HomeMy WebLinkAboutMINUTES - 01282003 - C11 CLAIMBOARD
BOARD A IO t iANtiARY 2$ , 20,03
Chain Against tqe County, or District Governed by
the Board fSi:pervisors, booting ndorse .eras, NOTI ILAIMA��
and Board Action. All Section references are to ) The copy of this document mailed to you is your
al forr ia GoveMinent bodes. notice of the action Waken on your claim by the
Board of Supervisors. (Paragraph IV below), given
Pursuant to Government Code Section 913 and
t r r
915A. Please note all "Warnings". -
AMOUNT: $]_, 152 . _5!,7
CLAIMANT: TSCHUM EOYMIN
A117 3RNY. UNKNOWN DATE XIECEI`V D. DECIEMBER 23 , 2002
ADD SS 6309 HIL1.MONT DRIVE BY LIVRY TO CLERKON. DECEMBER 23 , 2002
AKLAND, CA 9460
Y MAIL P ST Ali Dw DECEMBER 20, 2002
FROM- Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
JOHN SAFEi N�
DECEMBER 23, 2002 Deputy
Deou � �����
11. FROM: o my Counsel TOClerk of the Board of SEapery sors
« `n bs claim complies substantially with Sections 910 and 9 z 0.2.
Ibis Claire FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimahnt. 'rhe
Board coot act for 15 days (Section 91 0.8),
< Claire is not timely filed. The Clerk, should rete clam,on ground that it was filed late and send yarning of
c lairriant's right to apply for leave to present a late claim(Section 911.3),
}
Other-
Dated: r. � ; ��_' � y; �' r 1.14/,; cYr � — 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).
I , BOARD ORDER: y unanimous vote of the Supervisors present;
( `phis ,;la;rn 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:
JANUARY 28, 200; JO " S` FETE , CLERK, By 6 v �� .� � v,<� p Deputy Clerk
.A. "" I (Gov. code sedtion 913)
Subject to certain exceptions, you have only six(5) months from the date this notice was personally set'ved or deposited
in the mail to file a coa rt action on this clam. See Gove"mment Code Section 945.6. You may seek the advice of an
attorney of you-?- choice in connection with this utter. T-you want to consult an attorney, you.should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILINiG
I declare gander penalty of perjury that I am now, and at all times herein mentioned, have been a citizen: of the finite
Status, over age 18; and that today I deposited in the United States Postai Service in Martinez, Califomia,postage (ally
prepaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
4:
Dated: A 2 2003 JOHNS JEETE ,CLERK By Deputy:��� � � A = - Deputy Clerk
m��—
CLAIM
TY
BOARD ACTION: 'JANUARY 28 , 2003
Claim against the Countyr, or District Governed by
the Board of Supervisors, Routing Endorsements, NOTICE TO CLALVLAINT
and Board Action. All Section references are to The espy of this document-ailed to you is your
California Government Codes. notice of tthe action taken on your claim bythe
Board of Supervisors. (Paragraph IST below), given.
Pursuant to Goveniment Code Section:913 and
915.4. Please note all"Warnings".
,L&ITMA-,SLT: ` 'SC UM BOYKIL
ATTORNEY: UNKNOWN DATERECEIVED: DE, %CMBER 23 02
ADDRESS: 6809 HILLMONT DRIVE BY DELIVERY TO CT E O DECEMBER 23 . 2002
OAK-LAND, C"A 94605
IT DECEMBER 20, 2002
BY MAI�POSTMARKED:
FROM: Clerk of the Board of Supervisors T . County Counsel
Attached is a copy of the above-noted claire.
JOHN SWEETEN, Cler
Dated: - DECEMBER 23, 2002 ByDeputy. n t.. �..
H. FROM: County Cvansel TO; Clerk of the Board of Supervisors
This claire, complies substantially wide Sections 910 and 910.2.
This Claire 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 rets clam on ground that it was filed late and send warning of
claimant's right to apply for leave to present a late clam.(Section 91193).
Oth en
Dated: By: deputy County Counsel
IT-1. FROM: C,lerk of the Board TO: County Counsel(1) County Adrninistrator(2)
( ) Claim was reramed as untimely with notice to claimant(Section 911 3). --
IV. BOA ORDER.. By unanimous vote of the Supervisors present:
f This Claire is rejected ir:fill.
ether;
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this elate.
Dated. - -- JOHN S` E T N, CLERK, By _ , Deputy Teak
- AR,.'� (Gov. code sectio:9l3) - -
;abject to certain.exceptions, you have only six (6)months from the date this n�esticU was personally served or deposited
n the snail to file a court action or,this claim. See Government Code Section 945.6. You may seek the advice of an
kttorriiey of your choice in connection with this matter. E you want to consult an attorney, yoa should do so
mm,ediately. *For additional Warning See Reverse Side of This Notice,AFFIDAVIT I All LNG
declare under penalty of perjury that b arm now, and at all times herein mentioned, have been a citizen of the United
',bates, over age 1&; and that today I deposited in the`'united States Postal Service in Martinez,California,postage filly
.repaid a certified.copy of this Board Order and Notice to laimant, addressed to the c ai�tarrt shown above.
Ike ut clerk
dated: JSWEET
ENT, CLERK By _ p- y ----
Cl i to: BARD OF SUPERVISORS VF CONIM MSTA , "
N=U117-11ONS TO CLAiNkVr
A. Claims relating to causes of action for death or for injury y to person o5 to per-
sonal
er-
so l property or growing crops and which accrue on or before December 31., 1987,
mast be presented not later than the 100th day after the accrual of the cakes of
action. Claims relating to causes of action for°.death or for injury person
or to personal property or mowing crops and which ac=e o� or after -Jae" 1,
19881 most 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 actio. "Govt. Code §90.2.)
B. Clams most be filed with the Clezrk of the Board of Supervisors at its office in
Rocm 106t County Administration Building, 651 Pine Stmt, Martinez, A 4553
C. if claim is against a district governed by the Board of Supervisors, rather than
the County, the naRn of Qe 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. - gaud. See penalty far fraudulent claims, Perms. Code Sec. 72 at the end of this
form-
RE:
o -PEm Clain By Reserved for Clerk's filing stamp
in thef atm Cis DEC
CL R I ;
TA
District)
M11 in name)
At undersigned claimant hereby makes claiminst the Nunty of Contra Cost, or
.. I . 1 - and in support of
the above-named District in the sum of r
this claim represents as fol:!ogs r
l$ When did the or injury occur? :
W:iat are the names of county or district officers, servants or employees causing
the darage or injury?
e °sat damage or injuries do yo claim resulted? (Give Pull extent of inj,=ies or
d es claimed. Attach tip estimatestfor facto damage. 6)v'k�
s :a,a ai.a'"`"= ;4 �es-2 tWy,..+'..,. +� Z,,,Fi..?.1 aos%v�..,¢e%d'4_soe':+ J Gh.-:
7. Hose was the amount, --laimed above computed? (include the estimated amount of a-ny
prospective injury or e.)
C
&
8e mN es and addresses of witnesses, doctors and hospitals.
® List.�the�e endz t s you made on account of this accident or injury..
DATE ITEM AMOUNT
. V
Gov'. "ode Sec. 91M r ovIdes a
�Ine claim zust be signed by the cla.i t
SEND NOT?' TO: (Attorney or.bX. some person on his. 'beh if.11
dame and. Address of Attorney
C3ait's i' tu
rt Address
s
Telephone No. TeIeDhone No.
NOTICE
Section 72 of the Penal Code provides:
"Every person who, with intent to def-aud, 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 e if genuine, any false or fraudulent
clam, bill, account, voucher, or writing, is puni.s`t ble either by impr�iso nt in
the county flail for a period of not more the orae ye r, by a fine of not exceeding
one thousand '1 d ,000), or by both su&, imOrisonment and fine 8'. or by impr°i.son n t in
the state prison, by a fine of not exceeding ten thotmand dollars ($10,000, or by
both such imprisonment- and fine.
........................................................................................................................................................................................................................................................................................................................
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#.Uric"{rt" >�4•:. � �'ti� 5 �� 3v.' R�}��� ,.>sYy,2,% 2�� '}?A .'.iN5.
1551 Concord Ave,
Concord, CA S4520
(1 25)... .... 2
Repair order A 50161511
Date Printed 12; 00,
6809 RILLMOUNT DR Date in 12/ 3/01f
Proolied 121
Mesa Phann 510-130-150
t'.:....n:.,s3s .+t1.>.., ........ if!�2 .....112 &VU
55XRISOO RED jBIST74022106528
.... .....w...,.. ._ .:.......,
t ESTIMATE
y'
54 u.v.. <:O .P A y e +:Via.. Eli sit,
0126E-25061 El 2SX52XI5 BENIN.,
job sobtotal
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STORE HOURS TUESDAY-FRIDAY 9,00-5:30 SATURDAY Before YWi i{. Total t !h
.�..... :. .,,t,:. ., .. REPAIR ARDO ....9212.4-c. Sales Tag 5& r..:.
R Repair Grow Total
AGREE TO ALL OF THE ABOVE CHARGES,
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CLAIM
BOARD OF SUPERVISORS OF CONTRA C0jTA COUNTY
BOARD ACTIONN, JANUARY 2a, 2003
Claim Against the County, or District Governed by
the Board of Sui�?rvisors, Routing Endorsements, NOTICE TO CLAIMANT
and Board Act-ion. All Section references are to The copy of this document mailed to you is your
California Governm ent Codes. notice of the action taken on your claim by the
Board of Supervisors. (Paragraph IV bellow), giver.
Pursuant to Government Code Section 913 and
915.4. Please note all"Warnings".
J,A.
AMO-UT-NT: UNKNOWN
WALSTETN BLAS
CLAIMAN'T:
A
ATTORNEY:MICHAEL F. WOHLSTADTER DATE RECEIVED, DECEMBER 23 , 2002
488 SEVENTH STREET, T DECEMBER 23, 2002
ADDRESS: OAKLAND, CA 94607 BY DELIVERY TO CLERK ON:
RECE T VED THROUGH
BY MAIL POSTMARKED:
FROM: Clerk of the Board of Supervisors TO: County Counsel
Attached is a copy of the above-noted claim.
DECEMBER 23, 2002 JOHN SWEETEN, Qjl�
Dated: By: Deputy_--- ../t�-
H. FROM: County Counsel. TO: Clerk of the Board of Supervisors
his claim cornplies substantially with Sections 910 and 9101.
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'Mave to present a late claim(Section 911.3).
Other:
Dated: By: 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 9113). .
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
This Claim.is rejected.i in fiili.
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 SA TO, CLERK, By gly Deputy Clerk
e.a. JkNUARY 28, 2003
(Gov. code sectiofi 913)
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in fine 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. T-F you want to consult Pan attorney, you should do so
immediately. *For Additional Warning See Reverse Side of This Notice.
AFFIDAVIT OF MAILING
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 Ulnited States Posta'. 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: JANUARY 29, 2003 JOHN SWEETE N, CLERK By, DeDu Clerk
ty
MICHAEL F. WOHLSTADTER
Attorney at Law f r.
466 Seventh Street
Oakland, CA 94667 � € .� .� <� �•€
Tel. taloa 619/6398161
Fax. No. 510/639-4269
December 165 2902
1 It.
Clerk c #
Contra Costa Board of Supervisors
3 ifikc�5 Y
651 Pine Street
Martinez, CA 94553
Re Claim of Waltsteira Blanton
Dear Clerk:
Enclosed is an original and espy of the CLAIM OF WALTSTEIN
BLA TON. Please notate the copy with receipt of the claim by the Board, and
return the copy to u (preaddre sed return envelope is enclosed). Thank you.
Vern]trdly yp r ,
„
Mark Mapdel
Office of` icha l Wohistadtler
MICHAEL F. WOHLSTADTER
Attorney at Law
488 Seventh Street
Oakland, CA 94607
Tel. No. (510) 839-1612
Fax No. (510) 839-4250
Attorney for Claimant
CLAIM M FOR DAMAGES AGAINST CKUWTY u1' CONTRACCSTA
1. Name and Address of Claimant .
Wh tstein 73719757, 546-IS-1890) , 2220 Oak Rill
Circle, #37, Pittsburg, CA 94565.
2 . Name and Address of Person to whom Notices are to be sent .
M! ae F. i+,acs eta tee°, 488 Seventh Street, Oaf ane , CA
946079 telephone no. 510/639-I612.
3 . Date, Di ace and circumstances of occurrence giving rise to
claim. At the east County Jail on 7/14/2002, clamant was
subject to unnecessary force 11, county sheriff's personnel
when claimant was placed in solitary confinement. Claimant's
left arra was brought behind his back, injuring or aggravating
a prior injury to the left shoulder and arm.
4 . De:scrition of injuries sustained.
Irl ury of IeFt s ou! er an- arm
5 . Nares of nub ig E'mplo ees Cc,.11sing damaaes it occurrence,
.
Wknomn at this time. A disciplinary report 0 .oe l eyed to
have been prepared lar authorities in connection with the
incident.
6 . Amount claimed as of date of Dresentatjc n _claim,
clai , �oc€et�er
_d
with basis of camDutation.
C�a mant
fle-c—el- ed medical attention at the Pittsburg C nic
in and about September 20102 when he was released from
custody. Claimant claims special damages of medical expenses
and wage loss, and general damages for pain and suffering, in
an amount W"ithin the general jurisdictio of the Superior
Court.
�f
Dated: December 18, 2002 # f�
d;
MI CHST'AD`I`ER
PROOF OF SERVICE
In re Claim of Walstain Blanton
The undersigned declares that he is over the age of eighteen, not
a party to the within action, a citizen of the united States and
employed at 463 Seventh Street, Oakland, California 94607 . That
on December 18, 2002 the undersigned served true copies of
Claim of Wa ti tsstein Blanton
on the parties by _ XXX First class Nail in a sealed envelope,
postage Prepaid, return receipt requested, deposited with the
United Mates Post Office in Oakland, California., addressed as
follows, or XXX personal delivery to the address set forth below:
County of Contra. Costa
Clerk of the Board of Supervisors
651 Pine Street
Martinez, CA 94553
I declare :ender penalty of perjury that the foregoing is true
and correct and that this declaration was executed in Oakland,
California on December 18, 2002 .
MARK W. MANDEL
Attorney at Law
488 Seventh St-eet
Oak]-and, CA 94607
Lel . No< i51v; 839-1612
Fax No, (5101) 839-4250
Attorney for Claimant
CLAIM FOR DAM-GES AGAINST COUNTY OF CONTRA CCS TA
Name and address of Claimant .
Wa tstain Blanton (571-9757, 546-15-13-90) , 2220 Oak Hall
Circle, 37, Pittsburg, CA 94565.
2 . Name and Address of Person to whom Notices are to be sent .
X4 0 sae , T�3o sta- ter, 488 Seventh Street, Oa �a r CA
94607; telephone no. 5101839-1612.
3 . Date, 'Mace and c-roust—ances of occurrence ��V T '� se to
cl a�M. At- the West County Jail on 7/14/2002, claimant was
,subject to unnecessary force by county sheriff's personnel
whe-12 claimant was placed in ,solitary confinement. Claimants
loft arrm was brought behind his back, Injuring or aggravat��zg
a prior injury to the left shoulder and arm.
4 . Descri titin of injuries sustained.
y ury o �t
shoulder and arm,
Names of ublic emDlo ees causia c, da na es in occurrence.
Unknown at t_ is tzi.r.ea A disciplanary report is el eyed to
have been prepared by authorities in cc=ect�oz2 with the
nci den t
6 . Amount- claimer as of ruts of vresent-at9 on of claim, together
with basis 0-IP co T4 =ration.
i
C_aimant receve mea;lca7 attention at 'Che Pittsburg Clinic
in and about Septe-mber 2002 when he was -released from
custody. Claimant claims special damages of medical expenses
and wage loss, and general damages for pain and suffering, in
an amount within the general jurisdiction of the Superior
Court.
Dammed: Dece: er k8, 2002 �r, ;
PROOF OF SERVICE
in re Claim of Walatein Blanton
T � declares that he is over the age of eighteen, not
The undersigned
a party to the within action, a citizen of the United States and
employed at 488 Seventh Street, Oakland, California. 94607 . That.
on Dece7her 18, 2002 the undersigned served true copies of
Claim of Waltstein Blanton
on the parties by XXXX first clam mail in a seamed envelope,
postage prepaid, return receipt requested, deposited with the
United. Staves Post Office in Oakland, California, addressed as
follows, or XXX personal delivery to the address set forth below:
County of Contra Costa
Clerk of the Board of Supervisors
651 Pine Street
Martinez, CA 94558
i declare under penalty of perjury that the foregoing is true
and correct and that this declaratiqn was executed in Oakland,
California on December 18, 2002 . en
AY
r
MARK W. MANDEL
CLAIM
7 T �
� `S S S_OF COQ'- COSTA QT Y
BOAP,D ArTTO !JA rARY__2S , 2003
Claims against the Courity, or District Governed by
the Board of Supervisors, Routing Endorsements, ) NOTICE TO CTAI ANIT
and..Board Action. All Section references are to ; g��copy of this doc�i lent mailed to you is your
California Goveirim ent Codes, r r 1: -w.., notice of tie action taken on your slain:by the
1 Board of Supervisors, (Paragraph IV below), giver,
r. Pursuant to Government Code Section 913 and
915.x. Please note all "Warnings".
A M0TJ`NT: $2 ,000 ,000 .
EENDCI:YN ZMARSHA L -DARR€ W, CAVIL DARRCW
IOI : TERRY liLER DATE RECEIVED: DECEMBER 2 , 2002
ADDRESS, 1.418 LAKESIDE DRIVE BY DE WERY TO CLLR ON: _LECzi 2
OAKLAND, CA 94612
BY.MAILPOSTMARKED- By
PnTAM nARRQW AT
FROM: Clerk of the Board of Supervisors TO: County Counsel 1 :07 psi
Attached is a copy of the above-noted claim,
JOIE S1I ' ,
Dated, DECEMBER24 . 2002 � y: Deputy
II. FROM: County Counsel TO: Clerk of the Board of SureX v ors
(-,This clam.m complies sui"b tantially with Sections 910 and 91 .2.
This Claim.FAILS to comply substantially with Sections 910 and 910.2, and we are so notifying claimant. The
oarrd, cannot act for 15 days (Section 910.8).
i Claim is not timely filed.. The Clerk should return claim on ground that it was filed mate and send warning of
clairnant's right to apply for leave to present a late claim(Section 911.3).
Other:
Dated. �., y Y 4 -r X, Deputy County Counsel
III. FROM: Clerk of the Board TO: County Counsel (1) County Administrator(2;
Claim was returned as smtirnely with notice to c aimant(Section 911.3').
IV, BOARD ORDER.: By unaninious vote of the Supervisors present:
( ) This Clam is rejected in Xll.
Other:
I certi y thaw this is a true and correct copy of the ward's Order entered in its minutes for this date,
teAy 28, 203OH'.,N* SWEETEN, CLEC B �� Deputy Clerk
ARF C (Gov. code section 913),
Subject to certain exceptions, you have only six (5) months from the date this notice was personally served or deposited
in the snail to fi.e a const action or.this cla rri, See Government Code Section 945,6. You may seek the advice Zan
attorney of your choice in connection with this matter. If you want to consult an attorney, you should do so
imr-media *For Additional Wing SReverse Side of This Notice.
a _tely. onaWarning See APPI:DAVIT OF MAILING
I declare cinder penalty of perJury that I ars':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 Mazttinez, California,postage fLdly
prepaid a certified copy of fiis Board Order and Notice to Claimant, addressed to the claimant as shown above.
JANUARY 29, 2003 � � , �y� �
Dated. �O�SWEETEN, C.��� ,� _. - .�,..W.- Deputy Clerk
CuAI��AQA?.�,.�_wCv;_T��� ? �rFU'4"L�
----
CLAIMANTS ' NAMESADDRESSES
Florence Marshall-Darrow, Zachary arsYaa l-'Darznz .�
3501 SrT., a ? f . � ._ CA. 9331Y7
Gavin Darrow, 1091 Olde Bridge Rd. Colfax 95713
ATTORNEY FOR CLAIMANIT, TERRY D. BULLER
Professional Corporation
1418 Lakeside Orive
Oakland, CA 94622
(510 , 83r -4295
DATE OF OCCURRENCEt june 26, 2002
LACE OF OCCURRENCE: Contra Costa. County Hosp to_i_
SAID CLAIM AROSE FROM THE FO!2OWING CIRCUMSTANCES :
t:,...t3i:.I;?ants , decedent, Roysel Marshall-Darrow, was attacked �"i"" `�
cx
killed by a patient , lana M1 tCi.eli, who had been negligently gently 2.va _uated,
treated and a aleas'e ' by 3":e ical per5onn v'd- at -Contra Costa Hospital an
YJr Y u coccasions . Lamar Mitchell was a danger to others Chet _ _ as
released '"T'.✓rl r.:Cs''. .C.0 ,.xat, medical facility a"iC`.}E this l;r.:;: ;CI"tGv,7n o.
:i:eas .Cli b_.y should have e "be 1.5. ;known l_.3 tQ county employees at the time o
3
e'�:�c'
_.,
his release.�. , TA1e treatment ,_:.',..'"t?a:: MAdhell received wcd inadequate
.
_
�?.andthe sO'�'+.I,C.,ci.., staff was t`aY'el>...sci and ilk!-Y.Ligf-.'ni:. in its t7':jJt.::'tei: . of
(r. Mitchell pro} ii- L.e 7y causing the death a %d the injuries sustained L
y
Roysel Marshall-Darrow and the damages to claimants herein.
ITEMS, NATURE AND EXTENT OF DP_VKAGES OR !NJURIES:
As :l result of the wrongful death of Roysel Marshall-Darrow,
claimants have sustained emotional disturbance and shock and creat:
physical ical a acs. mental pain and suffering; they have been deprived of the
sC:+.defy, love, comfort, protection, services, and support, of said
decedent; and further`__e have paid ani/or incurred funeral a.i"1d burial
expenses as VJE`ll as rina Z,- hospital expenses in an amount not known at
this
t
is time.
AN00UNT Off, CLAIMP TWO MILLION DOLLARS
jURISDICTIOr` OVER THIS CLAIM RESTS IIS THE SUPERIOR COURT OF THE STATE OF
CALIFORNIA.
DATED: December_ 24, 2002 Professional
}} � TER^RvY D. BULLER
Corporation
Attorney for Claimants
CLQ � ABOARD OF SUPERVISORS OF CQ�4LTRA COSTA COUNTY
130ARD ACTION-JANUARY 281 2003
Claim Against the County, or District Governed by
the Board of Supervisors,pouting Endorsements, NOTICE TO CLAIMANT
and Board Action. All Section references are to
The copy of this docuent railed to you is your
California Government Codes. notice of the action taken on your claire by the
%> Board of Supervisors. (Paragraph IV below), given
.. Pursuant to Govern
bode Section 13 and
15.4. Please note all "Warnings".
AMO TINT, $320- 76
CLAI ANYTo A :F RED H. TR 1 SDEl,Z
A'PTOKNI Y: UNKNOWN DA'T'E RECEIVED: DECEMBER 24, 2002
ADDRESS: 363 Pu3 'DELIVERY°IL , IR 24` 22
OR?�NDA, A 94563 �DECEMBER �
MAILPOSTMARKED: DECEMBER 23, 2002
FROM: Clerk of the Board of Supervisors TO, County Counsel -
Attached is a copy of the above-noted clam..
��� MFs�R 24 2C3�2 JOHN S`�EE'IT�', l
Dated: y; Deputy.
II. Pl counsel TO: clerk of the hoard of Sxpervis rs
O-This claire complies substantially with Sections 910 and.910.2.
This Clain.
cFAILS to cornply substantially with Sections 910 and 10,2, and we are so notifying claimant. The
Board cannot act for 15 days (Section.910,8).
Claim isnot timely filed. The Clerk should return claim on ground that it was filed late and send warning of
ciailmant's right to apply for leave to present a late claire(Section 911.3).
Other:
z.
D � �` f � � I� > �o�nty Counsel
Mateo. y i t % r✓
III, FROM: Clerk of the Board TO: County Counsel (1) Col mi ty.A.dministrator(2)
Claim was returned as u-itimely with notice to claimant(Section 911.3).
IV. BOARD ORDER., 13y unaninious vote of the Supervisors present:
This Chore 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. JAN--aR�? 28, 2003 JOHN SWEETEN, CLEC 1� /��>xi;--,�" r°,z,
b a., , s y �` '`_ , Deputy clerk
WARN'IN (Gov, code section 013)
Subject to certain exceptions, you have only six (6)rnonths from the date this notice was personally sued or deposited
1111 e mail to ale a court action on this cla m, 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 I AILS-N- 3
I declare under penalty of perjury ry that I am now, and at all tunes herein mentioned, have beer., a citizen of the u=nited
States, over age 18; and that today I deposit 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 alcove.
neputy Cl
ated: jANN LRY 29, 2003 JOHN SWEETHN, CLE B
'' Clerk
NO REFUNDS ON DEPOSITS
OR SPECIAL ORDERS
E.. NA"1ONAL CUSTOMER SEWCE
P1HCE#600 321-2446
CUSTOMER MUST PRESENT COPY
`U::,:51 Cr '•N+9=E FOR ANY VURRANTY
,x•:31:- '"'{ �`#`:< Ia:. l ,..t3
BL,V"
94549
°
121116,146E 12/18/02 j,....
C". .�1
Mil 1p. 170,60 t: 1t
ViL iii,&
1I)a A'B209330
CAL-0000060 .:86
1 part # QTY Description Peru Labm F "o ,1
_...� . ._.._. _.. ..........__.............n.. ......_,.
X849 1.001, 1' 15 H IGE 4 PLUS 88 121Q55 121.51
12 ZFWT 1$98 FM FFE FOR TIREB11 1.08 e x L
12 ZDISPT jj3o 1i1QSAL FEE IFOR TIRB 0A 2.W 0.00 2x
12 `1I P Rs"� ;EL11kE a I STALL 08 1 '.
v x � I � .; C . M 14 M ST �< ELAS`
hw
air C- TIRESNO 3
3323 A -T DI,9L3 SLVD
AAtTTa CA 9049
5252�322v�
Sale
3�ca
custoo.ea copy
THANK YOU
C% j;ii°3 £,' i.. 5e 'g't:{ Chci21€2. 5:1
1.4' .62
4CK,N0WLEO JE 2 O Y`E A,*a ORAL APPPO4A"s.OF ANY INCREASE N TME CRt G:NAL ESTIMATED PRICE: X
EMSE 'Nr-T :. PROX. T.S'r�L.E.,r`S MONYY;�1 P�E��`ASE SPECIFdw PAST DU CL4ARGE 1S COMPUTED BY A TERMS ACKNOWLEDGED&RECEIVE[)By
'ERWZ RA`# 1H'i PER -t GPs UMPAiY7�+.A:A@ shWCH 2S V AA#`dUAL PERCFNTAG=RATE
F 45Th s NECEW'-
A Y T'O';NST,-Pq*`TE LES4L AC`101.1 TO ENFORCE COLLEC7ON'OF 1 HE AMO+tiT DUE
�flER YMI�1., E,BIKER AGRtES TO PAY AU-NEeCE,s ARY COSTS AND ATTORNE—S FEES. �
TIRF.q WHFFLSBRAKES SHOCKS STRUTS ALIGNMENT
a Now
Invoice
1AM%1M# M1= M W11EM- EL
"Stock WheelsOnly"
771 Coleman Ave.
SAN JOSE, CALIFORNIA 95119
PHONE (493) 275-1218
FAX (493) 275-1499
CARD 23191 /2/1812902
ALFRED H TRUESD L L
Type of Sale
A A 00 M/
X5558 ALLOY 1 $ 35,09 $135,€
k
Subtotal $135299 {
TYPO Of Sale Taxable$11.14
Acceptance subject to 10% per day restocking Weight 9 lbs.
fee on all returns. ShIPP1119 Fee
i
COD Fee
fee,
'�7 Invoice Tota $146.14
12/18/2002
'lyY irl�' •.il . , i1 i {.4�8 CSS�1J. $$$$$$�p
k) :_i h,=J;.'. 8€V
c t s
tt r-
MIDAS SAN PABLO
71, 14W SAID PAPLC3 AVE PAGE 1
t ��g qQ I�
GBdMg2;'TyeAyytgq4W ppb� EWCAL. 76
,v SAN PA O,qC�A
Customer ED. 1225006105 Year. 85 DOW: 42115/022
Name., ALFRED T UESDELLMake: PEUGEOT Time: 15:16:15
Address: DOSPCSCS M : 505 Estimate#: 31271
Address 2: Lic : 3NXC791 In #: 137897
C`1},S e,ZWP taI Com: SAT PABLC,CA,948M VIN: PO Number-,
Plc 'phone: )e COIN-: Small Addr :
Wok Phone: ()- Er4nw- ANY Fl i le: N
Other Phone: ?> In: 17'-A-M
Weep Out: 17
Commems:whi e w e Vraf?I we nom :
e +€€ # Loc 1 o2 List Labor TOW
MISCELLANEOUS
1 MI LABOR MOUNT SPARE 0.00 25.00 25.00
TOTAL MISCELLANEOUS: 25.00
Caste°Mshes To Discard Old Parts R�
14640 SAN P A E L G A..0:
SAN PAS-Ga CA 94806:244
51 -236-5539
4341/322135274575
r
b�. 43e.322`352'457d
'ERt"INAL NUMBER; 02
A 141
12/ 16/04 X �S3a
4 1 S.�^,
XXXXXXXXXXXX3652
Exp: 06/05
Au h Bode:063444 Ba:392
044
;s
r { 165 e�;
:HANK YOU
PLs�SE COME
PAY AMOUNT PARTS TOTAL 0.00 RAbrbRAb......FbtrFbRh-0AAAA
MC/VIS 25.00 SAILES TAX 0. -SPE C I A L.Abb
LABOR TOTAL 25.00 COMPLETE
TECH:00DO44 J.NEWCOMER GRAND TOTAL 25.00
BRAKE
INSPECTION
AAFbtrFAFtrFAARFFtrA-0FF-0F-0tr-0b
Claim to: BCAYD OF SUPERVISORS OF CONTRA COS COJUUNT7.
iNSTRUC TIONS TO OLAL�`
A. Claims relating to causes of action for death or for injury to Wson or to per-
sonal property or growing crops and which accrae on or before December 31, 1987,
must be presented not later than the 100th day after the accrual of the cause of
action. Claims relating Q causes of action for -death or for In�ury to Person
or to psTscral property or growing cutups and uhich accrue on cc after january 1,
1988, am be presented not later thin six months after the accrual of the cause
of action. Claims relating to any other cause of action must be- pr-esented not
later than one year after the accrual of the cause of action. (rGovt. Code 5911.2. )
B. Claims must be filed with the Clerk of the Board of Supe-rvisors at its ,office in
Room 106, County Ministration Building, 651 We Street, Fartinez, CA 94553.
C. if claim is against a district governed by the Board of Sapervisorn rather than
the County, the nano 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 claival Penal, Code Sec. 72 at the end of this
form
RE: Maim By Peserved fora Clerk's filing stamp
A14ePxA
RECE]VE,D
136 Des i (AIIAIC
Against the County of Can costa _0 DEG 2 4 2002
or
C,LEF,.K
District) P
The Lmdersi=_ ed clay hAreby takes claim in t the County of Contra Costa or
the above-named District in the sun of 4,, - and in support of
this claim represents -as follows%
1. Wher. -did the damage or iplury occur? (Give exact date and hour)
0 0, 0-r, 2, i -3 0
20 there did the damage or injany caour? (include city aid a unt
00,
3. How did the damage or injury occur? (Give full details; use extra paper if
required) f
5" junk) ek,KXA
4. What particular act oramission. on the Dart of county or district officers
senvantz or ,employees cased. the injury or Wage?
AA Wnw-k
4'a
a wnat are the res of co=my or district officers, servants or employees causirr
the damage or injury?
a What damage or injuries do you claim resulted? (Give foil extent of injuries or
damages claimed. Attach two, estimates or auto damage.
7. mow was the aw=t claimed above computed? (Include the estJ.Mated amioiuntl of any
prospective injury or die.)
< t
w
---
8. Names and, addresses of witnesses, doctors and hospitals.
R
i
ao*v.avwwe.se+woma.wwaummoeomaw+uo8 m...ws...,mm.m.a .n+ m�«..Damm.�u.+sae .mes«�.saw,.m�,*w.wa».d....am...tr....�.w.amwwwme�wme�.m ..*-.*�.x.+.u�
a ;'ist the exppendlitlums you made on acro=nt of this accident or inn yz.
DAM I_ A*DT T
Gov. Code Sec. 91M vidas a . .
he cla; t be sued by the claimant,
L NOTICES 'i"C, ( ,t or ori b some eb r; o �:is. b f b
Name and Address of Attorney �
' _ 4 Z..
Claimant I s Sigzatw a
AT ess
c. .. 9 +.5 `
Telephone No. °Telephone Nom 9 L 'i, '*2,,"L.
NOTICE
Sectio. 72 of the Penal Code provides
"Every person who, with intent, to defraud, presents for allowance or for
payment to any state board or officer, or to any county, city or district board or
officer, wit'hcrzed to lvw or pay the same if genuine, any false or fraud'ulent
clams, bill, account, voucher, or wmitings is pu aishable either by i°apr°isoe ent in
the county jail-fora a period of not more tin one-y '$ by a fire of not exceeding
one thous=d ( l,000)t or by both such' irisonment and fire or by impr i.sonmera t in
the state prison, by a fine of not exceeding ten thousand dollars ($10,000, or by
both such imprisomment and fine.
---------------
Mrs ERS
REFUNDS ON DEPOSIT'S
OR SPECIAL ORD
NAT#CNAL CUSTOMER SERVICE
PHONE 4 800 321-2446
CUS;C EP MUST PRESENT COPY
OF 'VOICE 'FCP ANY WARRANTY
CA 9411',-149
1-4,5317 P
A _F't4#:D T€waUESDEr,_i,e. tja:�?-�
Ili t; in. M,600 Diti, 179,(M
1s .. Fart Qin' Description -rots Labor", FF T Te l
r............._.......t.,.........._....,.........................,,,.,........... ......
c 57849 1. 1�f&G- 1,`"�t H, ',�°''.bt_.If°LIM {1XV4 PLUS 88 8.* 0.00 121.15-1
WWI 1. ERs?. FEE FOk ME5 a:m 9.00 6t'�;06 1.
12 D 1, D19 FFE FOR TIRES �Ol g 2. @l 2.40
a
.1� C TIRES NO 3
3323 A Ni D140 BLVD
(;,PFAYETT e m$ 54543
52w3�3�2��
Sale
12/1842
Basch Ns aet431
VISA
PP Cd i 2421 any#a ifl,922
`unto er Copy
THANK YOd
�.•`0 i-t n: is ;.�"frfi r. �.if.: 1"). °#{§ ?., i...%:g�:}4:bY",. .. e ,.00
(.35,.E a• ' 41ST: ;?dµ�S•'. e.3(.�i.3'�,r'Cf" (;4.f. a .1.,: 7 oe ;';P::.
1CKNOWLE C—E NO-TICE AND ORkk,APPROVAL OF ANY INCREASE#d TSE+CRiG;°*AL ESTIMATED PRICE: X
285 4 1" PPDX.-UNLESS SPECIM-301, PAST DUE CriRA3E 3S CCv.?JTE, BY R
ERtOt3 aq T CF 4.555 P53 ?tiv�3;E t, vPR SA AhC t�?,C§#-#S Ali AF §2123?AGE#SATE TERMS aG c aox_sCGEnsCetve BY
18%.}F tiESES$ARY TO `SST€' TE LEGAL ACTION'TO S`frORCE'C,OL#EC''f N OF THE AMOUNT DUE
BUYER,AGREES TU RAY ALL NECESSARY COST S AND ATTORNEY'S FEES. x
TIRES WHEELS BRAKES SHOCKS STRUTS ALIGNMENT
ACKER WHEEL
Invoice
;, Stock Wheels Only;
771 Coleman Ave.
SAN JOSE, CALIFORNIA 95110
PHONE (406) 275-1216
FAX (408) 27591493
BARD - 28131 2!12
S
Type of Sale
MARIA y�
66656 ` ALLOY 1 1 �34 135.0 3
Subtot'a $135,00
Type of 019 Taxable 1
Acceptance subject to 10% per day restocking _ ._ eight Q lbs,
tee on all returns. Shipping Feej
COD Fee
fee.
N iWlE Invoice Total $146.14
,AN JOSS- C8 qull�j
r
12/1812002
i . ii Yellow
MIDAS SAN PASLO
BAR*AMM2332 EPA*CALOW223676
SAN PASLO,CA
14640 SAN PAPLO AVE PAGE I
Customer 0. 122600610 Year: 85 Date, 12116102
Nam: ALFRED TRUESDELL H.4eke: PEUGEOT Time: 1515:16
Add: : DOSPOSOS Vii: 5W Estimafe 31274,
Address 2: Lt No: -MX0791 Invoice 0: 1,37897
Clty,S ke,ZlptEos'al Code: SAN PABLO,CA, VIN: PO Number:
Home phone: cow: Email Address:
Work Phone: Ervine: ANY wleethA. le: N
Other Pho,°ne: Mileage In: 17-9500
Mileage Wt 1795M
LW Labor Total
>iSCEL#A1 MOUS
1 M,LABOR MOUNT SPARE 3.00 25.00 25.W
TOTA#MISCELLANE S: 25,00
Custmmr Wishes To Discard Old Part
1110AS SAN r ASL.0
4640 SAN PASO AVE
SAN PAB'O: ::�.) 94806-244
510-236-5539
430iSZZ1362'4575
Sate
10' 4301 322135274575
4#f}{m ¢} I A$$d NUMBER 02}}g
.�`0
4�5
XXXXXXXXXXXX3652
Expt 05/05
A th gods9063444 6at .392
004
Tots,I It'.5x01
THANK YOU r
LaASW "µ AGAIN.
PAY AMOUNT PARTS TOTAL 0.00 ..........................
10-AIS 25.E SALES TAX 0.10 .,,.S P E C€A;
LABOR TOTAL 25.00 COMPLETE
TEC,4:X44 J.NEWCOMER GRAND TOTAL 25.00
BRAKE
eNSPE^-T10NN
.................*........
CLAIM
BOA OUNTY
BOARD ACTION. jAWARY 28j 2003
Claim Against the County, or Distnict Governed by
the Board of Supervisors, Routing Endorsements, NOTICE TO CLAIMANT
and Board Action. All Section references are to The copy of this docmrent,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 Goverriment Code Section 913 and
4
Q 915.4. Please note all "Warnings".
L W.
AIMOUNNT: $701.06
'1vyJ'R-R0W OUINTYooNSE--k
CLAIMANT: DA'NT N�ARi-NN11EZ CAL,z;:�,
ATT ORNE-i: UNKNUWN DATE RECEIVED: DECEM3ER 27, 2002
ADDRESS: BOX 565 BY DELIVERY TO CLERK ONT :DWECEMBHR 2 7.a 2002
CLAYIONN, CA 94517
BY SIL POSTMARKED: DECEMBER 261 2002
FROMt Clerk of the Board of Supervisors '10: Cw-mtyCounsel
Attached is a copy of the above-noted claim.
JOHN SWEETEN, Clqk
Dateda DECKER 27, 2002 By: Deputy .. . .....
II. FROM: CountyCounsel TO: Clerk of,he Board of Supervisors
Ythis claire complies substantially with Sections 910 and 910.2.
This Claim FAILS to comply substantially with Sect-tons 910 and 910.2, and we are sonotifying claimant. The
4
Board cannot act for 1115 days (Section 910-8).
Claim isnot tirnely filled. Ifne 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 9113).
Other:
Dated.. /',2_4,L 4-c", zy. Deputy CouCo
nty tinsel
B
111. FR OM- Clerk of the Board TO: County Counsel (1) County Administrator(2)
Claim was returned as untimely with notice to claimant(Section 911.3).
IV. BOARD ORDER: By unanimous vote of the Supervisors present:
Q
phis Claim is rejected in x.110
,X)
Other'.
I certify that this is a true and correct copy of the Board's Order entered in its minutes for this date.
J/_)
JA-*LqTjARY 28, 2003
Dated, JOIDN' SWEETEN., CLERK, By Deputy Clerk
WARNTING (Gov. code section 3) ' VI,"
Subject to certain exceptions, you have only six(6)months from the date this notice was personally served or deposited
in. t k the advice of an
t:-le maili to file a court action on this claim. See Government Code Section 9455.6. You may see'
. TfyoU ey,
attorney of your choice in connection with this matter. " want to consult an attorn , you should do so
immediately. For Additional Warn.ing See Reverse Side of This .Notice.
'r
AFF3DAVIT OF MAILING
' declare under penalty ol"perjwry that I am now, and at all times herein mentioned,have been a citizen of the United
Mates, over age 18; and that today I deposited in the United States Postal Service in Martinez, California,postage fully
)repaid a certified copy of this Board Order and Notice to Claimant, addressed to the claimant as shown above.
JANNUARY 29, 2003 Deputy Clerk
)ated: JOHN SWEETEN, CLERK By