial environment, and the right to familial association. 5. Names of the county or district officers, servants, or employees causing the damage or injury. Persons whom Claimants are presently aware caused the damage and injury are: Dr.Nathan Thurma 999 Adams Street#300D Saint Helena, CA 94574 Raymond Jennings, M.D. 415 C Talmage Road Ukiah, CA 9482-5953 Stephanie Find Acting Program Director Crestwood Center Clarence Howell Mental Health Worker Crestwood Center Gloria Hill Contra Costa County Mental Health 1340 Arnold Drive, Suite 200 Martinez, CA 94553 Dr. William Walker Contra Costa County Health Services Director 20 Arnold Drive Martinez, CA 94553 Clerk of the Board of Supervisors Contra Costa County September 23, 2402 Page 5 6. Damage or injury claimant claims resulted from the above described acts or omissions: Wayne Michael Simpson suffered excruciating pain, physical injury and trauma, emotional distress, and death as a result of the above described acts and omissions. Wayne E. Simpson and Cathy Simpson suffered emotional pain, anguish and distress, and loss of the love, society, comfort and affection of their son. They also incurred out-of-pocket funeral, burial, and travel and related expenses. 7. How the amount claimed above was computed: This will not be a limited civil case. 8. Names and addresses of witnesses, doctors and hospitals: Stephanie Find Acting Program Director Crestwood Center 296 Pine Breeze Drive Angwin, California 94508 (707) 965-2461, Ext. 11 Dan Del Florentino Mental Health Worker Crestwood Center Michael Barton Mental Health Worker Crestwood Center Barbara Findsen, LVN Medical Records Supervisor Crestwood Center Pat Roe, LPT Crestwood Center Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 6 Clarence Howell Mental Health Worker Crestwood Center Jay Jones, Coroner's Deputy Napa County Sheriff's Department 1125 Third Street Napa, California 94559 (707) 253-4256 Louis E. Dougherty, MD Forensic Pathologist Office of the Coroner of Napa County Lubornyr Kyrwonis Patient Crestwood Center Robert A. Middleberg, Ph.D, DABFT, DABCC National Medical Services Forensic Toxicologist 370 Walsh Road, Willow Grove, PA 19099 Telephone: (800) 522-6671 Raymond Jennings, M.D. 415 C Talmage Road Ukiah, CA 95482.5953 Dr. Roy Kaplan Mount Diablo Hospital 1400 Treat Boulevard Walnut Creek, CA 94596 Dr.Nathan Thurma 999 Adams Street 4300D Saint Helena, CA 94574 Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 7 Gloria Hill Contra Costa county Mental Health 1340 Arnold Drive, Suite 200 Martinez, CA 94553 Karen Cortese-Duena, RN Crestwood Center Ramon A. Garcia, MD 4300 Auburn Boulevard#202 Sacramento, CA 95841-4103 Dr. William Walker Contra Costa County Health Services Director 20 Arnold Drive Martinez, CA 94553 Elmer Taglorin Case Manager Contra Costa County Health Services Mental Health Division 1420 Willow Pass Road Concord, CA 94520 (925) 646-3220 Joyce Fults, RN Contra Costa County Health Services Mental Health Division 1340 Arnold Drive Martinez, CA 94553 Rebecca Lapasa, Mgr. Oak Hills Residential Facility 143 Green Meadow Circle Pittsburg, CA 94565 Clerk of the Board of Supervisors Contra Costa County September 23, 2002 Page 8 9. Expenditures made on account of the injury: See Mos. C and 7 above. Send notices to: John Houston Scott Sheila A. Reid The Scott Law Firm 153 Townsend Street, Suite 950 San Francisco, California 94107 Telephone: (415) 442-5100 Facsimile: (415) 442-5108 Sincerely, THE SCOTT LAW FIRM SHEILA A. REID JSAR cc: Wayne E. & Cathy Simpson